<p>I just received a threatening letter from a collection agency, for several hundred dollars stemming from an ER visit for S2 last winter. This is coming from the ER physicians’ organization bill, not the hospital itself. It states that it is the second notice, but I have not received any notices before either from the billing service or from the collection agency.</p>
<p>This is an in-network provider for Empire BC/BS. I have the explanation of benefits, noting a balance of exactly the amount I am now being billed for, shown as a “discount” with the patient responsibility shown as zero. I have called BC/BS just now and confirmed that I am not supposed to be billed for this balance. They are going to call the physicians’ organization, and I tried calling them just now and left a message.</p>
<p>My husband and I have never gotten a bill from a collection agency before, and we have an unblemished credit record, and I’d like to keep it that way. What should I do to make sure this is the case? What should I demand from the billing service, the collection agency, the hospital? I am also worried that we will need to use the ER again, and we will be on some sort of deadbeat list.</p>
<p>I am also wondering whether I should make a formal complaint to the state insurance commission. I’m sure that plenty of people, seeing a bill like this, would just pay it.</p>
<p>I do realize that, in many cases, the reimbursements are ridiculously low, and I am completely in sympathy with the hospitals and doctors. (In this case, I actually think the amount that was paid is generous given the amount of time this doctor spent on my son.) But this does not give the physicians’ organization the right to illegal collection practices.</p>
<p>Before assuming that the physicians office is doing something illegal, it is a good idea to call the Drs office’s billing dept and inquire as to why this was sent to a collections agency. It is quite possible that a clerk made an error and read the wrong part of the EOB. Typically ER docs are employed by the hospitals, so you want to double check as to whether the bill is a hospital generated bill or is truly from a separate drs group. Also, sometimes the “group” is in network but the particular doctor who happened to be on call isn’t. In those cases you can typically get the insu co to cover at the “in-network” rate. In your case, you say the bill was paid at 100% of the allowable with no copay and no deductible, so there is obvioulsy an error somewhere. If the billing office says “its been turned over to collections there is nothig we can do” ask to speak to a supervisor because it shouldnt have gone to a collection agency inthe first place. Also, there are companies that buy up old debt at pennies on the dollar and then contact you with threatening sounding calls and letters when you do NOT owe anything. You should insist on getting a copy inwriting of what they think you should be paying, and you can end them a copy of what you have that shows you do not owe this. If they continue to hassle you you tell them that you will file a complaint acc. to the fair debt collections act and you will sue them for any damages they cause to your credit (which you can do). That should stop it. I think the “illegal practice” is being done by the debt colection group, not the drs group. So please, lighten up on the docs If the doc group or the hospital sold off what they thought was uncollecteable debt, and yours was in there in error, that should be fixable.</p>
<p>What I have done, once I have clearly ascertained that there is no debt, is bill them right back at a rate of $75 “per encounter”. An encounter is every time you get mail from them, every phone call, and every response you give. I put it on official letterhead (my own), with a note on the bottom that notes that with every contact with me, they have agreed to the charges, and another note that interest will accrue at the rate of 18% per annum.</p>
<p>You wouldn’t believe how quickly I got their attention!</p>
<p>jym, the billing office is doing something illegal. Perhaps it was a mistake, but I would think that before turning an account over to a collection agency, someone would check to make sure the bill is valid. In my experience, most doctors on hospital staffs belong to physicians’ organizations, and are not hospital employees. The doctors’ billing office is responsible for the illegal practice, since they turned an invalid charge over to a collection agency. I certainly hope the error is easily fixable - I imagine that it will be taken care of quickly, since BC is also calling them - but if they give me any (more) trouble, I will file a complaint.</p>
<p>I agree with jym626 – call the physicians office and get their “take” on the situation. There are way too many possible scenarios about how this unfortunate “referral” might have occurred.</p>
<p>Send a copy of the EOB to the doctor’s office, along with a letter stating that if, after ten business days, you do not have a written response that this error has been corrected, you will consult an attorney. BTDT, many times. </p>
<p>I have never had a medical bill that has gone to collections wind up on my credit report, even if it has taken quite a while to resolve (i.e., in situations where something has been coded/charged improperly, etc.).</p>
<p>By all means call, NYMomof2. We had much the same thing happen when D had her broken nose reset at college. </p>
<p>It was a mistake, and the hospital helped us sort things out very quickly once it came to light. (As well they should have, since the mistake started with them, but since things don’t always happen as they should, I appreciated it.)</p>
<p>NYmom-
While technically ,yes, it is out of compliance with the Drs BCBS contract (and trust me, they won’t like getting a call from BCBS inquiring about the balance billing) my point is, its a good idea to check first as to how this oversight occurred and if it can be easily fixed. People, like $7/hr billing clerks, can make mistakes. They process claims quickly and errors can occur. If your bill got put in a wrong list and that list (with thousands of other outstanding bills) got sold en masse to a collections company or recovery group, it probably isnt worth their time and expense to manually go through each and every bill to verify its accuracy. They probaly know that if there are errors, as in your case, you will call them to rectify it. All I am saying is its worth checking into, which I know you will do. If they are aholes about it (as collections agencies can be) thats the time to pull out the big guns.</p>
<p>We rec’d a collection letter about 6 months ago from a doctor that practices out of our state and claimed that he saw my husband in the hospital , close to two years ago.
Not only did my husband never see or hear of this doctor, but when I called them asking for documentation of any kind, no one could provide any answers. I did do an online search and found some other apparent issues and complaints about this physician…
I haven’t had the time to follow thru , due to my work load this time of year , but I do check with credit reporting agencies ( had a small concern with the possibilty of someone sealing my identity ) Nohing has appeared.</p>
<p>I have had a few oddball calls from parties claiming they were Verizon and I owed them money too…checked with Verizon and no issues whatsoever. It happened to co-incide with the economic stimulus checks , and they suggested I use mine to " clear my outstanding debt "
Some crazy stuff going on out there.</p>
<p>lje62-
There are people now stealing not just identities but people’s insurance information. Its possible that someone went to the dr under your h’s name and used your h’s insurance info. Its getting to be a crazy world out there. Check your credit report-- hope your H wasnt a victim of identity theft.</p>
<p>When we see a new patient, we make a copy of their drivers license so that (1) we can verify that they are who they say they are and (2) I can remember them when I see their photo in the chart!</p>
<p>jym626,
I was concerned a few months back about my own identity being stolen as I was being bombarded with phone calls from car dealers and auto insurance companies in my area…it seemed that someone chose me , perhaps out of the phonebook and entered me into an on-line data base for people searching to purchase a car.
I put an alert out with the credit reporting agencies and removed my name with the company…so far so good.
I seems like more and more scammers are out there , rying to prey on the vulnerable…I took the necessary steps to protect myself, but it seems like often times the elderly are victims, and out of fear of smearing their credit, are all too willing to give up info that they should not.
Really, an enire thread could be started on this topic</p>
<p>lje-
Funny you should say this-- someone started today about a phishing email they got supposedly from paypal. Hopefully that poster has forwarded the fake email to <a href="mailto:spoof@paypal.com">spoof@paypal.com</a>. Lots of bad people out there, sad to say… as these are desparate $$ times for many folks.</p>
<p>I think you would all be surprised by the level of balance billing that goes on across the country. Unfortunately balance billing has become a common practice by many physicians, especially those in large groups. as well as hospitals. It has become a particularly common practice with older adults to whom all the new insurance rules and regs can be quite foreign. They were raised to “pay their bills” and if they get a bill from the doctor, hospital etc. they pay it. This is just a new version of the Medicare and Medicaid fraud that took place and was the root cause of the tougher approvals and required paperwork/verification now imposed by insurance companies for reimbursement.</p>
<p>The person /group issuing the bills has nothing to lose, they can easily say “oops it was mistake” if they are caught, but in many many cases, they receive payment from those who either won’t question the bill or don’t know their way around EOBs which can be confusing. </p>
<p>Please don’t take this as an indictment against all or even the majority of physicians, because it is not, but you would be surprised at the level of activity that does exist.</p>
<p>Yes, I actually would be surprised if there was a high level of purposeful balance billing going on with many Drs., <em>especially</em> with Medicare of Medicaid. Medicare investigations, from what I hear, are an absolute nightmare, accusations are outrageous (and often unfounded), and professional practices go bankrupt just trying to defend themselves against false claims of fraud. I have heard of perfectly honest Drs having been subject to audits with ridiculous comments by Medicare such as "oh- your progress note on DOS 5/18 doesnt have the length of time you spent with the patient on the note {note: there is no requirement to document the length of time in the pts chart}. Therefore, this claim for $57.31 shouldn’t have been paid. And we’ll assume this is true for all your medicare patients so we are going to demand $50K back from you. And we are going to fine you $$XXX and charge you interest. " I cannot imagine the nightmare of going through a harassing Medicare audit. Medicare pays so poorly, I cant imagine a small practitioner purposefully doing that to theselves. And many of the accusations of “Medicare fraud” are false accusations. Now mind you, there are big hospitals that overcharge and upcharge and double bill and what have you, and they’ve been appropriately fined. But smaller practices would be stupid to take that kind of risk. JMO</p>
<p>
On the contrary, the practice and the doctors have everything to lose. Bad press, fines and even legal charges of fraud, and the potential cancellation of the contract with the insurance company. This can be a lot to lose. Not worth the risk.</p>
<p>You missed my point; this has replaced the Medicare/Medicaid fraud as the new way to increase revenue because it IS harder to prove and less prone to those audits. I agree the victims are the “perfectly honest” MDs who have well run, honest practices but they have always been the victims of the small minority who still represent a big number when viewed across the nation.</p>
<p>My wife works for a health insurance company and has seen it first hand both professionally and personally.</p>
<p>The majority of older adults who get these balance bills simply pay them; they aren’t running to the newspapers or TV stations generating bad press for the perpetrators. My mother-in-law never questioned the bills she got until she read an article that made her start to pay attention to them and admitted that she had in the past paid some bills that she thought had been covered but she didn’t want to do anything to ruin her credit.</p>
<p>We had it happen to us. One hospital in particular tried it three times; my wife produced EOBs, and other documentation the first two times and still had to fight the charges and even collection letters that came AFTER she had proven that they were balance billing. The third time she directed her call to the head of the hospital, informed him that she was aware of their “practice” of balance billing and that she was about to contact the insurance company AND the State Board of Insurance…only then did the first two situations get resolved and the third magically went away.</p>
<p>I have a son in medical school so I am certainly not anti doctors or healthcare…I have great empathy for their rising costs and reduced income. Had it not been for the enormous amount of fraud that took place, things would probably not have gone to the extremes that are now the norm.</p>
<p>That said, I won’t go into the practice of the doctors that require office visits to get prescription refills so that they can collect the income for an office visit, billed at the highest level, not a “short visit” coding but rather “long visit”…it happens all the time. I changed to a new primary care doc after he adopted that practice and later found in talking to colleagues that it was happening to them as well.</p>
If the doc group or the hospital sold off what they thought was uncollecteable debt, and yours was in there in error, that should be fixable.</p>