Hospital is threatening me and harassing me. They released my very personal informati

[linkavb]

What is the name of your state (only U.S. law)? Indiana

I was in ER at local hospital in 2012. The doctor who was assigned to me looked like any other ER doctor. He was wearing the same uniform and had hospital's logo name tag. He provided his services and released me after a few hours of treatment for bronchitis.

About six months later I receive hospital's bill in mail : $1780 for Dr.XYZ's services....I call the hospital tell them, contact my insurance company. They said they did and the insurance co isn't paying for his services. The hospital IS in my insurance's network. So I call insurance co and they tell me the hospital never filed a claim! The insurance agent was kind enough to get a person from the hospital and me on the phone at the same time and he told the worker their code where to send the bill to. The worker at financial services at hospital said "The doctor is OUT of NETWORK and your insurance co won't pay for that doctor"..... ok why the heck nobody told me that the doctor was out of my network to begin with? Why was I assigned some doctor that the hospital claims he's an independent doctor and not employed by the hospital when he was wearing hospital's scrubs and the name tag with hospital's logo??? Why wasn't I notified?

So now I am not employed been in and out of hospitals due to health issues and getting slammed with this $1700 medical bill.

Here's where it gets nasty...

I've received a letter from an attorney (hospital had hired to represent them). The hospital is a mega huge hospital that makes $600 mill annually. Yet they hire an attorney who can't even afford his own stationery and prints me his black and white letters on cheap papers. Why am I writing this? Because I feel like this "attorney" is operating out of his home's basement if you will.

Then a month later a woman calls me. She says her name very fast over the phone and I can't even understand it. Then she asks me to verify my personal information over the phone. I ask her what is this about? She replies : "It's about personal matter". I said : "I am sorry ma'am. I can't verify my information to some stranger over the phone. Then she says this :

- I know where you live!
- You have a son named xyz....right?
- I said yes.
- You know what this is all about!
- I said : No ma'am I don't know. I am assuming. You are asking me to verify my personal information but you wont' tell me exactly what it is about.

Then she says :

- Ok we'll talk next time but it's not going to go away!
- You know what this is about!

Again, I said : "No ma'am, I don't know. I am assuming". She hung up the phone.

What really tickles me that what right did the hospital have to give this 3rd party information about my son who is not even a teenager? Why his name is getting pulled into this? And what does my child have to do with me affording or not affording paying medical bills that a hospital forced on me to see a doctor out of my network! WTH?

The line "We know where you live" is really stuck in my head. The woman on the phone sounded like she was chewing gum or eating...
I don't know who these people are, who they employ and what type of background they have. I feel that my family is being exposed by the hospital and that my privacy policy had been violated.

Someone please help me what rights do I have to defend myself? Can't afford a lawyer atm but if I could I'd love to sue the hospital for it.

 

[swalsh411]

The fact that you have children is not legally protected by any privacy law I am aware of.

Why did you not verify with your insurance company that the hospital filed a claim after you received service? That is your responsibility.

If you do not want to pay this debt, then you can tell them in writing to stop contacting you at which point their only recourse would be to sue you.

As to whether or not you owe this debt given the circumstances you have described I will defer to somebody more knowledgeable about insurance and medical billing.

If anything, the hospital (or whoever they sold the debt to) will be suing you. I would more concerned with getting this debt taken care of than worrying that some bill collector knows where you live. (which is also a matter of public record)

 

[Zigner]

You can put more pressure on the insurance company to pay the bill. What is their reason for not paying (and an out-of-network doc in the ER isn't going to be the reason, unless it wasn't an emergency).

Alternatively, you could pay the bill.

 

[linkavb]

My insurance company has its guide lines..... they have a list of in network doctors and out of network doctors. In-network doctors are covered. Out of network doctors are not covered and have to be paid by the patient.

The hospital never disclosed to me that the doctor I was about to see was NOT in my insurance's network. Even though they had my insurance card on file before I was seen by the doctor.
The literally forced that doctor on me who saw me two times in 3 hour long visit and charged me $1700.

I CANNOT afford to pay $1700. it easily said than done : "Pay the bill" If you had a choice between eating and paying some hospital bill what would you prefer to do? I have a child I am taking care of and I have to provide for him best way that I can. I have to buy him school supplies, clothes for school and books. I can't just gush out $1700 out of somewhere. I am in over my head in medical bills due to my failing health and I am not even 40 years old and non drinker/non smoker and never did drugs.

 

[Zigner]

It is not the hospital's responsibility to know the details of your insurance plan.

Use the appeal procedure at your insurance company. If this was truly an emergency, then you don't really have a choice about the provider and it should be covered.

 

[linkavb]

The fact that you have children is not legally protected by any privacy law I am aware of.

The woman from the collection agency knew my son's name. When a hospital released my debt maybe it said that I had children/child but I never wrote on my file anywhere my son's name. In order for her to know his name, she had to have his record/file and that's patient's privacy abuse because my son has nothing to do with my medical bills and he's not even a teenager why she's dragging his name into this is beyond me and what right did the hospital have to release his information to her/collection agency when his account is in EXCELLENT standing!?!?!

Don't schools and other organizations ask us as parents to sign consent forms when children go to field trip to movies with school etc? Why was my child information released to them without my consent that's my main question!

 

[Zigner]

The woman from the collection agency knew my son's name. When a hospital released my debt maybe it said that I had children/child but I never wrote on my file anywhere my son's name. In order for her to know his name, she had to have his record/file and that's patient's privacy abuse because my son has nothing to do with my medical bills and he's not even a teenager why she's dragging his name into this is beyond me and what right did the hospital have to release his information to her/collection agency when his account is in EXCELLENT standing!?!?!

Don't schools and other organizations ask us as parents to sign consent forms when children go to field trip to movies with school etc? Why was my child information released to them without my consent that's my main question!

How do you know the caller was calling from/regarding the hospital? She never said so, right?

 

[cbg]

FYI, you cannot assume that every doctor, even in an in-network hospital, is also in network.

Believe me, both the hospital and the insurance carrier would love it if they could force every doctor in the hospital to join the network. But they can't. The doctors have free choice as to whether to join or not. With very rare exceptions having to do with the doctor's contract with the hospital, it's entirely up to the doctor whether to participate or not, and there are certain departments, ER being one of them, where the doctors do not have private practices and therefore can make more money out of network than they can in network. (Others are radiology and anesthesia, in case you want to know.)

It's up to you to double check which doctors that you see are in and out of network, even in an in-network hospital.

ETA: It is NOT the responsibility of the hospital to tell you if the doctor is outside your network.

 

[linkavb]

How do you know the caller was calling from/regarding the hospital? She never said so, right?

That's right. She never said what it is about. She only said "You KNOW what it is about" - I said "Ma'am, I don't know I am assuming". Yet she demands for me to verify my personal information : address/date of birth etc...before she can speak with me. I wonder what background check these people have working with collection agencies. She was also eating or chewing gum while she was talking to me...

 

[linkavb]

FYI, you cannot assume that every doctor, even in an in-network hospital, is also in network.

ETA: It is NOT the responsibility of the hospital to tell you if the doctor is outside your network.

Well i went to the hospital that's covered by my insurance co. First of all I did not even know the hospital can hire independent doctors and have them wear hospital's scrubs and name tags with hospital's logo. Then the doctor should've had different uniform - indicating he's a contractor. Then I would've asked the question. It did not even occur to me that the doctor could be out of network. I've never had such cases. When I select a doctor dentist/surgeon/ob-gyn I always make sure their are in my network. I still think it's hospital's negligence/fault for not notifying me that the doctor wasn't in my network. Now I am slammed with this large bill that insurance co refuses to pay and I have to find somewhere the money to pay for it. Yet they released my son's records as well without my consent.

 

[swalsh411]

Stop barking up this tree about them knowing your son's name. You have no way of knowing how they got it and it is irrelevant and doesn't help you with the bill issue. There is countless terrabytes of information floating available out there on everybody.

 

[Zigner]

The hospital has NO responsibility to verify the specifics of your particular insurance plan. It's not their job and it would be impossible for them to have the resources to verify the specific details of every person that walks through their doors. It's YOUR responsibility. Don't even waste your time going there.

With that said, why is it that you haven't filed a formal appeal with your insurance company?

 

[justalayman]

If I had some very basic info about you, far less than what the hospital or a collection agency would have, I would be able to find out the names of any and all children you have, a fair determination of how much money you make, where you live and probably where you have lived in the past and quite possibly the names and addresses of your parents and siblings. All of that is available via public records and general information available via an Internet search. Quit worrying about them knowing the name of your child. It was more likely referred to to attempt to verify that you were you than anything nefarious.

 

[justalayman]

I am curious to know the insurance provider though. I have personally dealt with at least a half dozen different carriers and a couple different policies within a couple of those carriers and none of them have ever had a blanket policy of no coverage on out of network doctors, especially in an ER setting

 

[tranquility]

You can put more pressure on the insurance company to pay the bill. What is their reason for not paying (and an out-of-network doc in the ER isn't going to be the reason, unless it wasn't an emergency).

Alternatively, you could pay the bill.

It is not the hospital's responsibility to know the details of your insurance plan.

Use the appeal procedure at your insurance company. If this was truly an emergency, then you don't really have a choice about the provider and it should be covered.

The hospital has NO responsibility to verify the specifics of your particular insurance plan. It's not their job and it would be impossible for them to have the resources to verify the specific details of every person that walks through their doors. It's YOUR responsibility. Don't even waste your time going there.

With that said, why is it that you haven't filed a formal appeal with your insurance company?

My feeling is that it is not the patient's "job" to verify the status of each health care provider in such a situation.

The hospital was a participating provider. As the doctor comes up in the ER for the initial exam, the patient asks him, "I have Super Health insurance. Are you a participating provider?" As the phlebotomist comes up to take blood, "I am Super Health insurance, are you a participating provider?" When the blood gets taken to the lab, "Make sure the lab you send the blood too is a participating provider for Super Health!" Same for the technicians who do the xray, ct scan, mri AND the radiologists who read the films. When the nurse comes in to put a band aid on the boo boo, does he need to ask her too?

I think that all the services received at a hospital listed as a participating provider should be participating providers absent specific disclosure to the contrary. At least that is the position I've taken and won with at the lower in-company appeal processes. I've been though this situation many times during my wife's illness.

One thing (other than appeal) I think the OP should consider is if, in fact, the doctor is not a participating provider. I had this specific situation at a local ER with the difference being the ER doctor having an out-of-state billing service. Because the billing service was not a participating provider, the co-pay was 80% rather than 20%. I explained in a letter to the insurance company and pointed out the actual name of the doctor and where he practiced and the insurance company did a check and found the doctor was a participating provider AND found that because of the billing service was getting compensated (from both the patient and the insurance company amount combined) at a greater than contracted rate, the billing service owed the insurance company some money. Probably some patients too, but I was not made aware of any litigation regarding that.