How can I make this go away? Can I counter sue?

What is the name of your state? New Jersey.

Please bear with me as this might get a little long.

In February of 2002, I went to the local hospital for a head injury. I gave them my insurance card and all the other relavant information upon entering the emergency room.

Naturally a few months later a bill came for the amount of my copay. Which I paid.

Fast foward 2 years, and I get papers in the mail saying that I am being sued by the hospital's cat scan department for $525, which I never paid.

I filed all the paperwork I was supposed to. I got in touch with my insurance company which paid the original claim submitted by the hospital. The car scan was not on the claim. I got copies of all my paperwork, including the admissions form, which has a copy of my insurance card on the third page of the packet, and my insurance company name and my policy number on the front page.

I have been in touch with the court, the plantiff's lawyer, the hospital and the insurance company. In April, my insurance company said to resubmit the bill, with a note on it, and the original claim number and it would be paid. However, the hospital wouldn't give me a copy of the bill, nor would their lawyer. In July, the lawyer called me and said for me to resubmit the bill and if it was paid, they would drop it. When I told them for the 100th time I didn't have a copy of the bill, they said they would submit it.

I called my insurance company and they told me it was submitted July 16th. But they didn't make a decision on it. I called the court and the lawyer and got the court date pushed back again.

I called my insurance company again and they told me the claim was denied because the hospital didn't file it properly and that they were notified of it. Something about they needed to explain why it was filed two years later. The insurance company said that the hospital is now liable for the bill.

This is driving me crazy. Between taking time of work to go to court, to go to the lawyers, payment for the lawyer, having to make personal phone calls at work, my pay being docked because of it, I'm going nuts.

My question is this. I had insurance when I went to the hospital. It's in their file. They submitted a claim to my insurance company which was paid, which proves that they knew I had insurance. Do I have grounds to counter sue them for legal fees and my missed time at work, cost of phone calls I had to pay from a business phone, since the court and their lawyer's office close the same time I get off work? And what about how this affects my credit? I'm being sued over a mistake they made. and it's messing up my credit. What can I do to get this all rectified?

Thanks for reading, and for whatever advice you can offer.

Oh i forgot to mention, the lawyers office sent me a form that I "filled out" after I was admitted when I got my cat scan. It's not in my handwriting, my name, my parents names, my street name, my work place, all of it spelled wrong and on the bottom in someone else's handwriting it says that "I, Helena Frank, do not have insurance and agree to pay $20 a week." I know I never signed that because I did have insurance, I already gave them the information, It's not my handwriting, and I know how to spell my name, my parent's names, my street name and my place of work. Don't know if that is relevant or not. But it's better to have all the facts.

Thanks again,
-helena

"I had insurance when I went to the hospital. It's in their file. They submitted a claim to my insurance company which was paid, which proves that they knew I had insurance. Do I have grounds to counter sue them for legal fees and my missed time at work, cost of phone calls I had to pay from a business phone, since the court and their lawyer's office close the same time I get off work?"
*** No. The problem here (I believe) is that you have misunderstood this bill. It is very common (in fact, required in MOST if not all states), that any radiology (and cat scans qualify) be 'read' by an independent, qualified radiologist. Very likely, this is the bill that you got. Your assumptions that you submitted your insurance info to the hospital does not apply in this case. Bottom line is that it is YOUR insurance company and thereby, YOUR obligation to make sure that any bills are paid. As such, you cannot recover your 'damages' for a problem that you created.

"And what about how this affects my credit?"
*** As an unpaid bill that you owe, the creditor clearly has the right to report your 'history'.

"I'm being sued over a mistake they made. and it's messing up my credit. What can I do to get this all rectified?"
*** Pretty simple... pay the bill, then battle with your insurance company.

Jet,
It was not an outside bill for the CT, it was the hospital's own bill for the CT which was not submitted at the original billing to the insurance company for other services she received. She received the bill 2 years later which had never been submitted to the <hospital> Insurance, an accounting error that happens all the time. When the CT bill was submitted to the insurance, it was not paid because the HOSPITAL failed to explain why they had submitted the bill 2 years after service, so it wasn't paid.

Interesting that they also come up with this billing agreement to pay for the CT 2 years after when the other parts of the bill were timely submitted and paid, looks like someone covering and if it was filled out by or for a person suffering from diminished capacity following a TBI then she is not responsible. If what she says is accurate she might depending on NJ law have some options for countersuit etc. This sort of confusion is very frustrating for people with head injuries.

rmet4nzkx said:

It was not an outside bill for the CT, it was the hospital's own bill for the CT which was not submitted at the original billing to the insurance company for other services she received.

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*** How do you KNOW that is the case?? Lots of hospitals contract outside for radiology services and bill them internally. Simply, you do NOT have sufficient facts to make a statement like that.... only the OP knows the facts!

She received the bill 2 years later which had never been submitted to the hospital, an accounting error that happens all the time.

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Again, you are making statements of fact without any basis in proof. And I have to disagree in that 2 year old bills are NOT an "accounting error that happens all the time".

When the CT bill was submitted to the insurance, it was not paid because the HOSPITAL failed to explain why they had submitted the bill 2 years after service, so it wasn't paid.

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That is what we are being told.... yet, I find it hard to believe that this bill was NEVER submitted to anyone previously. More than likely it was sent to the OP.... and just ignored or overlooked as 'to be paid by insurance', or some such. Again, only the OP (and the billing party) know the truth on this one.

If a person is being billed or sued for a Bill , they are entitled to see a copy of the Bill . A previous bill may have been sent, but once it goes into collection, the debtor has a right to verification of the bill in question.

One way to obtain it , if it's in a credit report, is to dispute the bill. The original Creditor Must verify the bill .

The original poster should send a Return receipt Certified Letter to the Creditor for a copy of the bill.

JetX is correct. Even though the CT scan may have been done at the hospital, it would be a separate bill. Just because the poster submitted his ins. to the Hosp. doesn't mean it was provided to the CT scan dept .

I just had a CT scan of my lungs,and I had to provide that Dept. with the ins. info.

"One way to obtain it , if it's in a credit report, is to dispute the bill. The original Creditor Must verify the bill ."

Verification of a notation on a credit report has nothing to do with obtaining verification of the debt from an original creditor, and/or validation of a debt with a 3rd party collector.

JETX said:

*** How do you KNOW that is the case?? Lots of hospitals contract outside for radiology services and bill them internally. Simply, you do NOT have sufficient facts to make a statement like that.... only the OP knows the facts!"

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I said "If what she says is accurate " But she does indicate that it was the HOSPITAL suing her not a contract radiology service and that it wasn't on the original bill were she paid the copay and that the HOSPITAL refused to provide her with a copy of the radiology bill and that eventually the HOSPITAL sent to CT bill to the insurance, that is why I am assuming it was an accounting error at the hospital and not a contract radiology, since it was the hospital suing her. I have seen this happen frequently with bills for regional HMO's for example, you go to XYZ Hospital on your XYZ Medical plan, same organization different accounting operations, I had to call each and every time because they had a glitch in their systems that was difficult to resolve, in this case ER physicians cost were not reimbursed and took 1 year to resolve each time. Going to ABC Hospital on the XYZ medical plan paid without a problem, this is an example of one type of accounting error.

Furthermore, when you enter the ER these services are usually authorized and they take your billing and insurance at admission, you sign the paperwork and they have your insurance card, they take it away from you, sometimes they forget to return it to you also. And you trust that now that they have taken this from you that they will bill you according to your insurance plan just as OP claimed. The CT would have been paid for without question if it had been submitted to the insurance, it wasn't submitted and not on the original bill for which sh epaid the copay. With head injuries there are frequently neuro deficits that may be subtle and to expect her to be responsible for the hospital's error is not reasonable especially once they submit the bill they neglect to state the reason for the delay!

JETX said:

***"That is what we are being told.... yet, I find it hard to believe that this bill was NEVER submitted to anyone previously. More than likely it was sent to the OP.... and just ignored or overlooked as 'to be paid by insurance', or some such. Again, only the OP (and the billing party) know the truth on this one.

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It is true sometimes these bills come stating that "this is not a bill" but tells you what the charges are, that may have happened, but then why did the HOSPITAL fail to bill the insurance company?

Skylyn said:

"One way to obtain it , if it's in a credit report, is to dispute the bill. The original Creditor Must verify the bill ."

Verification of a notation on a credit report has nothing to do with obtaining verification of the debt from an original creditor, and/or validation of a debt with a 3rd party collector.

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When you dispute a negative credit report, the CRA contact the original Creditor for verification, via a written form, which a debtor has a right to a copy of verification from the CRA they sent the original Creditor .

Also, even if a 3rd party collection agency is involved , a debtor does have the right to request that collection agency for a verification of the debt and be provided with it .

Having said that , if the original Creditor does not return the validation , the CRA can remove that report from records. Also upon the CRA's investigation of the dispute, if they determine the Debtor does not owe the bill, the CRA can remove it from the report.

I simply suggested this as ( One way ) of disputing the Debt . The original poster stated it ruined their credit .

it falls under FTC the Fair debt collections practices act and fair debt reporting act .

Also,On the verification form would name the creditor. It would show weather it was the Hospital or radiology Dept .

I had somewhat of the same problem.

Check with your Insurance EOB, or Explanation of Benefits. Its essencially the terms of the insurance company for your policy. If a hospital is covered in a particular policy they agree to abide by those terms as well.

Essentially your healthcare provide is saying the hospital violated this.

What you need to do is answer the the complaint. In my case I countersued for damages alleging that they knowingly violated the EOB. I know Jet will probably have a heart attack becuase I probably did about 100 things wroing but it worked. Once they saw I was going to fight the suit they dropped it in return for a release of my counter.

Good luck

Wow, I wasn't expecting this many posts. There's alot to read through still, but I have answered the complaint.

The hospital is sueing me. Their cat scan section is part of the hospital, it's not an outside company.

I recieved a copy of the bill for everything except the cat scan. I never received a copy of the cat scan bill. When I called the hospital, I was given the run around. My insurance company is sending me a copy of the bill, now that it was submitted to them by the hospital on July 16, 2004.

I am going to go talk to a lawyer next week. I'm sure they['d be able to help me more since they are more familiar with the hospital, and the state laws.

BTW, the hospital is notorious for doing this to people, and most people just roll over and pay.

Once I made it clear I was going to fight this, the lawyer changed their song from you're going to pay, we don't give a crap, to oh, well how about if I call and get the court date postponed and we'll have our client resubmit the bill. I'm sure we can work something out, maybe if you pay half, they'll drop the suit.

I'll come back and update.

Thank you all again.

If this was frivilous or their fault which it seems it is, then they should resolve the costs either from appropriatly submitting them to the insurance company or eating the costs, waiving the copay and paying your legal costs, keep track of everything this has cost you and they should drop the case but make sure you get your costs paid for. You might ask that the court order them to explain the forged document presented as evidence and consult an attorney regarding your futher options. There are several complaint options that may be applicable to keep this from happening to others.