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Newbie wants to know: pay or not?


aries4
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I'm brand new to this or any forum, so please excuse any "protocol faux pas." Here's the problem/question: I had a hospital stay in 11/03 and subsequently rec'd. a $3,400 bill with no explanation. As I was still recuperating, my husband tryed to handle by getting an explanation of charges, but the hospital wouldn't disclose any info b/c of HIPAA laws. After several months w/o contact, the hospital sent us a notice in 4/04 that the ins. co. denied the claim; DH notified them to refile with our other ins. carrier. Rec'd no further word until a CA notified us late 11/04. DH spoke with them via phone (I know, a big no! no!) in early '05 and requested bill documentation. Somehow, they were able to get an itemized bill from the hospital showiing ALL svcs. performed. Now the CA is calling several times/wk; I'm "never home" to take their calls and they are handling things "discreetly." We have the $ to pay the bill and would like to pay the OC for delete and get both them and the CA off my CR, but I'm wondering what exactly we should do since I think they may have violated my privacy rights. Is this a violation of HIPAA or should I just go ahead and try to negotiate with the OC for pay for delete? Thanks.

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No problem...welcome...we'll do what we can to help...

First, should this have been paid by one of the insurances? If so, then you need to beat up on the insurance company and / or medical provider to get it taken care of. Don't spend your money correcting their mistake.

Second, CAs working on behalf of medical providers do have some leaway with regard to HIPPA. I'm not sure I know all the details, but the jist of it is they're allowed to have enough access to the data to do their job...i.e., collect money.

So...bottom line...call the accounting department at the hospital and find out where this stands with the insurance company. If it should have been paid by insurance, make them handle it...

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Thanks, willingtocope. Apparently proper pre-auth. process wasn't followed, so it is my responsibility, unless ... this IS a HIPAA violation. Also, if I do go back to the hospital for pay for delete, it's ok to negotiate a percentage of the bill, right?

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Pre-auth for both insurances? Whose responsibility was it to get that done? Surely not yours...

Anyway, talk to the OC. I don't think you'll get very far trying to pay less, unless there was some sort of hardship involved. Hospitals sometimes do charge different rates depending on whether you have insurance or not...sometime higher, sometimes lower...depends on the insurance company. But, you should be able to talk to the hsopital about "...gee, thought the insurance was taking care of this...really sorry...we'll pay in full...how much?...call off the collector?...mark our credit report paid in full?..."

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