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HELP. CA SENT DOCUMENTS ON MEDICAL BILL

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I sent a DV to a CA reporting a medical bill. This is an ER bill back in 2010 that was supposed to be charged off by the hospital to their charity care. I was unemployed and uninsured at that time. I disputed with CRA and came back verified. 

 

Today, I received letters in the mail from the CA. 

 

Letter #1:

 - Addressed to me and my ex-husband to my address since 2008.

 - Ex-husband has never lived at this address. The divorce was finalized in 2009. 

 - The Amount due is $400 more than the amount due on the CR.

 - Basically just says they received the dispute from a CRA and advised that the info is valid and will remain unchanged.

 

Letter #2

 - Response to my DV.

 - attached is an itemized bill of EVERYTHING that was done in the emergency room. Including type of ultrasound done, drugs administered and laboratory tests done. 

- It also indicates "Self Pay Adjustment" that I never actually paid.

-  It reflects the balance/amount due as the same amount reported on CR.

 

I sent a CMRR letter to the hospital too but have yet to receive a response from them. I basically told them that this is a billing error and should have been charged to their charity care and provided unemployment records to support my claim.

 

Is there a HIPAA violation here? 

 

What steps should I take next? 

 

Thank you for all the help.

 

 

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" Ex-husband has never lived at this address. The divorce was finalized in 2009."

 

If you were married to him at the time of care and listed him as next of kin then the CA has assumed you are still married.  They won't research the divorce records to determine your marital status.

 

" - Response to my DV.

 - attached is an itemized bill of EVERYTHING that was done in the emergency room. Including type of ultrasound done, drugs administered and laboratory tests done. 

- It also indicates "Self Pay Adjustment" that I never actually paid.

-  It reflects the balance/amount due as the same amount reported on CR."

 

If they attached the itemized bill then they have a current business relationship with the provider and can continue to collect.  That is why they were given the records by the hospital.  The "self pay adjustment" is the discount they gave you for being uninsured/low income.  It is not an amount you actually paid out of pocket.

 

"I basically told them that this is a billing error and should have been charged to their charity care and provided unemployment records to support my claim."

 

This is the MOST common incorrect assumption patients make.  You received a discount on the bill because you were uninsured and that may have been all you qualified for or all the money that was available towards your bill from the charity fund.  There is absolutely NO legal obligation for the hospital to write off the entire bill simply because you are unemployed.  Every facility I have EVER worked at required patients to apply for charity care and be approved.  It is NOT automatic.  You must supply tax records and proof of income not proof of unemployment alone, along with rent, utilities, and other expenses for daily living.  Charity care funds are limited and once the fund is exhausted it doesn't matter how poor someone is the hospital cannot tap an empty fund for the bill.  If you did not apply to the fund and get approval it is likely that they did not even consider charity care at all. 

 

"Is there a HIPAA violation here? "

 

No.  As long as the collection agency has a current business relationship with the hospital they can legally request the proof you requested in your DV to comply.  It also is not a HIPAA violation to report medical debt on a credit report despite what you read on other sites.  

 

"What steps should I take next?"  

 

I would start by finding out if you ever applied and were approved for charity care.  If not then the next step is to see if they will retro-actively apply it.  Odds are slim to none but it can't hurt to ask.  Typically they don't because each fund is annual and once the fund is spent they stop offering coverage until the next fiscal year and a new fund becomes available from a new budget.  

 

If they won't apply charity care then your options are to wait for it to drop off or make payment arrangements.  

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I would see if you can deal with the hospital directly and try to pay this bill.  They might be able to recall it from the collection agency.  If not, I would dispute with the CRAs the entire bill.  

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Thanks for the responses.

 

@Clydesmom Divorce was finalized in 2009. The ER visit was in 2010.

The hospital has it clearly laid out on their charity policy that anyone with income below 250% of the federal poverty guideline, the charges "will be deemed charity". That is verbatim on their charity care policy.

 

"Validation that a patient’s gross income is less than two and one-half times (250%) the Federal Poverty Guidelines (FPG) applicable at the time the patient has applied for financial assistance. A patient with this income level will be deemed eligible for 100% charity care" and "Self pay patients with gross incomes at or below 250% of Federal Poverty Guidelines. The entire balance will be deemed charity."

 

Also, California has a hospital fair pricing law enacted in 2006.

(http://www.oshpd.ca.gov/hid/products/hospitals/fairpricing/HSC127400_CharityCarePoliciesSB350.pdf)

 

I will call the billing department and ask about retroactively applying it.

 

 

Thank you!

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Did you apply for charity care or just assume that since you were unemployed the hospital was going to figure that out?  If you applied for charity care and it was granted, just forward the award letter the hospital sent you and this should be taken care of.

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i was given a hospital bill where i  was in ER and self pay adjustment made was in the thousands? 

 

However, i also applied for charity/medicaid and found out later on that becoz i was level 5 emergency i had to be transported to the nearest hospital from my place.

At that time, i had county hospital medical coverage and did not apply to this private hospital.

However, i did apply for charity/medicaid coverage and was told that becoz i carried county hospital coverage that i would not qualify for charity care at this private hospital.

 

Isnt that wierd? i had county hospital coverage, i insisted to ambulance to take me to county hospital but since it was level 5 (critical) emergency that i was transported to the nearest hospital?

 

They covered me back at this same hospital for emergency visit in 2010. That means my county hospital coverage paid the private hospital its bills/expenses. I was left with only $600 to pay out of total owed amount of $18000.

 

strange things have happened in this lifetime when in hospitals???? lol

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