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Is this a violation?


goodstuff
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I sent a DV to a CA in ref to a medical bill, typical DV asking them to provide signed copies, etc... They had previously sent me a computerized statement from my first DV 2nd DV I said this isn't correct DV blah, blah... they sent me yesterday another printout with all of my medical info on it (it was for a pregnancy) but line by line it says hemoglobin test, HIV test, all those blood test they give you when you're pregnant.

They then sent stuff I signed that it was OK to be tested, etc... About 7-8 pages of stuff, but one of the pages showed that I have a 250 insurance deductible and my insurance pays 100%, they have billed me for 600 bucks so this supports my whole argument that there is no way that I could owe 600 when my insurance pays 100%. Anyhoo, I just recently found another website talking about HIPPA violations. The CA sent this info and it doesnt list their name or contact info anywhere, nor where to remit payment nothing, it just appears to come from the OC. And it gives so much personal medical information it scared me to think that if someone else had've opened this letter that was only taped shut and looked as if it had been previously opened all of the information they could've had about me. I can't recall for sure but I think one of the pages even had my social security number on there.

Did the CA violate some kind of HIPPA law for privacy?

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I say yes as to the violation, but, some of the others who have more knowledge of the HIPAA say different as on the papers you sign appears to allow this info to be shared. I am still looking for this myself to better understand this.

As to your problem, you need to call your insurance carrier before you do anything else. When they answer, ask them to pull up your EOB and explain to you what is your responsibility, such as co-pay. This is all you are laible for. In short, if the CA's balance due does not match your EOB, something is wrong. Many insurance carriers have a special department to assist their beneficiaries in this type of problem. Some examples of what medical providers do to try and get paid for things they shouldn't are:

Balance Bill - Will bill beneficiary full amount of denied claim with knowledge they can only bill for the allowed amount.

Mutually Excluded - Will bill beneficiary for amounts that are agreed to be written off.

Non-covered Treatments - Will bill beneficiary for treatments that were known to be non-covered, and failed to follow proper procedure, such as, having the beneficiary sign a specific line on paperwork acknowledging they will be liable for non-covered treatments.

Assign To Collection - Some carriers have it written in their rules that no claim is to be sent to collections. What they are supposed to do is contact the carrier and it goes from there.

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Thanks Ladynred for that extra A, typo mistake ALL of my clients have to sign HIPPA forms so I should definietly know how to spell it by now :oops:

Retmar, thanks for your reply as well, I contacted insurance provider and since this was from 12/03 they had already purged their automated records. But she did tell me that they do have a policy that states if a doctor/hospital doesn't submit a claim within 12 months of service they can not come back and charge me for it later. She said this appears to be what happened, I told her the doc's office claims to had submitted the files but b/c I hadn't met my deductible the insurance denied it and sent it back. The insurance clerk said that would NOT be the case, they don't send things back. She told me to call the doc's office and ask for evidence of that, a copy of the EOB that the insurance supposedly sent them in their return of the claim. In the mean time she said get the statement the CA sent me with dates on it and call her back tomorrow b/c she can go in and do a special search under claim dates. So hopefully something will come from this, I'll keep ya posted.

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Outstanding! Good work!

From your description, this is telling me they are balance billing. To explain this more, when a provider agrees to accept assignment from a beneficiary, or sponsor, they agree to all rules and regulations regarding the accepting of assignment with the carrier. You said they want $600. Now, if the $600 was the amount billed, and the claim was denied, due to deductible not met, the provider can only bill you for the allowed amount. How this works is the carrier receives the claim for $600, but, after working the claim, the allowed amount is $175, this is all the provider can bill you for. Therefore, the EOB will show exactly how it all pans out, such as, amount billed, amount allowed, and, if deductible not met, will deduct this from any balance remaining of the allowed, which will then be an amount which the carrier will pay to the provider, if any remains. You are only liable for the amount shown on the EOB as your responsibility, such as copay, cost share, or however it is worded. Your carrier can pull up the EOB. Usually, they have to go to their archives to locate, and it does take some time, but, usually, they can find the EOB. Don't call the provider at this time. though your carrier was proper in asking you to do so, I am not supportive of this as too many times the provider will not talk to you, and then calls the cA to tell them what you are doing. If your carrier is as good as they claim, they can do this themselves. Therefore, when you call this person tomorrow, just tell them that you checked into calling them and found it is not a good idea for you to call the provider as it could possibility cause you unnecessary problems.

They should respect this from you.

Regarding your comment about the timeframe, this is true with most carriers. They set certain parameters for the provider, such as billing. If the provider fails to file within those parameters, they are to write off as a loss and not bill the beneficiary. Also, if the claim is denied for some reason , and returned to the provider for correction, such as, is their another carrier who may be primary, it is the provider's repsonsibility to obtain this information, not the beneficiary. An example is one of our past problems. A claim for my DW was denied as the carrier had knowledge of another carrier. It was returned to the provider to obtain the information. The provider failed to do so by trying to claim it was our responsibility. I had told them the other insurance was already in their files and all they had to do was resubmit their claim with this info. They failed to do so and sent to collection. They got spanked hard for this and the other two they sent over (These were balance billed and their problem why not paid at time of servie). Besides not getting paid, they were sanctioned from participation in the Tricare/Medicare program for "awhile".

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