Confused about medical collections and HIPPA Laws.

[apes]

So, my DH has about a $1000 in medical collections listed by his current doctor. They have NEVER once asked him for a co-pay and he has been seeing him for about 4 years now. I always wondered why he never had to pay anything when he went. I guess I just assumed maybe he got a financial hardship and had it waived. Silly me. Meanwhile, I got copies of his 3 reports and there are several listings at $35-$50 a pop!!

So, when he went for his 3 month check up last month, they REFUSED to see him unless he paid them $150 THAT DAY! What?? That is the first time they have even asked him for any money. I can't understand why they continued to treat him for so many years while they were putting his co-pays on his credit report. I NEVER once got a bill from them. Why would they not ask him for the money before? Anyway, he HAD to see the doc because he had to get prescription refills and we HAD to pay $150 to them that day. As I understand it, $50 of it was the co-pay for that day and the other $100 should go toward his collection accounts?? We do not have a problem settling up on this debt as he will continue to see this doc every 3 months. If we make arrangements and have receipts for all the payments would we just dispute with the CA and they have to remove it automaticlly being as it is a paid medical account? Or do we have to do the whole PFD method with the Doctor's office?

I need a little guidence on this one so any advice is appreciated!!!

ADDICTED TO CREDITINFOCENTER.COM!!!

EQ 3/15/08 580

[Ahntara]

Do the whole PFD thing with the Doc. Insist on them withdrawing all collection accounts from their CA. Then dispute the TL's showing on his CR.

Leave HIPPA out of it until you have to get ugly. Try to keep things cordial, since he will still be seeing the Doc for some time.

[apes]

Thanks. I thought that was the best route to go. So, if we talk with the doc and get them to agree to delete them (in writing) once it is paid in full, would this work if we paid it in a few payments or do you normally have to pay in full?

I still am unclear on how the HIPPA laws affect medical collections. Is there anyone who could possible clear this up for me? Is it that once there is no money owed to a medical provider, a CA no longer has any right to report to the CRAs?

Thank you all!

[Ahntara]

"...agree to delete them (in writing)..."

The thing is, the doctor's office isn't reporting and therefore can't delete. Their CA is the one reporting. You have to get specific with the DR to withdraw the account FROM the CA. The CA may not automatically remove the TL. But if all goes well, and you dispute the CA's listing to the CRA's after the DR has taken it back...the theory is that there is nothing for the CA to verify at that time = suppression.

"...HIPPA..."

If you want details about HIPPA, I'd suggest reading the text for yourself. Yeah, I know it's written in legalese, but at least you'd be getting your info from the horses mouth. It shouldn't be too difficult to find the text. HIPPA has to do with privacy of your medical info, not credit reporting. Once you have a good understanding of what HIPPA is actually about, come back here for pointers on how to use that law to your best advantage.

[Flipper]

Let me give an example. Here's one of mine that I got deleted and I went directly to the MD's office, not the CRB and threatened a lawsuit under PHI violations and FCRA violations.

There was a collection account on my TU report from a MD's office by the name of Female Healthcare Associates. They did not ever place this account with a CA...they reported it under their own name. The name of this provider alone is suggestive of diagnosis. Providers with names like "Northwest Oncology Associates", "Cardiac Care Associates" and other specialists disclose diagnosis to all n sundry. That is a huge no-no. That is where the PHI portion of HIPPA comes into play that forces these types of providers to hire outside collection agencies. If that is what is transpiring in your situation, then you've got a very good case for deletion. And shame on the CRBs for allowing that listing to be posted.

Your post doesn't indicate whether these charges were reported by the MD or by an outside CA. If it was reported by the MD and the practice name in any way is suggestive of diagnosis (specialty care), then inform them of this and stress that the listing cannot remain on the CR the way it is for the reasons I cited above. That's a good way to get it pulled without having to formally dispute....meantime, tell them you are shocked and embarrassed to realize that you had an outstanding balance, that you feel badly nobody from their office ever contacted you about it and that you are of course going to pay them every dime to which they are entitled. Also indicate that the charges were allowed to accrue and it's a bit difficult for you to settle the account in full immediately....offer a payment plan.

If there's a CA involved, they can still verify the debt without divulging Protected Health Information; in other words, HIPPA does not qualify in this scenario.

[Moriah4]

It is my understanding under Hippa that it is the DR. or medical institute that is governed by Hippa not the CA"s.

It is extremly important that the Dr. offiice pull the account from the collection agency. According to where you live in KY they may or may not remove it before the 7 yr. reporting period.

I spoke with attorneys re: this matter and was basically told that they can report anywhere from 2-10 years. Take your pick.

So it is very important that the Dr. agrees in writing to pull the account from the CA.

Blessings

Moriah

[Flipper]

It is my understanding under Hippa that it is the DR. or medical institute that is governed by Hippa not the CA"s.

HIPPA extends to any entity that is charged with an individual's protected medical information. That includes but is not limited to, medical care providers, pharmacies, government programs, insurance companies, brokerages and yes, CAs. The MD office can contract with a CA for the financial aspect of a bill without divulging diagnosis, etc. Also, when you are seen at a medical office, you sign an authorization to release information pursuant to the payment of a bill. You authorize the medical provider to furnish a bill to outside parties (ie, insurance carrier) in order to collect payment. If you signed the authorization at the time of service, you have no recourse under HIPPA to dispute that.

[apes]

Let me give an example. Here's one of mine that I got deleted and I went directly to the MD's office, not the CRB and threatened a lawsuit under PHI violations and FCRA violations.

There was a collection account on my TU report from a MD's office by the name of Female Healthcare Associates. They did not ever place this account with a CA...they reported it under their own name. The name of this provider alone is suggestive of diagnosis. Providers with names like "Northwest Oncology Associates", "Cardiac Care Associates" and other specialists disclose diagnosis to all n sundry. That is a huge no-no. That is where the PHI portion of HIPPA comes into play that forces these types of providers to hire outside collection agencies. If that is what is transpiring in your situation, then you've got a very good case for deletion. And shame on the CRBs for allowing that listing to be posted.

Your post doesn't indicate whether these charges were reported by the MD or by an outside CA. If it was reported by the MD and the practice name in any way is suggestive of diagnosis (specialty care), then inform them of this and stress that the listing cannot remain on the CR the way it is for the reasons I cited above. That's a good way to get it pulled without having to formally dispute....meantime, tell them you are shocked and embarrassed to realize that you had an outstanding balance, that you feel badly nobody from their office ever contacted you about it and that you are of course going to pay them every dime to which they are entitled. Also indicate that the charges were allowed to accrue and it's a bit difficult for you to settle the account in full immediately....offer a payment plan.

If there's a CA involved, they can still verify the debt without divulging Protected Health Information; in other words, HIPPA does not qualify in this scenario.

So would "open mri" or "womans care physicians" be considered specialists thus divulging personal medical info?

[Flipper]

Absolutely! Anything in the provider's name that is suggestive of diagnosis is divulging protected health information and is a blatant violation of HIPPA. Women's Healthcare Associates...hmmm, what distinguishes that practice from any other? Something to do with female reproductive system disease perhaps? That is way too much information right there. Open MRI is another one....people don't have MRI's for the hell of it.

More specifically, if the debt is being reported by a CA and in the notes there's a "MED1" with a note following that lists who the OC is, then that's reported within the scope of FCRA. The MED1 notation shields the name of the OC from others who view your report. If the debt is reported by the medical provider itself without a MED1 in front of it on the report, then anyone can see this and that's a violation. If that's the case, then by all means, go after full deletion! Cite Protected Health Information violation and FCRA violation as your cause for dispute.

I would suggest contacting the OC first - they are all scared to death of HIPPA non-compliance blowback and will probably delete the thing immediately.

Think about this.....irrespective of the personal embarrassment this type of listing causes you, imagine what would happen if you were applying for a $250,000 life insurance policy and a listing from "Northwest Oncology Associates" was sitting on your credit report? Insurance companies routinely pull credit reports as part of the application/underwriting process. These medical providers are causing far more harm to your life than just a bad debt reporting. They are divulging Federally protected health information and possibly prohibiting you from obtaining insurance....neither of these two issues has a damned thing to do with an outstanding balance.

In yours and my cases, these are simply free-standing medical providers who don't want to lose money by relinquishing the debt to an outside CA. For that reason, and fully understanding that their profit margins are not on the same par with those of CC companies, etc, where they can afford to just sell the debt for pennies on the dollar, I always make them a higher priority as far as payment goes. I'm not unsympathetic to their situation. However, that does not give them the right to throw something on my credit report that divulges information that is unrelated to the debt or compromise my standing in a non-financial manner with other businesses.

[Desert Bloom]

Search this site for 'medical collections' there are a lot of us out there who have dealt with this issue. I have removed my own, my sisters and a good friends negative TLs using the 'WhyChat' process.

By and large doctors offices just want to get paid -- and the staff is often overworked, and mistakes are made in billing addresses, etc -- so a cordial approach with a tale of woe is generally most effective.

Make a payment arrangment and stick to it -- but make it clear that your PHI (private health information) should not have been disclosed, and that your credit has been harmed because the office did not bill you. Approach it that it was probably an honest mistake by their office, but it has caused you a serious problem and you need their help to resolve it.

I have experience in medical billing and let me tell you it is hard for a doctor to get paid by anyone! Medicare reimbursement rates do not generally cover the cost incurred by the doctor. Private health insurance companies pay a small % over the Medicare rate, and these insurance companies routinely 'lose' the billing records and do all kinds of other stuff to avoid paying a claim -- it frequently takes 90 days++ for a doctor to get paid and only if he has an efficient medical billing/collections person on his staff.

Fixing our medical health crisis is going to be a big problem if we do not resolve the problem of getting the doctor a fair payment for his services -- without it he can not reinvest in equipment or hire a staff that does a good job. Add to this the cost of medical malpractice insurance and you can understand that the days when doctors made lots of money are long gone!

The reality is doctors are often dealing with sick people who are also facing financial pressures as well.

Bottom line -- these guys just want to get paid -- and are generally really willing to work with you if you approach them in a cordial way.

[Flipper]

Not to get too far off topic and I'm sure you encountered your share of frustration working in medical billing....but, having worked 10 of the 20 years of my insurance career on the carrier side, I can say your claim that insurance carriers "lose" medical claims in order to avoid paying them is patently absurd. I have never once experienced any such thing. I don't know how you can, on the one hand, dismiss a provider's conscious decision to violate HIPPA compliance regulations by reporting a debt illegally as a "mistake", only to turn around and make some wild allegation that insurance carriers deliberately "lose" medical claims.

The vast majority of complaints regarding outstanding medical debts on this board cite the provider's failure to bill the carrier as the cause. Further to that point, an MD voluntarily enters into a managed care contract - nobody is holding a gun to his/her head. So with that said, there is no justifiable cause for a provider to chase people via a method that is highly unethical...and believe me, they ALL know the PHI requirements inside and out. I look at it this way....if they are unethical enough to report a debt in that manner, then they are unethical enough to pull just about anything. Like I said, I understand their situation, but again, that doesn't give them the right to violate their patient's confidentiality.

[LeslieR]

More specifically, if the debt is being reported by a CA and in the notes there's a "MED1" with a note following that lists who the OC is, then that's reported within the scope of FCRA. The MED1 notation shields the name of the OC from others who view your report. If the debt is reported by the medical provider itself without a MED1 in front of it on the report, then anyone can see this and that's a violation. If that's the case, then by all means, go after full deletion! Cite Protected Health Information violation and FCRA violation as your cause for dispute.

I have two medical accounts and went to check them after reading this. TU has the "Med1" notation on both of them but neither EQ nor EXP have it. Does this mean the CA is choosing not to report Med1 to EQ or EXP or that the CA is not transmitting the data correctly to the CRA so that the CRA doesn't understand what type of account this is? Follow me? Since I assume the CA reports the same data to all three (they report the same day every month and this is obviously automated), I'm trying to determine where the error is.

One of these accounts is "sensitive" in that the name of the provider reveals the problem. I'd like both of them gone, but this one in particular.

BTW, thanks for this helpful thread.

[Flipper]

Hi Leslie,

If the provider's name is showing anywhere on the listing without a MED1 notation preceding it, then it is an automatic HIPPA/FCRA violation. In my case, it was the MD office itself that was reporting the debt. There was a MED1 notation in the "comments" field....big deal. The reporting source was Female Healthcare Associates...that's what gives it away...and anyone can see it. I sent the provider a rather nastily worded letter (they deserve it) demanding they delete their listing.....they can't change/update the information that was reported, because the reporting source is what causes the violation to exist...therefore, they have to delete the entire listing. If they don't, not only will they have to deal with FTC violations, they will be dealing with HHS violations as well. It will cost them far more than the $120 they reported when it's all said and done.

I would assume that whomever is reporting your debt is responsible for ensuring that the info is protected under FCRA/HIPPA regs when submitting to the CRA's. But the CRA's are not exactly populated with NASA engineers, so it wouldn't surprise me if the error is on the CRA's end either.

FEMALE HCARE

Creditor Name: FEMALE HCARE

Account No.: 3464*

Original Creditor: MED1 FEMALE HEALTHCARE ASSOC LTD

Responsibility: Individual

Condition: Derogatory

Original Balance: $120

Balance: $120

Date Opened: 10/01/2000

Date Reported: 04/01/2002

This is from my TU report....do you see how Female HCare is the reporting entity? Also, do you see where the Creditor Name is also showing as Female HCare with no MED1 notation preceding it? You will note that in the Original Creditor field, there is a MED1 notation....like I said...big deal - it's already divulged in two other places on this listing. Kind of pointless to shield it in one field and put it out there like a big neon sign in two others!

[LeslieR]

Many thanks Flipper - this will be my project of the week!

[Flipper]

Good luck and please update your progress; I'd like to know how it works out for you. I can tell you, it's just lovely knowing that someone was thoughtful enough to not only prevent me from getting a mortgage, but awarded anyone viewing my report with the added bonus of letting them know I might have a problem with my ovaries! LOL!

[lovelydria]

CENTRAL FINL CONTROL

Address:

PO BOX 66051

ANAHEIM, CA 92816

No phone number available Account Number:

1234567 Original Creditor:

SAINT FRANCIS HOSPITAL

Address Identification Number: 0236004797

Status:

Collection account.

Status Details:

This account is scheduled to continue on record until Nov 2011.

This item was verified and updated on Sep 2007.

Date Opened:

04/2005

Type:

Collection

Credit Limit:

$95

Date of Status:

08/2005 Terms:

1 Months High Balance:

NA

Reported Since:

08/2005 Monthly Payment:

$0 Recent Balance:

$95

Last Reported Date:

03/2008 Responsibility:

Individual Recent Payment:

$0

Account History:

Collection as of Mar 2008, Sep 2007, Jun 2006, May 2006, Aug 2005

This is from Experian is this okay reporting?

[Flipper]

They probably wouldn't delete the listing if verifiable, since it can be corrected to shield the medical provider's name by inserting a MED1 in front of the hospital's name in the Original Creditor field. But I wouldn't hesitate to dispute with the CRB citing HIPPA violation and see what they do...they might delete or they might correct it...but since the reporting source is a CA, they can easily insert the MED1 in the other fields and be in full compliance.

The way it's reported right now is a violation. Give it a shot and see what they do.

[tarbaby]

I'm jumping in here a little late...but..have you tried sending/emailing the billing dept or the CEO asking for a pfd? I emailed the CEO of the hospital last week for my dxh. He has six medical collections on his reports. The CEO agreed to delete the accounts when he pays them all. I also did the same for one medical collection on my reports.

[Webbk012]

I am a bit confused as well with Medical Collections..

I have on my CR from TU listed Original creditor: MED! 02 METROPLITIAN ANESTHESIA PC and currently being collected by M & M credit. Is this a violation??

[Flipper]

No, that is actually a very good example of the correct way to report medical debt. The account was reported by a C/A and there is a "MED1" in front of the Original Creditor's name. That "MED1" shields the provider's name from anyone viewing your report. Nothing in that listing divulges Private Health Information.

[Webbk012]

Thank you!:D

I have been reading, reading and reading, trying to soak up all this information I have read so far on this site. Thank you everybody!

[lovebug5]

Well this is a very interesting thread for me to view...

I have one CA reporting to all three CRA's on various accounts - not one report shows the "MED1" notation in front of the OC's name. So basically, if what is being said here is valid information, I have one individual CA on at least 8 different HIPAA violations for this.

Is this correct?????

[Flipper]

Essentially, yes. But it's very easy for the CRBs to fix the listings so that they don't have to delete and the info will remain....they simply need to insert a "MED1" in front of the OCs names and voila! Fixed. The reporting party is a CA, so no med info is divulged there.

I would dispute with the CRBs....I would word my letter that "x account" is in violation of the FCRA and HIPPA regulations...ask for a deletion. DO NOT tell them what aspect of the listing is in violation - they should know that already and you definitely don't want to tell them how to fix the listing - you want it deleted. Hope that they don't know what they're doing and/or get freaked enough by the HIPPA violation aspect of this to simply get rid of the listings completely. If the C/A reports the info again, odds are they'll do it in the exact same fashion they did the first time around and be guilty of yet another violation.

[Flipper]

Update:

The account with Female Healthcare Associates has mysteriously disappeared off of my TU report. I'm pretty sure the provider requested the deletion, insofar as TU hasn't touched a single other one of my disputes (they are now in violation of the 30 day limit, btw).

Score one for the little guy!

[isislc]

You know, I already tried using WhyChat's HIPAA dispute process and I basically got a letter back from the OC to blow it out my . The next step in the process says to file a HIPAA complaint, is this my only recourse now?