How do I contest an incorrect medical charge?

[drphilosopher]

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

Hi,

I recently visited a lab for an MRI. To make a long story short --- details available upon request --- the MRI was supposed to be $615 and I paid $123 (or 20%) at the time of the appointment. Unfortunately, at the time the bill came, it was for $615 (as if no co-payment had been made at the time of the appointment.

First, I tried calling the company and they said they would fix the bill, but I received another bill and the error had not been fixed.

Second, I sent a letter to the company within 60 days informing them of the incorrect bill. Since I didn't think to obtain a return receipt, I sent another copy of the letter with the return receipt, but this one was a little outside the 60 limit. (Hopefully, the company is honest enough to acknowledge receipt of the first letter.)

At any rate, I want to know what happens next. First, there was only one address on the bill --- the payment address (in three different places) --- so I hope the company doesn't claim that I sent my letter to the wrong address. If they do not supply an address for disputing charges, i.e., a customer service address, must they accept complaints at their billing address?

Second, I was under the impression that the company must, by law, acknowledge the receipt of the dispute letter and act upon it within a certain amount of time. Does anyone know what that time limit is and what they are required to do within that time?

Should I go ahead and pay the undisputed part of my bill while I am waiting for the company to act on the disputed part? I am reluctant to do so as I feel that I have more leverage if I owe them more money. If I pay them the other 80% of the bill, they will have no motivation to refrain from turning the disputed 20% over to collections.

Any thoughts?

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

 

[Zigner]

The MRI was $615? Or, was it $3,075, of which $615 was your copay?

In any case - pay the $615 minus what you already paid. Then take it from there.

 

[drphilosopher]

The MRI was $615? Or, was it $3,075, of which $615 was your copay?

In any case - pay the $615 minus what you already paid. Then take it from there.

The MRI was $615. Actually, of course, it is more complicated than that. The lab told me on the phone before my appointment that I would have to pay 20% or $123 at the time of my appointment, from which I inferred that the cost would be $615.

In the bill, the lab attempted to charge me for two MRI's, one with dye and one without, and each was more than $615 --- I don't recall the exact amount right now. However, the insurance company reduced the amount owed to $615 by allowing only one MRI and allowing only $615 for it per their contract with the lab.

The key point is that the lab did not acknowledge anywhere on its bill that $123 was ever paid. Also, it did not report to the insurance company that $123 was paid. However, I have the receipt from the lab and the credit card statement proving that $123 was paid.

As a general observation, I am astonished at the way most medical businesses conduct their business. They are, as a rule, dishonest and deceptive in their business practices. They are reluctant to reveal their prices up front and when they do, they purposefully give low ball estimates, omitting procedures and costs. They double bill insurance companies. And, finally, they take advantage of people with medical emergencies, knowing that those people are not in a position to negotiate over rates or procedures.

At any rate, does anyone know the answer to my main question, what happens next? How long does the lab have to repond to my dispute letter?

 

[awasinger]

Hi there-

I work as a medical biller, and I think I can offer some extra information for you.

The bill that comes from your insurance (also known as an Explanation Of Benefits) will not have what you paid reflected on it. They don't keep track of that - they just let you know what "Patient Responsibility" should be.

Your lab bill should have the $123 on it. If not - definitely get on to them about that! Your payment to them should already be posted!

So, are you getting the bill from the lab, or something from your insurance company? I know that with some insurances, they will pay 80% while you pay the 20%...

And yes, I can tell you that my office wants me to bill for every last thing I can! Frustrating to the patient, and can be unnecessary, but true!

Let me know who you are getting the bill from, and maybe I can help clarify the situation. Medical billing is sticky business!

 

[Zigner]

Hi there-

I work as a medical biller, and I think I can offer some extra information for you.

The bill that comes from your insurance (also known as an Explanation Of Benefits) will not have what you paid reflected on it. They don't keep track of that - they just let you know what "Patient Responsibility" should be.

Your lab bill should have the $123 on it. If not - definitely get on to them about that! Your payment to them should already be posted!

So, are you getting the bill from the lab, or something from your insurance company? I know that with some insurances, they will pay 80% while you pay the 20%...

And yes, I can tell you that my office wants me to bill for every last thing I can! Frustrating to the patient, and can be unnecessary, but true!

Let me know who you are getting the bill from, and maybe I can help clarify the situation. Medical billing is sticky business!

Your post is correct. It is also off-topic. OP was clear that the bills he is receiving are from the medical provider, not the insurance co.

 

[drphilosopher]

Your post is correct. It is also off-topic. OP was clear that the bills he is receiving are from the medical provider, not the insurance co.

Read what the respondent said more carefully. He/she was right on target.

 

[drphilosopher]

Hi there-

I work as a medical biller, and I think I can offer some extra information for you.

The bill that comes from your insurance (also known as an Explanation Of Benefits) will not have what you paid reflected on it. They don't keep track of that - they just let you know what "Patient Responsibility" should be.

Your lab bill should have the $123 on it. If not - definitely get on to them about that! Your payment to them should already be posted!

So, are you getting the bill from the lab, or something from your insurance company? I know that with some insurances, they will pay 80% while you pay the 20%...

And yes, I can tell you that my office wants me to bill for every last thing I can! Frustrating to the patient, and can be unnecessary, but true!

Let me know who you are getting the bill from, and maybe I can help clarify the situation. Medical billing is sticky business!

Thanks for the info. Today, I received a final demand for $492 from the lab. They never previously sent me a statement saying I was one month or two months or three months behind but today they sent me a final demand. Anyway, I'm hoping the fact that they're asking for $492 rather than $615 means that they fixed the bill. I plan to pay the $492 and wait to see what happens. If I still have problems, I'll contact you. Thanks.

 

[awasinger]

Just wanted to make sure where you got the statement from - many patients can mistake an EOB for a bill...

Sorry for not answering the "main" question you had, but for future reference, the lab would have 30 days to respond to a disputed bill in which time they are not allowed to turn over to collections until the matter is resolved or proof of debt is shown.

 

[Zigner]

Read what the respondent said more carefully. He/she was right on target.

No - respondent suggest that you had an EOB in your hands, when you CLEARLY stated you had a bill. If the respondent was right, then you are the one who doesn't read their correspondence.

 

[drphilosopher]

No - respondent suggest that you had an EOB in your hands, when you CLEARLY stated you had a bill. If the respondent was right, then you are the one who doesn't read their correspondence.

You are right. I stated that I had a bill from the lab and I did have a bill from the lab. However, the respondent's response was still useful as I was not aware that the EOB (which I discussed in a later posting) would not show the payment that I had made to the lab, directly.

 

[drphilosopher]

Just wanted to make sure where you got the statement from - many patients can mistake an EOB for a bill...

Sorry for not answering the "main" question you had, but for future reference, the lab would have 30 days to respond to a disputed bill in which time they are not allowed to turn over to collections until the matter is resolved or proof of debt is shown.

I guess I did not fully understand your previous post. To answer your question, no, I did not confuse the EOB for a bill.

Thanks for answering my main question, however. As the lab never directly addressed my dispute, I will assume that they have acquiessed to my point of view if they do not send me any other correspondence in the next couple of days as it is now more than 30 days since my original letter was mailed. (I'll allow a couple of days for the mail.)