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medical Collection Biz Relationship


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I have always had issues understanding a business relationship under HIPAA between a CA and Hospital.

 

I m told via various sources that for a CA to report a collection account, there must be a business relationship between the Hospital and CA.

 

There is a condition of Service Agreement in place between the CA and the Hospital? I was made to sign that upon discharge from the hospital emergency room;

 

does anyone know if that establishes a business relationship between CA and Hospital? I mean Condition of Service establish the biz relationship?

 

For Medical Collections I m told its ALWAYS a good idea to pay the Hospital (OC) instead of a PFD with CA. Does the payoff have to be "in full" for deletion/removal. Can it be reasonable n Customary Charges under HIPAA and still get deletion when paying the OC?

 

If nearly fours years since Date of Service (DOS) has gone by do they have any effect on your scores? I know they can report for 7 years, but likelihood of getting sued for it goes away

 

If you had hospital stay for 5 days in sept 2010 and had $18k in bills, the hospital gave you as much as $ 17,400 in adjustments (not paid by charity/insurance) and the CA is reporting collection for the $600 wouldn't one think it must be a "LEFTOVER writtenoff Balance" versus a real bill. somehow, I m to believe that under HIPAA, the hospital got paid from somewhere but is reporting it as adjustments? have you ever known such a big amount listed as "Adjustment" . I have copies of the statement given to me and it shows " adjustments"

 

Strange but true?

How do I dispute this?

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I have always had issues understanding a business relationship under HIPAA between a CA and Hospital.

 

I m told via various sources that for a CA to report a collection account, there must be a business relationship between the Hospital and CA.

 

For the CA to VALIDATE there must be a business relationship in place between the CA and the hospital. If you dispute to the CRAs and there is no business relationship they cannot validate and the TL will be deleted.  They are not required to remove the TL automatically if the business agreement is no longer in place and the TL does not reveal protected information.  "Medical debt" does not reveal protected information in a TL.

 

There is a condition of Service Agreement in place between the CA and the Hospital? I was made to sign that upon discharge from the hospital emergency room;

 

does anyone know if that establishes a business relationship between CA and Hospital? I mean Condition of Service establish the biz relationship?

 

It would be HIGHLY unusual for a hospital to ask a patient to sign a service agreement between a CA and the hospital.  I suspect what you signed is your financial guarantee statement indicating that you will be responsible for the bill.  That does not require a business relationship with a CA at that point as the hospital does not assume it will automatically go to collections.  

 

Part of the financial guaranty does state that they do use a collection agency if you do not pay within 90 days and that you acknowledge this.

 

does anyone know if that establishes a business relationship between CA and Hospital? I mean Condition of Service establish the biz relationship?

 

The financial guaranty a patient signs has ZERO affect on the business relationship the hospital has with a CA.  The contract the hospital signs with the CA is what controls the relationship.

 

For Medical Collections I m told its ALWAYS a good idea to pay the Hospital (OC) instead of a PFD with CA. Does the payoff have to be "in full" for deletion/removal. Can it be reasonable n Customary Charges under HIPAA and still get deletion when paying the OC?

 

If you can pay the provider it is best.  The problem that exists is that large providers such as hospitals frequently own their own in house collections and if they do outsource it RARELY if ever change providers so the agreement is likely still in force 4 years later.  The second problem is many of these contracts now state that even if the payment comes to the provider they agree to turn it over to the collection agency.  Once it is turned over to collections they are bound by their contract with the CA and many of the outsourced ones are paid on a percentage of what they collect.  They do not want to do all the leg work getting a payment to make nothing for the provider getting the check.  You cannot force them to violate their contract with the collection agency.

 

As for a fee reduction:  if you used insurance they are legally obligated to collect the amount your carrier says you are responsible for an it is ILLEGAL to discount it.  If no insurance was used they MIGHT discount it now but the time to negotiate a reduction in fees if not already given was 4 years ago.  Once it goes to collections your options are much more limited.  

 

If nearly fours years since Date of Service (DOS) has gone by do they have any effect on your scores? I know they can report for 7 years, but likelihood of getting sued for it goes away

 

The older the collection the less affect it has on your score however, that does not mean potential creditors don't view it as negative having an unpaid collection even if it isn't causing a major ding to your score.

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@Clydesmom

 

I received my wife's TU report yesterday n much to my surprise this medical collection from sept 2010 showed up on the report. It also says " Dispute Investigation Complete" Consumer Disagrees" placed for Collection

 

If Date of Service(10/5/2010-10/8/2010) is also the DOFD, then  Oct 9  2014 will be 4 years for me in TX. sending them another DV letter or disputing with CRA's for other reasons may not be to my advantage.

 

The balance on it is $600. What I m not sure is what they refer to as "adjustment". is it really adjustment of that big $$$$ or really they got paid by charity/insurance? Here's the Account Summary

 

Total Charges: $19422.62
Adjustments: $18, 822.62
Paid by Insurance: 0.00
Paid by Patient: 0.00

Interest: 0.00

 

Amount Owed: $600.

 

Nowhere it says any charity/hospital/insurance paid anything.

 

I would like to dispute it as " balance Writeoff" ... just don't know how to do that. No point going to CRA's with the dispute!!!!!!!! or should I? just to find out if a business relationship exists?

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The balance on it is $600. What I m not sure is what they refer to as "adjustment". is it really adjustment of that big $$$$ or really they got paid by charity/insurance? Here's the Account Summary

 

Total Charges: $19422.62

Adjustments: $18, 822.62

Paid by Insurance: 0.00

Paid by Patient: 0.00

Interest: 0.00

 

Amount Owed: $600.

 

You got a discount of over 90% and you want them to forget the entire balance?  You need a reality check.

 

Even if they applied charity funds or simply discounted the bill they are not required to itemize how they did it.  That is internal accounting and their business.  The list states there is no insurance payment so the hospital basically ate your bill.  Now you want more:  sounds REALLY greedy to me.

 

I would like to dispute it as " balance Writeoff" ... just don't know how to do that. No point going to CRA's with the dispute!!!!!!!! or should I? just to find out if a business relationship exists?

 

They didn't write off the entire balance.   They gave you a HUGE discount.  WAY more than I have seen other providers give.  If this is the same account that you filed the complaint with the CFPB and it was found to be valid and accurate reporting you can expect that both the hospital and the CA have already agreed to dig in their heals and report until the bitter end.

 

In previous communications with this same CA, upon requesting a non-medical DV I have received a response mentioning the Condition of Service agreement.

 

Is it enough to assume that a biz relationship between hospital & CA exists?

 

If they responded to you then they have a business relationship with the provider.  There is no assumption.  If the business relationship no longer existed they would refer you back to the provider.

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If upon disputing with the CRA's , as " not mine" account or other reasons, if the CRA's sent it back saying verified, then I must expect a response to my dispute from the CA? is that correct?

If the CA responds to my dispute with the CRA's with Data, then it is fair to assume that a biz relationship exists?

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@Clydesmom

 

Thanks for your immediate response. If they could go 90% what would stop them from maybe 95% or 98%? why not give 98% discount? what determined 90% discount was fair enough?

 

Why would you think in their crooked minds, 90% discount was considered "FAIR" discount?

 

BTW: I have not yet filed a CFPB complaint regarding this account

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I have some other accounts with the same hospital and same CA from 2013; They chose to give me only 72.58 % discount then? can you tell why? I m beginning to get super excited in getting an understanding of the criminal mind of these hospital administrators and their theory/biling tendencies of patients discounts.

To me, they would take absolutely anything they can get no matter what $$$ amount it is? why would I want to think otherwise?

Here's the Account Summary from service of 7/22/2013-7/23/2013

 

account summary; as of jan 13, 2014 Statement

total charges $ 6286.95

adjustments          00.00

paid by insurance;0.00

paid by patient: 0.00

 

Amount Owed: $ 6286.95

 

Fast forward to January 17th statement

 

Total charges :       $ 6286.95
Adjustments:          $ 4563.40
Paid by Insurance: $     00.00

Paid by Patient       $     00.00

 

Amount you Owe    $ 1723.55

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If upon disputing with the CRA's , as " not mine" account or other reasons, if the CRA's sent it back saying verified, then I must expect a response to my dispute from the CA? is that correct?

 

NO.  Nothing requires the CA to respond to you because you disputed with the CRAs.

 

If the CA responds to my dispute with the CRA's with Data, then it is fair to assume that a biz relationship exists?

 

Yes.

 

@Clydesmom

 

Thanks for your immediate response. If they could go 90% what would stop them from maybe 95% or 98%? why not give 98% discount? what determined 90% discount was fair enough?

 

Why would you think in their crooked minds, 90% discount was considered "FAIR" discount?

 

BTW: I have not yet filed a CFPB complaint regarding this account

 

You got a 96% discount.  That is enormous.  You are nothing but greedy.  I lost my last job because of patients like you who refused to pay their portion.  The practice closed due to being too far in the red carrying people like you.

 

Funny how you didn't see them as crooked when you needed the care.  Funny how you have gone back there more than once for care and received discounts and don't complain.  Seems like as long as they are doing something for you then you are happy but if you have to actually pay for the services they provided you are not.

 

"FAIR" has nothing to do with the discount they offer.  It is what they can afford to write off. Did it occur to you that another needy patient got less of a discount later in the year because you got a HUGE discount at the beginning of the fiscal  year?  How is that fair to other patients who are in need?

 

I have some other accounts with the same hospital and same CA from 2013; They chose to give me only 40% discount then? can you tell why?

 

A LOT depends on what time in the fiscal year the care happens.  Once the funds in the charity account run out the discounts stop.  The discount they offer is also often based on what service was provided.  An established service where the equipment is owned outright might get a bigger discount than a brand new procedure still being paid for by the hospital.

 

Since there is NO requirement they give any discount at all I find it disingenuous that you would complain about the amount they do discount and then still refuse to pay your portion.

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If by my appearance alone I am billed OUTRAGEOUS amounts and then given 96% discount what does that tell you.

 

If my TYLENOL suddenly cost $150 for two tablets in an emergency room, you would sure loose your job? there is no way to sustain that? over and beyond hospital employees pay?

 

I alone made absolutely positively no contribution in whether you keep or lose your job?

 

So if all patients were discounted highest from January to March but may or may not get a discount between October and December, that's suppose to make Hospitals " Profitable".

and pay your salaries? I doubt it

 

I sure am complaining about charging me $150 for two Tylenol Tablets? welcome to ObamaCare.

 

and BTW this is a Privately owned Hospital

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 this is a Privately owned Hospital

 

Private hospitals are NO different than any other private business and as such they can set their prices however they want.  It is no different than a five star hotel charging $700 a night for a room that Motel 6 charges $35 for.  

 

You had the option to go to another facility but chose this one.  If you don't like their fees why keep going back?  

 

This is NOT political.  Hospitals have always charged a huge mark up for medication and services to offset the patients like you who do not pay their bills and want care for free. You cannot go to a private hospital and demand care for free anymore than you can go to Ruth's Chris Steakhouse and demand they feed you because you are hungry.

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You r not aware of Supreme court law that requires HOSPITALS to accept patients IRRESPECTIVE of financial strength!!!!!!!! Private or government, hospitals cant DENY patient care in Emergencies.

What world you come from is always a MYSTERY to me!!!!!!!!ClydesMom, you must have worked in RANK &file and have no idea what ADMIN at hospitals do?

 

Supreme court hasnt yet come down on Ruth's SteakHouse!!!!!!! or for that Matter Motel6 . seeing is believing!!!!!!!

 

we still live in a free country!!!!!! when Supreme court Mandates no one denied- for-EMERGENCY room Visits, it STINKS ...sure does

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You r not aware of Supreme court law that requires HOSPITALS to accept patients IRRESPECTIVE of financial strength!!!!!!!! Private or government, hospitals cant DENY patient care in Emergencies.

 

Yes, I am it is called EMTALA.  The Emergency Medical Treatment and Active Labor Act.  All that law requires is that a hospital treat you until medically stable or until the baby is delivered without regard for the patient's ability to pay.  It does not regulate how much the hospital charges for care or require that they not bill the patient.  Clearly YOU do not understand that law.  Even in an emergency if the facility does not provide the care the patient needs they can transfer them to another facility.  EMTALA has NOTHING to do with the bills after you are discharged.  

 

I have NO idea what you are ranting about but even if you went to a private hospital all they are required to do is treat you until stable and then they can transfer you to a public facility if you cannot pay.  

 

No grocery store or restaurant is required to feed you until no longer hungry if you can't pay.  You don't seem to understand analogies so I won't waste anymore time trying to help you understand the situation.  Clearly you want the care but don't want to pay.

 

we still live in a free country!  when Supreme court Mandates no one denied- for-EMERGENCY room Visits, it STINKS ...sure does

 

EMTALA was enacted to keep private hospitals and outlying facilities from dumping their patients on the large academic and public hospitals because they could not pay for care.  Some facilities were keeping the paying patients and dumping the poor.  It has NOTHING to do with billing for care.  

 

Part of living in a free country means that the hospital can bill you for the emergency care you received and you are expected to pay what you owe.  

 

Oh and lay off the exclamation points.  All of those extra ones are just ridiculous.  They don't make your posts anymore urgent or relevant.

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Energizer, you have been asked to avoid personal attacks.  I am now asking you to check your attitude.

 

We are a self-help type group.  Folks here have been doing this for a long time.  This isn't just about fixing your credit report, at times, it is about fixing you and what got you here to begin with.  You are free to take whatever advice you choose to take, but the rules (of life and credit) don't change just because you don't like them.

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IMHO, much of this thread seems to imply a belief that you should not be held responsible for what was charged for a valid service.  It seems that there is a belief that if you don't agree with the charges, you should be able to say, "Uh, no.  I am not going to pay $xxx.xx, but I will be willing to pay $xx.xx and you won't get a cent more...."  in addition, there seems to be a belief that once you have made such a determination, you should not have any negative marks on a credit bureau.  There also seems to be a belief that the charges are outrageous just to be outrageous. 

 

When it has been pointed out that the beliefs expressed are misguided, you double down in attack dog fashion.  That might work for Morning Joe, but that doesn't work here or in real life.

 

You chose to go to a private hospital.  Once there, you received services.  They have the right to be compensated for those services.  Nothing in the law forces any hospital to treat you for free.  When you refuse to pay and they never get that money from you, it causes the costs to increase for those that do pay.  Enough non-paying customers and a hospital will have to cut staff.

 

This is real life. You pay for what you get.  You had the choice of which hospital to go to.  You chose the private hospital.  If you don't pay, they will put it into collections and it will go on your credit report.  Those are consequences of your decisions - no one else's.

 

We aren't here to tell you what you want to hear.  We are here to guide folks in methods to improve their credit reports AND to change the behaviors that got them here in the first place.  Yes, there are those that lost jobs.  That may not be their fault, but they did get into debt, and that was their choice.  We don't subscribe to shaming people who made less than optimal decisions.  We also do not advocate blaming someone else for consequences that they are suffering.  We will do our best to give accurate information.

 

We don't force you to take our advice.  You are free to reject it.  You are free to stay in the hole you are in.  Your choice.  Come here with a bad attitude and folks will choose not to help you.  Attack those who tried to get through to you and you will get warned.  Continue that behavior and you will get banned.

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