[mealymama]

Case closed.
I don't know if this is the proper place to vent this frustration, or if there even is a proper place.
I've just been given the run-around by my medicare provider, by the credit bureuas, by every system set up and run by fallable human beings who have supremecy over my life, and I'm at the END.
Oh, I'm going to cry.

Here's the latest kick in the head:
I visited the emergency room this past January and provided them with my insurance information. The hospital billed my insurance, but a separate company that is set up to do the billing for the physicians did not submit the bill. So in May I got a collections letter. The collection company told me to deal with my insurance company who told me to deal with the physicians company who told me to deal with the collections company, and round and round we go. In the end, everyone says their hands are tied. There is no medical record to be resubmitted at this point, and my ONLY option, because some dumb billing clerk didn't do his/her job, is to pay the collection company. That's it. Otherwise my credit, which I have managed to keep clean to the full extent of my power, gets a nice blemish on it.

Last year I was in a similar situation w/ Hollywood video who claimed I never returned a video... they waited a year to suspend my membership, never sent me a bill, and have no interest in hearing me out when I say that this movie was returned. What can you do? It's on your credit report to stay.

People who have money can hire lawyers to harass creditors and force them to remove items from their reports, but even so they have to pay off the debts in addition to the lawyers fees.

I am 7 months pregnant. I was in the hospital because I was so sick from the flu that I needed 3 IV bags to rehydrate me. My fever was so high it jepordized my pregnancy. I'm on medicare and food stamps, I'm a single work-at-home moom, and I'm expecting baby #2... some clerk never submitted to my insurance. My insurance company says they can't force the doctors to submit the bill. The doctors say there is no longer a bill to submit once it's in collections. The collection company tells me there's nothing I can do but pay them off. Nothing.

I can't even keep my home heated in the winter without government subsidies, and I'm being told that the only way to keep my nose clean so that someday I may actually be able to own my own home is to pay hundreds and hundreds of dollars because somebody screwed up and didn't do their job.
The only way I'm going to be able to get around this is to not pay my rent this month, and then apply for emergency assistance for single mothers who are being evicted, so that the good state of PA pays my rent for a month.

This whole system really makes me sick. If only I could get a job that would cover more than the cost of childcare and the food stamps I would lose.

I live in Pennsylvania. If anybody knows of any legal recourse to all of this that's available to low-income families, please let me know. I don't know if this is vaild for small claims court, or what. I just don't know.

If not, let me just say: aint life just a nice little hole that there's no climbing out of?

 

[sohj]

That is horrible.

*Bump* for anyone who have a legal contact in PA!

 

[TiredX2]

I am so sorry

Since it is in collections, I think it is on your credit report anyway. Can you try to set up a lump sum settlement amount?

Good luck!

 

[mealymama]

Thanks for the thoughts.

I have a brief period to pay before it goes on my credit, but that is the only option they're giving me. I'm just feeling like the cards are stacked against me, today. Other days I am very grateful for all the programs out there to help single moms and children, even with all the people who want to limit them. I just wish I knew a way to climb out from it all.

 

[Colorful~Mama]

my understanding with collections is that even if you pay a small amount like $5/mo in good faith they won't put it on your credit report

then you can file a claim in the meanwhile against the doc office for not billing your insurance and putting you in this position in the first place.

??

 

[wemberly]

Call the social work department of the hospital immediately . Explain the situation, point out how unlikely it is that you would neglect to give the ER your insurance card, and then ask them to fix this for you. Spill it mama, tell them how paying this bill would strap you, and ask for help.

Be polite but firm in expecting the hospital to take care of this mess.

Best wishes mama

 

[CharlieBrown]

i don't have any words of wisdom just feel for you.

 

[mealymama]

The hospital won't deal with it because they bill their portion separately, then the physicians bill for their time through a private agency. Thankfully, the hospital did submit their bill (if they hadn't, I would be talking about thousands of dollars instead of hundreds). It's the physicians billing people who messed up.
Thank you for the advice about small claims court, that's what I was leaning towards doing. And I'm going to have to make payments in the meantime. That's going to mean asking my parents for help and that's a whole other thread

I just got their mailing address, and it's in DE, so hopefully if I file in court here in PA they won't bother showing up and I'll win by default.
They never sent me a bill or anything; if they had, I could have submitted it to my insurance myself. The first notice I got was from collections, at which point it was too late to submit.
The best thing I have going for me is that the hospital did submit, so obviously I presented my insurance info. Creeps! Jerks! Rrgh!

 

[Lucky Charm]

Colorful mama, as someone who once did the $5 a month deal, it in fact does show up on your credit, even if you are activley paying. The only time they dont report it if the bill is less than $100.

I was in a situation where i was insured as well, there was a slip up similar to the OP's only i got a call almost 5 yrs later! i had my card and explanation of benefits, but they wouldnt budge. Of course i couldnt get anywhere with the hospital as they had turned it over to the collection, i called the insurance company i was with at that time, and they refused to pay even though i was fully insured because the bill was presented in a "timely manner" (which i believe is 18 mnths). anyway, i went round and round and i finally refused to pay. but here is my clincher, i called an attorney who told me the collection agency had waited too long and that by law they couldnt report me. for the hell of it, i had a friend pull my credit report and sure enough it wasnt there. Anyway, i am with the OP as far as paperwork and filing goes, and it seems like the rest of us are stuck. At the time, we were paying almost $700 a month for health benefits, no way was i going to pay for something i was covered for.

Mealymama, can you call an attorney, one of those with a free consultation? maybe he or she can help.

 

[chicagomom]

Mealymama, don't pay anything!

Post edited: Please see my post below. My husband works for a health insurance company at the financial level, and has suggestions that may help resolve this.

 

[JoshuasMommy]

DON'T PAY IT! Even if you do pay the bill it will not be removed from your credit. It's already been tarnished. They will still report it late and there is really no difference. As a matter of fact it looks worse when you pay late! Stay cool. Continue the process of insisting that the Dr.'s billing department resubmit for proper payment fron the insurance company. Stick with it. Write letters and call. Be NICE! Even when you want to spit...It takes about 60 days for the bureau to actually report the collection. You should have this handled by then. SOMEONE is going to get sick of hearing from you and help. In a couple months request a copy of your credit report you get 1 free report a year. If it is on there (and it will be)then write a letter to ALL 3 credit agencies Equifax, Experian and TRW disputing it. They will have 30 days to respond. They will investigate and send you a new report with the change. Side note medical bills do not effect you adversely. No creditor will hold medical against you when applying for a loan. They will require an explanation. Stay calm, be kind but persistant. People make errors all the time. They count on you to get scared and pay so they don't have to back track. It's all good mama...

 

[chicagomom]

OK here's what dh (who works for a healthcare insurance co) said:

I will assume that she has commercial insurance and is not on Medicaid. If she is on Medicaid, she has remedies, but they are a bit different from what I will propose here.

Here is what probably happened. The insurance company has a contract with the physicians, and it probably requires the physicians to file a claim within 90 days or eat the cost. The billing group didn't file in time, and rather than eating the cost, as per the contract, they are trying to screw the member. She needs to fight. She's getting screwed.

She should NOT EVEN THINK ABOUT PAYING the "collection agency". She needs to pressure both the insurance company and the physician group to work together to solve her problem by doing the following:

1. Before she does anything else, she should file a formal complaint with the PA Department of Insurance against the insurance company. Here is the link:

http://www.ins.state.pa.us/ins/cwp/v...26991&insNav=|

Insurance companies take this VERY seriously and they have a legal requirement to respond very quickly and thoroughly.

Did the insurance company claim that the physicians didn't file the claim? Too bad. If they paid the hospital claim, she can put the onus on the insurance company to prove that they didn't lose the physician claim.

2. Tell the physician group to call off the collection agency and to file the f*ing claim with the insurance company immediately. File a complaint against the physician group with the PA Better Business Bureau. Don't threaten to do this, do it for real. Here is the link:

http://www.nepa.bbb.org/

This is her first shot. The physician contract with the insurance company VERY LIKELY FORBIDS the physician group from billing a member (her) for a covered service. They can only bill the member if the service was not covered and was *formally denied* by the insurance company. After she files the complaint against the insurance company with the State Insurance regulators, the insurance company will most likely go after the physicians to get the claims.

3. If the physician group tells her a lie that they don't have her medical records or something like that, she should file a formal complaint with the PA State Board of Medicine. This will be her second shot and she should freely threaten them with this. Strictly speaking, the State Board exists for the investigation of fraud. Here is the link:

http://www.dos.state.pa.us/bpoa/cwp/...=1104&q=432785

What they are doing to her is not fraud, exactly, but here is the language concerning fraud from the site:

*The Department will not involve itself in a monetary dispute unless it involves an allegation that services were billed for, but were not rendered -- or if there is evidence of other billing or insurance fraud.

The point she should make is if they can't provide a record of the claim, they can't prove they provided the service.

4. She should avoid dealing with the third party billing service altogether. Don't agree to anything with them! She should deal with the physician group. If the physician group says that it won't talk to her (and that she has to deal with the billing group), she should call the physician group and tell the receptionist that she needs to confirm the group's correct address and the spelling of the names of the principals in order for her to file her complaints with the various agencies. This should get her an audience. If it does not, then she will at least know the names of who she should be harrassing.

5. Will this affect her credit rating? The physician group can call off the collection agency immediately with a single phone call. She should suggest that they do this to both the physician group and the insurance company. Since one has to pay to get a credit agency to mess up a credit rating, it is unlikely that they have done this yet. She is probably at the stage called "soft collections", harrassment by mail. But when this is resolved, she should check her credit rating. If there is something on it, she can get it removed by contesting it with the credit rating service. This is easy to do (they usually include a form with the credit report).

Good luck!

 

[TiredX2]

You guys are soooo great!

Its nice to know where to come if I ever have a problem!

 

[wemberly]

I

the members (and their spouses) here!

 

[Meiri]

We had something vaguely similar happen to us with a bill from a hospital group being sent to collections. What happened in our case was the physical therapy place had a capitation agreement in place with our insurance at that time, so our bill was covered under that. Years later the hospital it had the contract with tried to bill us, despite the written contract that they were absolutely not allowed to bill us directly and the fact that the payment had been covered by the capitation contract (they get paid a certain amount and provide services to as many as sent that are covered by that insurance. It's a gamble: if fewer come than services cost, they make out. If more need services than the amount agreed to, the provider loses.)

After many well documented phone calls accomplished nothing, I wrote a letter detailing every phone interaction, the facts of the capitation agreement, the facts of the insurance agreement, and what we expected and would do if they didn't fix this yesterday and apologize, and then I sent it to all three parties in the problem return reciept requested. I got coaching from the law practice that had done our wills and put a cc with their names on the letter too, with the understanding that we'd be calling back if that didn't work.

It worked.

 

[mealymama]

chicagomom, you are a rebel. Thank you so much for all the time you put into your response... but, er...

Quote:

Originally Posted by mealymama I don't know if this is the proper place to vent this frustration, or if there even is a proper place. I've just been given the run-around by my medicare provider...

et cetera, et cetera...

How different are the remedies when dealling with medicaid, I wonder?
Thanks, everybody, for the advice.

Quote:

Originally Posted by TiredX2 You guys are soooo great! Its nice to know where to come if I ever have a problem!

What she said!

 

[chicagomom]

Here's an update re Medicare:

If she has Medicare through a commercial insurance company, she should follow all the steps anyway. If she is dealing with Medicare directly, she should only follow steps two and above to put pressure on the physicians group.

Medicare is, of course, run by the federal government and it has its own grievance procedure:

http://www.medicare.gov/

She should file a claim directly and can get the forms from here. She should also tell the physician's group that she is a Medicare patient and that she has filed a complaint against them with the Feds. If anything, the Medicare administration is even more brutal than the state administration. It should work.

If she has the time and really wants to pull out some artillery, she should also consider contacting her state or federal representative. Preferably the latter. If that person is up for election, she will probably get extra special service. The congressman or senator will have a staff whose job it is to call people like the physician's group and make them do the right thing.

 

[pilesoflaundry]

Same thing happened to me once, I got a bill for lab work that was covered and done while I was on medicaid, but I didn't get the bill until 2 years later and I wasn't even living in that state anymore! I fought it and told the lab they had to bill it the proper way and to stop dorking around because I know it was covered. I never heard another thing since.

I hope you get this straightened out soon.

 

[lilmiss'mama]

s The system does suck! I am dealing with FS, CA, Child care and Jobs right now. I need to find work (also a single mama with 2 kids), but they won't help me with child care until I am working. Okay, how am i supposed to look for jobs and start working with no one to take care of the girls! aghhhhh!

 

[polka123]

I moved to PA (orig from) after living 32 yrs in AZ.
What a backwards place this is !!!!!
My DH is a State Trooper & I cannot believe the lack of laws he has to deal with.
This being a Commonwealth really makes things different tho' VA (a commomwealth) got it's act together
The lack of social services in this state is apalling.

:

:
There are very few family advocates here.
I have no answers but wish you luck & hugs