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Medical billing / insurance - ?? help ASAP

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DH has two medical collections on reports.

First collection

Service dates 9/20/98 and 9/21/98 combined for one collection

Bill for date 9/20 is 72.00 DH paid 6.50 at service balance: 65.50

Bill for date 9/21 is 164.00 DH paid nothing on this date - balance $164.00

Total balance (65.50 + 164) = 229.50

Just got insurance claims information.

Med Provider submitted only $6.50 for service date 9/20

Med provider submitted only $145.00 for service date 9/21

Total bill submitted to insurance $151.50

Unclaimed portion (229.50-151.50) = 78.00

Insurance paid 92.70 and insurance discount was $58.80

Total paid on claim of $151.50 = $151.50

CA is trying to collect $246.25 (original balance of $229.50 + rebilling fee $5.00 + interest $11.75)

CA is reporting three balances: $234, $83, $72

Question: If the OC knew the patient had insurance, and didn't file a claim for the entire balance with the insurance company, I've seen/read that they cannot attempt to collect the balance from the patient. Or, likewise, they can never attempt to collect on any medical bill from a patient until they have submitted a claim to the insurance company and awaited the results of processing.

Is this correct? Or in other words, since insurance covered 100% of the claim made, even though the claim was not for the entire balance, does the OC or CA have any right to attempt to collect on the portion that wasn't submitted? Do we owe that balance? I don't think so, but I need confirmation from someone with more knowledge.

Collection 2:

Service date 10/4/99

Bill is 149.00 DH paid nothing at service leaving balance: 149.00

Med Provider submitted $149 claim to insurance

Insurance paid $69.10 discount of $79.90

Total paid on claim of $149.00 = $149.00

CA had account listed on two CRs one showing unpaid balance of $154 another showing as paid. After dispute, CA verified and updated paid listing to show unpaid with balance of $83, and verified unpaid listing so it still shows unpaid balance of $154 ($149 + $5 rebilling fee)

Now, the plain and simple fact is that between the OC and the CA we are going to pay all of our debt. Only question there is whether they give us a check within the week or I sue their arses.

The only reason I need to contact them at all on this matter is that I need this off his reports NOW. We are trying to get a mortgage. His mid score is 619 and getting these off will probably boost him over at least 670. They update every three months, so these look like they are from October/2004. Not re-aging, just updating. Hell, we might get it over 700.

I already know exactly what to go after the CA on. Question is what to go after the OC on. Is this medical billing fraud. Are they liable in federal court for the acts of the CA under FCRA and FDCPA. IN law states that a CA is an assignee of the OC and can only sue if the OC consents. This to me says that the OC has control over the CA and that they should be held responsible for acts of the CA. Especially in this case considering the reason the CA has acted in this way is that the OC has withheld information from them.

I want a fast clean credit report and at least $50K between the two of them within a week or so. I need to go after the OC but don't know exactly how.

I've already started applying for mortgages and getting crappy offers and rejections. He just bought a truck at 14% when he should have been able to get under 8%. We are going to have to refinance his truck based on the new score, and reapply for mortgages, which will cause this to take longer to get moved. So, please any help is needed right away. I want to move before the end of the month.

Thanks so much everyone.

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I have the printouts directly from the insurance company. Between the insurance discount and the amount paid, all claims filed have been paid 100%. The OC didn't submit a claim for the full amount. Patient Responsibility is zero. The only remaining balance is the amount that was never submitted. Since it was never submitted, the OC can't try to collect from DH can they? It's over SOL so it won't get paid anyway, but as a matter of suing them, is it billing fraud to try to collect from a patient when you knew the patient had insurance, but failed to submit a claim to the insurance company?

The CA is trying to collect the entire beginning balance of both accounts plus fees. I've already got them on a noose for a lot of money. The big issue is the OC. I don't know how to snag them. I'm sending out deletion demands and ITS letters today, with settlement offers of $30K to the CA and want the OC for even more (50K+).

I was thinking since these bills are pre-HIPAA, that the original divulgence of information wasn't illegal. But, since we started disputing just a few months ago, and they reiterated the information to the CA, and affirmed that this balance was owed, it was HIPAA violations post HIPAA. Anyone think I can use this as leverage? That's a whopping fine for them, and I might get them to settle for even more.

I'm not playing with these people or any $1000 settlement and deletion offer. I want a chunk of them. Ideas, ideas??

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There is also this thing called failing to mitigate your damges.

The OC failed to mitigate their damages.

They fudged up and now they are trying to stick your husband for the balance.

You need to call the Insurace board of your state, the Medical association and send these as$ monkeys a letter that states they have 30 days to remove it from the CA.. remove all marks from your report and then send you some cash for violating the FCRA, Fair Billing Act ((I think)) and find out whatever else you can.

Hope you get these monkeys

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I sent ITS to OC and CA. I sent letter and papertrail to Edelman, Combs to try to get help.

Heard back from CAs lawyer.

Letter to DH:

They will not speak to me about this account because they do not have written authorization allowing them to do so. They have a power of attorney. When they speak to me, they ARE speaking to him. So, knowing that he has an authorized representative, isn't that just another violation? They do not know that I am his wife. They think I'm a hired gun. I'll save that tidbit for the last minute.

They said they are reporting the CRAs to show the utility as paid. On the medical bills, they have been told by the OC there is an outstanding balance (the bill they didn't submit a full claim for), and as long as the CA marks it as disputed, they can continue to report the outstanding balance and there is nothing illegal about that. They were told by the OC that the other account was settled (the one that they submitted a full claim for), and that is how they will report it, and again, as long as they mark it as disputed there is nothing illegal about it.

The bastages have copies of the insurance claim forms showing that the accounts were paid by insurance. How is that a "settled" account? Anyway, it still shows as unpaid. Hopefully, the AG will chime in here and help since they also just got all the information.

Letter to me:

They are threatening to file criminal sanctions against me for the "unauthorized practice of law". What the bleeep? I am his authorized agent. I have the right to file suit in his name as a pro se litigant. Correct? So, how am I practicing law. Since when is it illegal or practicing law to file a pro se case?

Can I get the lawyer on anything there? It appears to me that they don't understand what a power of attorney is.

This is really a vent session. These people have me so peaved. They have copies of the insurance claim forms showing that these accounts were paid by insurance, and are claiming that they can continue to report whatever the OC tells them knowing that it's incorrect, as long as they have marked it as disputed.

And what about the OC. Are they saying that if you have insurance, you should expect a derogatory mark on your CRs. Because if insurance pays your bill, you have a "settled" account?

I think I'm going to call the federal courthouse Monday and find out what they have to say about an Attorney-in-Fact filing pro se on behalf of the authorizing individual.

So, we are trying to get a house. Nobody cares if the bills are paid or not because they are so old. But, because they update every three months, it is a score killer. And the score (619) keeps us in subprime rates. It limits the LTV we can borrow, and requires more documentation. What a bunch of BS. I just can't believe that they won't take them off even with the insurance claims forms.

I am so mad.

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  • 2 weeks later...

Now, this is completely strange. Both of the med bills have been removed from EX. But they're lawyer said they weren't doing anything wrong. 8-) Don't know if it was their lawyer, the state AG or the HIPAA complaint, but they are gone from EX after months of fighting over it. Gotta wait on EQ and TU.

Anyway, something is working, but like I informed their lawyer, fixing it now doesn't relieve them of the liability they already accrued, and I still plan on suing them and the OC if they don't send a nice check.

But the weird part - Not one FAKO point change in PG.

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and ..... LMFAO

CRs (just this CA) went from this:

Utility: EQ EX TU

Med1: EQ EX TU

Med2: EQ EX

to currently:

Utility: EQ TU

Med1: TU

Med2: EQ

I told them that since the utility was legit, they could leave it, but it needed to be reported 100% accurately (open date is wrong), or I would continue to dispute it until they did. Guess they are just getting sick of us.

It was not the HIPAA complaint that did it. I just got a letter from them saying that they were looking into whether they could take action. So, obviously, they didn't already take action. That means either their lawyer, or the state AG. I bet it was their lawyer. Looks like they should all be removed pretty soon. Probably put in the request, but CRAs are just taking their sweet time.

Hmmm, wonder how long before they add a check to this?

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The Office of Civil Rights went over my complaint and determined that there were no violations of privacy rights.

They stated that my allegations of divulging information for collection purposes to the CA and the CRAs, even though I sent proof they were paid by insurance IS NOT a violation of the Privacy Act, even if they investigate and substantiate the allegations.

Can you believe that? What the huh? They are only permitted to divulge the information if it's necessary, which this wasn't, am I right?

Med1 is off the reports. Down to three total listings from the original eight. One med2, and two utility remain.

Edelman doesn't want the case (not enough money), but are interested in a couple other ones I sent. I guess that's bad, but good news, in a way.

That sucks. Well, I still got the AG and the courthouse. It's tough to sue pro se when you're in the process of moving out of state though, so hopefully, the AG will shed some positive light. I want to sue them so bad, but just don't have the time.

If all else fails, all of those are due to fall off by Feb, 2006, so it's only one more year. Geesh.

Same CA found a med bill for ME, and is backlashing by threatening with lien on my property over $450. Ha Ha. There's a contract with the OC that keeps them from reporting, so a suit is their only recourse, and won't it just bite their arses when they find out I'm moving to a state where they aren't licensed, AND I'm getting ready to sell the property that they want to attach. Just thought that was funny.

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