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Collection Agency & Hospital Bill


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I wanted to see if you could kindly help me with regard to two bills I have received from a collection agency.  Any assistance you can provide would be deeply appreciated.


I owe money for medical services since I went to the hospital’s emergency room twice for heart problems. 


I stayed at the emergency room/hospital for about 4 hours or so the first time, and I stayed at the hospital overnight for observation on the second visit.


The original hospital bill was about $8,000. 


I have health insurance through Anthem Blue Cross and apparently the insurance plan covered about $3,500 of the bill. 


However, the collection agency claims that I am responsible for about $4,500.


Since I was taking care of my mother who is 88 years old, suffers from cancer and recently had heart surgery, unfortunately, I didn’t contact Blue Cross to understand how much of the bill they should have paid, and I did not contact the hospital to see if they would accept some sort of payment arrangement so I could pay the amount I owe in affordable installments.


Unfortunately, except for the last 2 years, I’ve never had health insurance before so I’m having trouble understanding the terms of my health insurance plan. 


I believe I have already met my $1,000 deductible and a large portion of my out-of-pocket maximum this year, so I think that a larger portion of the bill should have been paid by Blue Cross.


I also can’t understand the bill sent by the Collection Agency, since the amounts listed by the collection agency do not correspond to the amounts that were billed by the hospital even after taking into account the portions that were paid by Blue Cross.


The bill that was sent by the hospital shows a lump sum amount rather than a breakdown of the specific medical services they provided.


Would it be wise to ask the collection agency to send me a bill from the hospital that breaks down the amount they’ve billed to show how much they charged for the x-rays, how much they charged for the EKG, how much they charged for blood draws, etc. while I was at the hospital? 


Perhaps that way I could develop some understanding as to how they came up with the large lump sum amount.


I also understand that Blue Cross has a Negotiated Fee Rate (Pre-negotiated Discounted Fees) agreement with this hospital as to how much Blue Cross would pay for each type of service the hospital provides.


Would it be a good idea to ask that Blue Cross provide me with a copy of the Negotiated Fee Rate agreement with this hospital in order to verify whether Blue Cross paid the correct and proper amount for the medical services the hospital provided?


What are the chances of getting the collection agency to agree to accept a lower amount than what they are demanding right now? 


Would they agree to payment arrangements so that I can pay the amount due in affordable installments?


I would be deeply grateful if you could give me any advice, information and ideas regarding how I could handle this issue.


Thank you very much for your kind attention and time!  I greatly appreciate your help!



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First, call your insurance and ask them to send or resend all the explanations of benefits EOB for those hospital visit, from doctors to hospital etc.


For the CA, they don't care what happened at the hospital or what didn't they get an unpaid bill that the hospital sends, and proceed collection effort, regardless, they do not have records of all the medical expenses etc. They are just a third party trying to collect in the name of the hospital, for this gus you need to send a cmrr letter disputing the alleged debt (doesn't matter if you belive you own it or not, just dispute it). A sample:





Dear CA:


I dispute the validity of this alleged debt, and demand debt validation, also provide name and address of original creditor.


Sincerely Yours





Then call the hospital or however the bill is for, and ask them an itemized bill, if you got a copy skip this step.


As for insurance it really depends on what you got, but a normal rule is, you got a deductible of x, and after you pay that, then they cover 80% of the bill and you pay 20%, when you reach x amount, the maximum annual out of pocket, then you are no longer responsible for any bill.


Let's say they bill the insurance 20k, they applied the contracted fees to that and knocked down 12k. Of the 8k remaining they applied your deductible of 3k, and paid the other 5k remaining at 80%, so you end paying your 3k deductible plus 20% of 5k, so 1k more, total of 4k. More or less but those numbers depend on your insurance and the contractual fees, for example the hospital might not be an in network hospital and then the whole math is different.

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First of all blue cross and blue shield are part of State medical plans and providers whom agree to accept any state administered medical coverage sign an agreement with the state that what ever the insurance pays is to be considered payment in full and the person whom the policy covers can not be billed for any thing over that.


This procedure is called balance billing and is illegal. balance billing occurs when an insurance plan covers less than what a doctor, hospital, or lab service wants to be paid. The health-care provider demands the balance from the patient. State and federal laws generally bar the medical providers from pressuring patients to pay the difference.


Horizon Blue cross and blue shield has sued several doctors offices and hospitals for this practice. Call you insurance and discuss it with them.


To learn more about this practice and the law suits over it just google "balance billing"

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