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Hi, I hope this is the correct infocenter for my questions. I'll keep it brief!

My fiance' was working with his company on an out-of-town job back in 2012 when a temp employee mishandled a crane and dropped a 1,000+ lb table on his leg. Rolling mostly out of the way, the table only caught skin and muscle, causing a baseball sized hematoma on the inside of his knee. The project manager offered him a management position if he didn't report the incident/receive treatment under workers' compensation. Long story short, 3 days of not being able to walk and the issue was brought to HR; HR mandated that he go to the doctor. He was sent home on rest and return to light duty for 3 1/2 months while receiving rehabilitation. The temp employee was let go soon after and my fiance' left the company within a year.

It wasn't until a couple years later when we combined finances, etc, that I see the collection on his credit report for a few thousand dollars. He didn't know about it because he never checked his credit, and (I'm guessing) any collection notices may have been sent to one of several mailing addresses that were still mistakenly listed as current on his report. His company appeared to have assumed all responsibility and he was never notified otherwise. We have disputed the claim on his credit reports every year for the past few years, but the "investigation" has traced back to the debt being his responsibility each time. How do they determine this? Are we disputing it incorrectly? How do we get the information for exactly what the debt/collection is for (what charges/services) so we can somehow prove it was the above incident? Who would we take that information to (once we receive it) to get the collection removed? Thank you all for any information and advice you have.

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34 minutes ago, Cheri said:

How do we get the information for exactly what the debt/collection is for (what charges/services) so we can somehow prove it was the above incident?

You need to go directly to who ever is reporting and find out what the collection is for.  If he was subsequently determined not to be eligible for workers compensation benefits then that money has to be paid back.  There is no SOL for the government collecting benefits received that a person was not entitled to legally.  They can seize tax returns and all kinds of levies without having to sue.  

37 minutes ago, Cheri said:

Who would we take that information to (once we receive it) to get the collection removed?

Depends on WHY it is reporting.  There is no magic method to remove a valid collection.  First you need to determine what the alleged debt is they are reporting.

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Yes... I do understand all that, which is why I specifically asked the questions I did - because it is the "why" I'm trying to determine. Of course the first step I took was to call the collection agency and was told they didn't have the specifics on the account I was asking for. Only gave me the name of the hospital where x-rays were taken and said I'd have to call the hospital with an account number we don't have. This is why I was relying on the credit report investigations to provide some information.

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5 hours ago, Cheri said:

Only gave me the name of the hospital where x-rays were taken and said I'd have to call the hospital with an account number we don't have.

You don't need the account number to contact the hospital billing department.  However, YOU cannot contact the hospital about this.  Your boyfriend will have to handle it from here because of HIPAA privacy laws.  The hospital will not and cannot discuss this with you.  

He needs to find out what the hospital charges are for.  If they are related to the WC claim then his next step is to go back to his WC claims adjuster and find out if the claim was paid and if it was denied, why. 

If the claim was denied then he is financially responsible for the care.

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Can you clarify what state this happened in?  WC laws vary between states but many of the underlying provisions are the same.  I do not agree with CM that this is his responsibility.  If these bills are for a verified WC claim and have not been paid, your fiancé will need to address this.  The injured person normally receives the bills when the insurer will not pay, unless the claim or treatment was specifically denied.   And there has to be a pretty good reason to deny a legitimate claim/treatment in most states.  This is a typical action with shady WC insurers. 

Your company asking him to take benefits under the table should have been a huge red flag.   Not illegal to ask but show a lot about the character of the manager/employer and comp carrier.   BTW, WC claims are specifically excluded from the HIPPA regulations.  I have had many providers and others play that game only to find out how wrong they are.   While you will have a hard time getting the information, it is not impossible but easier of the significant other asks. 

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36 minutes ago, outtadebt said:

The injured person normally receives the bills when the insurer will not pay, unless the claim or treatment was specifically denied. 

As I said clearly above:  If the claim was denied the bills ARE the patient's responsibility.  

37 minutes ago, outtadebt said:

BTW, WC claims are specifically excluded from the HIPPA regulations.

When it comes to releasing documentation to pay the claims and handle the case.  NOT to a fiance upset that it is reporting on a credit report.

HIPAA still very much applies.

37 minutes ago, outtadebt said:

While you will have a hard time getting the information, it is not impossible but easier of the significant other asks. 

NO medical records department is going to release those records even in a WC case to a fiance.  They are not legally married nor is she the claims adjuster or employer.  Therefore, she has NO standing to get them.  The hospital will not compromise and commit a blatant HIPAA violation releasing protected information to a third party with no legal standing or rights in the case.  You are 100% wrong on this.  Any facility that did capitulate and release the information should be reported for the HIPAA violation.

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So, took a few days away.  Took only reading 3 sentences to realize how wrong someone can be.

Let me start by saying to CM, you are not always the definitive expert on all things medical related.  Also, there are significant details the OP has not included that define getting the information needed to clear this collection.   And I will start by saying the OP can clear this with a little work and perseverance.

First, let's be clear this is a WC case and that is completely different under the HIPPA regulations than a standard patient privacy situation.  I have over 25 years dealing with the WC system.  I have been successful retrieving medical records in EVERY case where a provider attempted to hide behind HIPPA and not release information.   I have obtained it from people with your attitude all the time.  I have even had spouses and other people obtain the information with the permission of the injured worker.  Here is the regulation as a reminder...

"Disclosures With Individual Authorization. In addition, covered entities may disclose  protected health information to workers’ compensation insurers and others involved in workers’ compensation systems where the individual has provided his or her authorization for the release of the information to the entity. The authorization must contain the elements and otherwise meet the requirements specified at 45 CFR 164.508"  Look up the regulation, the language is pretty clear regarding what is required to get the information. 

So stop telling this OP they can not help their significant other, you are wrong about that.  If the proper request is drafted, the SO can allow anyone access to his records., including you.   The provider has no choice but to accept it.  As soon as this was presented as a WC case, many of the HIPPA protections evaporated with the claim.  It appears this was clearly accepted by the provider as a WC case.

Now related to the treatment, once the treating physician accepts Comp as the payee, they are bound by the state rules for handling the case which includes payments and fee schedules for services.  A treating physician is not allowed to bill or collect from  patient for authorized WC treatment no matter how many documents they patient signs.  Those documents can be used for rear end fodder for all anyone cares.    If the treatment was authorized, the provider can only bill to the fee schedule set by the state or insurer.   Balance billing is an absolute no-no.  The only way I have seen an injured person sent to collections is because:

1.  The insurer was a piece of garbage and did not pay the bill.

2.  The medical provider provided treatment outside the approved scope or within the claim.  In that case, they know better and sometimes still try to bill the injured person.  However, how it works is if they provide unapproved treatment, it is at their risk.   They know what will be approved, not the claimant.

3.  The provider is trying to bill for more than the fee schedule allows and the provider is not happy with the payment.  Believe me they try this all the time.

So, to the OP, you can do this.   If this was me, I would have the SO contact the provider and provide the appropriate releases to allow you or anyone else he designates access to the treatment and billing information.  You can then see what they claim they have not been paid.  Your course of action may be clear from there.  I would also suggest you go back to the WC Insurer from the employer (call the adjuster) and let them know what is happening.  Not paying legitimate bills can have serious consequences, including sanctions against the insurer.   If all else fails, you may need to locate a good WC attorney for assistance, even if the case has been closed.   Unless you accepted a final payment that included settlement of all medical issues (hope not).  Remember, you need an attorney who handles comp cases, not consumer cases for this one if it comes to that. 

BTW, I am not an attorney, claims adjuster or HR professional, but have helped lot's of my employees resolve situations similar to this one. 

If the OP wishes to provide a few more details, possibly better suggestions on where they can get help is available.

 

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1 hour ago, outtadebt said:

So stop telling this OP they can not help their significant other, you are wrong about that.  If the proper request is drafted, the SO can allow anyone access to his records., including you. 

You are a so pathetic.  If the patient signs a HIPAA release the provider can release the records to the authorized party.  It has NOTHING to do with WC once the patient signs a release.  This isn't about a proper release.  You openly stated the OP could handle this on their own because it is WC exempt from HIPAA which is not true.  Getting a release from the fiancee changes EVERYTHING.  That is an entirely different issue.

 

1 hour ago, outtadebt said:

"Disclosures With Individual Authorization. In addition, covered entities may disclose  protected health information to workers’ compensation insurers and others involved in workers’ compensation systems where the individual has provided his or her authorization for the release of the information to the entity. The authorization must contain the elements and otherwise meet the requirements specified at 45 CFR 164.508" 

NOTHING in this regulation you quoted states they can automatically release the information to a fiancee in a WC case.  NOTHING.  The key word is "AUTHORIZATION" The patient signing a HIPAA compliant release under ANY circumstance allows the release of the information.  WC or not.

You didn't say ANYTHING in your first post about the OP getting a release from the fiancee.  You made it appear that all they had to do was call and get the records to handle this matter on the fiancee's behalf because WC is exempt from HIPAA which is patently not true.

You can argue all you want but the fact that you found ways to bully providers and circumvent the law doesn't make you right.  It makes you as bad as the JDBs this site fights. 

 

 

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1 hour ago, outtadebt said:

I have obtained it from people with your attitude all the time.

Not from me.  While you may have lied and manipulated your way to a provider violating the HIPAA Laws.  I DO NOT no matter how much someone of your ilk whines, threatens, or begs.  PERIOD.

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12 hours ago, Clydesmom said:

Not from me.  While you may have lied and manipulated your way to a provider violating the HIPAA Laws.  I DO NOT no matter how much someone of your ilk whines, threatens, or begs.  PERIOD.

Never once had to lie, manipulate harass, threaten someone or break the law to help get issues like this resolved.  So be careful how make your assumptions.  Learn the regulation then you know how to work within it,

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12 hours ago, Clydesmom said:

 

 

You are a so pathetic.  If the patient signs a HIPAA release the provider can release the records to the authorized party.  It has NOTHING to do with WC once the patient signs a release.  This isn't about a proper release.  You openly stated the OP could handle this on their own because it is WC exempt from HIPAA which is not true.  Getting a release from the fiancee changes EVERYTHING.  That is an entirely different issue.

 

NOTHING in this regulation you quoted states they can automatically release the information to a fiancee in a WC case.  NOTHING.  The key word is "AUTHORIZATION" The patient signing a HIPAA compliant release under ANY circumstance allows the release of the information.  WC or not.

You didn't say ANYTHING in your first post about the OP getting a release from the fiancee.  You made it appear that all they had to do was call and get the records to handle this matter on the fiancee's behalf because WC is exempt from HIPAA which is patently not true.

You can argue all you want but the fact that you found ways to bully providers and circumvent the law doesn't make you right.  It makes you as bad as the JDBs this site fights. 

 

 

And again, you like so many others only read the regulations and quote the parts that suit your argument.  That is a leading paragraph to the entire section that explains this all in detail.  If you do not bother to read and understand it, do not tell others what it says.  I am not quoting the entire regulation here for you.  Release of information is a reality with the PROPER authorizations executed.  It is not automatic, but can be done,   Name calling just shows how small an insecure people can be when your opinion is not accepted as a fact, Guess what, is it just that, an opinion not a fact. 

So at this, you have probably done nothing to defuse the issue for the OP or create less confusion.  I am done discussing this with you.  You may know medical billing, but this is above your head.   I hope the OP is open minded and tries to pursue this because they can and probably get this removed, 

Do not ever confuse what I know and suggest with a JDB.  I know more about WC through direct experience that probably anyone on this board.   Believe me I can also tell you that there are many doctors and providers who are leeches in this system and just as bad as anyone for gaming the process for their benefit.   Some deserve what comes to them when they do what may be happening here.

Edited by outtadebt

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Thank you, outtadebt. This has all occurred in Georgia, as you asked above. My fiance' will most likely be handling any releases of documentation, etc, so there isn't an issue there - I am simply on this forum trying to get advice on how to get started and where to begin dealing with the problem. From what I've been able to research online, I can't find a reason why his treatment would have been denied under WC, neither did his company nor the hospital give any indication that it would not be covered at the time of treatment or shortly after. This is what I am most puzzled by - how treatment/rehabilitation coverage could be denied under WC but him not be informed personally, nor his company be informed. If it was somehow decided he was responsible for services rendered, would his company not be notified? Are they not under legal obligation to notify him? Is his personal health insurance with the company null after a WC denial? I doubt it, though I do not know how that process works. What I do know is it's not possible to pay a bill that was never received or that he was never informed he was responsible for. Something seems underhanded to me, especially with the above-mentioned red flag.

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My suggestion to you is to go back and start with the work comp carrier or claims adjuster. 

Provide them with all the information, a copy of the bill in question and collection notice.  If this treatment was authorized, then you need to know why it has not been paid.  If you do not have the bill, you should have a file number from the insurance company and the name of the provider.  That is a start.  Go easy at the beginning and see what they say.  I have seen many times where this is a simple case of the bill was missed and the provider interpreted that as not paid when the insurer owed it. 

If you can not get anywhere with the adjuster, then you or the fiancée can go tot he provider and get their story.   Usually talking to the billing department (no need to push for medical records release yet), will yield information on why they think it is owed and why the insurer did not pay. 

If this treatment was actually authorized, either of these can get the bill resolved and prompt your SO to get the collections cleared.  This is the easy route if everyone plays nice.   If not, you may need to see legal counsel.  That usually straightens everyone out.   To some of your specific questions.

On ‎7‎/‎6‎/‎2017 at 1:43 PM, Cheri said:

Thank you, outtadebt. This has all occurred in Georgia, as you asked above. My fiance' will most likely be handling any releases of documentation, etc, so there isn't an issue there - I am simply on this forum trying to get advice on how to get started and where to begin dealing with the problem. From what I've been able to research online, I can't find a reason why his treatment would have been denied under WC, neither did his company nor the hospital give any indication that it would not be covered at the time of treatment or shortly after.

---- OK, they would normally notify both the injured party and the treating physician of any decisions related to accepting or denying treatment.  The key term here is reasonable and customary treatment for the injury incurred.  If the treatment is R&C, then it should have been approved.

This is what I am most puzzled by - how treatment/rehabilitation coverage could be denied under WC but him not be informed personally, nor his company be informed.

--------  I have seen it denied when the treatment is showing no results and the provider is not working with the insurer.   However, in almost all cases once rehab starts, it does not stop until the claimant reaches MMI (maximum medical improvement).  If you sought treatment under the case after that, there could be an issue of who pays. 

If it was somehow decided he was responsible for services rendered, would his company not be notified?

--------  The company should be very aware of when benefits were being stopped and why.  Both your SC and the physician should have been notified also.   Not paying benefits is the #1 reason injured claimants get lawyers.

Are they not under legal obligation to notify him?   ----  See above

Is his personal health insurance with the company null after a WC denial?  -------  Personal insurance will not pay anything for a work related injury.  Never unless you have a specific policy covering that (like an AFLAC thing).  If the personal insurer finds out the charges are for work related injuries, they will immediately go after the work comp carrier for reimbursement. 

I doubt it, though I do not know how that process works. What I do know is it's not possible to pay a bill that was never received or that he was never informed he was responsible for. Something seems underhanded to me, especially with the above-mentioned red flag.

------ I can not say of the bill was received or not. They have your contact information and will claim they sent the bill.  So you may be out of luck on that one, but do not worry.  Start with tracking down the history of what happened here and you will be in a better position to discuss next steps. 

 

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On 7/6/2017 at 11:43 AM, Cheri said:

From what I've been able to research online, I can't find a reason why his treatment would have been denied under WC, neither did his company nor the hospital give any indication that it would not be covered at the time of treatment or shortly after.

A workman's compensation claim is not a finite process until the case is closed.  While a worker can be sent for treatment and tests while the claim is open if the claim is ultimately denied then those costs may not be covered.  

On 7/6/2017 at 11:43 AM, Cheri said:

This is what I am most puzzled by - how treatment/rehabilitation coverage could be denied under WC but him not be informed personally, nor his company be informed. If it was somehow decided he was responsible for services rendered, would his company not be notified?

They don't have to prove that he received the notification only that they sent it.  A copy of a letter would be sufficient to prove that.

On 7/6/2017 at 11:43 AM, Cheri said:

Is his personal health insurance with the company null after a WC denial?

There is a limited time to file a claim for care under a personal health insurance policy.  Typically 6-12 months.  If it has already been longer than that his carrier will deny the claim for not filing timely.

Again, he needs to start with the WC claims adjuster and find out what the disposition was on the case.  Getting copies of records he may not need is a gigantic waste of time.  It is possible the bills were simply missed by WC.  They can make arrangements for copies if they need them without having to get a release.  If you try and get copies on your own the hospital can charge you up to $1.25 per page which has to be paid up front.  DO NOT pay for records you may never need to solve this.

 

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6 hours ago, texasrocker said:

Look who's talking.  King of throwing insults around here.

Nope. You've confused me with someone else.

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@outtadebt It's been a long time, but I've come back to express gratitude. The questions you answered provided me with a place to start to sort out the whole mess. After much hunting and searching and phone calls and emails, he got the situation figured out. Your advice was invaluable in knowing where to go and who to talk to. Thanks for listening to what was actually being asked and being willing to help. Much thanks! :)

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56 minutes ago, Cheri said:

@outtadebt It's been a long time, but I've come back to express gratitude. The questions you answered provided me with a place to start to sort out the whole mess. After much hunting and searching and phone calls and emails, he got the situation figured out. Your advice was invaluable in knowing where to go and who to talk to. Thanks for listening to what was actually being asked and being willing to help. Much thanks! :)

@Cheri  Your thanks is appreciated.

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13 hours ago, Cheri said:

@outtadebt It's been a long time, but I've come back to express gratitude. The questions you answered provided me with a place to start to sort out the whole mess. After much hunting and searching and phone calls and emails, he got the situation figured out. Your advice was invaluable in knowing where to go and who to talk to. Thanks for listening to what was actually being asked and being willing to help. Much thanks! :)

Just curious if the collection was indeed placed in error because the WC did not pay the full bill like they should have?  If so, were there any consequences due to the collections like denied credit or anything?

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Great to hear that you were able to work it out.  Sometimes just a little patience, courtesy and perseverance will solve the problem.  You put the work and got the results.  Good for you.  Congrats.

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