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We are residents of Orlando, FL and need help with medical debt for lab test. In summary

- the test was performed in Nov 2012, and the insurer had pre-approved this out-of-network lab as in-network

- the insurer and lab went back and forth over the bill and are still going back and forth over the bill, now with my employer’s HR involved

- we never received a bill from the lab, despite us updating our address with them and USPS with our new address

- On March 17, 2015, we received notice (dated March 10) from a collection agency for a $19K debt that includes $2600 of interest

- The lab claims they cannot take it back from the collections agency

- Lab has not responded to a request for the debt amount; instead, they sent a patient ledger dated Apr 8, 2015 that shows patient responsibility of zero for every test; note, they do not have a phone


My questions:

- Other than a request for debt verification to the collection agency, what should I do?

- Who do I negotiate with, the lab or the collection agency?

- Does the fact the insurer is still working on it (based on contacting the employer again) have any relevance?

- Is there a risk they could damage my credit score?



 On March 17, we received a letter from a collection agency, claiming medical debt of $ 19k, that is inclusive of an interest amount of $2,600.


The lab is located in Atlanta, GA. We received their services (a series of lab tests) for our son in November 2012. I have a family health insurance plan that is self insured by my employer, which is a large corporation, and administered by a TPA insurance company. Although the lab was originally out-of-network for the insurance company, we managed to obtain pre-approval for these services to be given with in-network benefits. In fact, the lab only agreed to perform those lab tests that were preapproved. We were expecting to pay nothing more than any applicable copay, coinsurance, etc.


The insurance company denied many of the claims from the lab. The lab ended up filing a large number of appeals to the insurance company, but the claims remained largely denied. In January 2015, the lab turned the account over to the collection agency. The collection agency made their first communication to us on March 17.


Pertinently, the lab seems to have turned the account over to the collection agency without sending us any billing statement that indicated that we owed them the sum of money that the collection agency alleged.


After getting the letter from the collection agency, we promptly wrote them back, disputing the debt, mentioning that no statement was sent to us, and asking the collection agency to validate the debt by providing relevant documents. We are still awaiting the validation documents from the collection agency.


Then we contacted the lab by mail and email (they don’t accept phone calls), basically asking that we resolve the issue with them directly and not the collection agency. In reply, the lab alleged that they sent it to our address. We have a hard time believing that because we moved to a new address in June 2013 but updated both the lab with our new address and USPS. Furthermore, despite communicating them with E-mail frequently, they never replied that way (granted, billing is often handled by a third party company) or called us. The lab also mentioned that they cannot retract the account from the collection agency but can request them to not report my credit account as we work on resolving the issue.


Pertinently, the lab did not send us a statement indicating the debt amount even as we emailed them with a request to send it to us. Instead, they sent us an itemized patient ledger dated April 8, 2015 showing every lab test that was done, along with the cost, amount paid by insurance and patient responsibility. Interestingly, the patient ledger shows zero amount in the patient responsibility field for each of the test and does not indicate any overall patient responsibility. In short, the patient ledger does not validate the debt amount being claimed.


At this time, we are unable to decide in which direction to pursue the matter. What options do we have now? The collection agency has not reported to the credit bureau yet. I am willing to make a settlement for a fraction of the original debt, say up to 30% (give or take), with the collection agency. However, should I hold off because the debt may not be theres. Or should I negotiate with the lab? My fear is they already turned if over to the collection agency. And what if the insurance company does pay off the provider?


I would appreciate any help

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