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Collections Threatening Lawsuit


farang
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The first question is, did you get the medical service, when did you obtain the medical service, and did you have insurance (and if you did, what happened there).

You should be somewhat worried but before you worry too much, we need to know some specifics.

Do not contact them by phone at this point. If you are unsure of the debt, then send them a DV letter within 30 days of when you received this letter demanding that they validate the debt. They are required to validate before filing the lawsuit and you can look into it in the mean time. Simply do a one sentence letter (not the huge 3 page ones you see on the internet) and send it to the collection company certified mail return receipt requested green card style. This will buy you some time.

If it turns out that you did receive the services and do owe this bill (and it is within the SOL which for Ohio, is very long), then you can either pay the amount or you settle. You might be able to pay directly to the medical provider but you might not depending on the contract they have with the collection company. If you do have to deal with the collection company, then demand in writing what the amount will be to settle the debt is and send the payment via money order or cashier's check. Do not give them access to you bank account. If they demand that, you do not have a deal and you wait for them to sue you and then deal with the attorney who will accept that type of payment.

As for insurance, sometimes insurance refuses to do payments and if more time as passed than what is allowed to appeal the claim denial, then you are out of luck. Trust me, I have been dealing with this for over a year now and I am sure my insurance company hates me because I am all over them like white on rice.

Sorry you are going through this.

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I did receive the service and I had insurance at the time. Insurance paid for the office visit but they said my coverage didn't include the procedure.

If I reach a settlement with the provider would the collection agency still be able to sue me?

Thank you for your help.

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52 minutes ago, farang said:

If I reach a settlement with the provider would the collection agency still be able to sue me?

No.  If you settle the debt there is no basis to sue.

One thing you should know that because you did use your insurance the provider cannot settle the balance for less as it would be a breach of their contract with the carrier and illegal rebating.  The contracted amount that the policy did not cover is what you owe.  

Have you filed an appeal for the denial of the procedure?   Sometimes this will get it paid.  Find out why your policy didn't cover the procedure.

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The problem is I would bet the time to file an appeal with insurance might have passed. I know I only get 6 months to file an appeal (having done 2 of them in the past year and was ready to do a 3rd when the insurance company coughed up).

If the procedure was not covered by insurance at all, the OP might be able to settle under the grounds that the insurance contract cannot apply to uncovered items.

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4 minutes ago, WhoCares1000 said:

If the procedure was not covered by insurance at all, the OP might be able to settle under the grounds that the insurance contract cannot apply to uncovered items.

Depends heavily on WHY the procedure was not covered.  Applied to outpatient surgery/testing deductible:  governed by contract.  Excluded from the policy:  maybe.  

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9 hours ago, farang said:

Can you tell me how to file an appeal ?

Use this form:

https://member.medmutual.com/~/media/Files/My Health Plan PDFs/L6854 Member Appeal Form 091112 FINAL.ashx

I do note that it says your first level appeal must be filed within 6 months of the denial.  When did you get that?

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  • 1 month later...

If this were me, I would send a letter stating that I received their validation, and while I still dispute this debt, in the interest of putting this issue to rest, I am willing to make a lump sum payment of $X to settle this matter in full.

To calculate the amount to ask for in a settlement, I would take the amount I can reasonable pay them in one lump payment and then back off of that number just slightly.  For instance, if I have $500 available, I would tell them I will settle for $400.  Depending on how old this debt is and what kind of collector has this will all factor in on how low of a settlement they may accept.  It may require a few back and forth negotiations to get a settlement agreement that you both can agree on.  Just make sure that if you accept a settlement agreement with them, that the terms of the agreement (i.e. what you pay and that it will be accepted as settlement IN FULL of the account) are given to you in writing.  It is important to save that agreement in writing in a safe place, just on the off chance that they try to collect the balance or attempt to sue again later down the road.

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