Health Insurance Billing - Could this be a scam?

[jen3kids]

I have a 2 part question here.....

My oldest went to the ER in early June and gave the hospital the wrong insurance card.  When we got billed by the hospital for the cost of his visit in December (!), I called their billing department and gave them the proper insurance information and they submitted it to the correct insurance company.  We just received notice from the insurance company that they are refusing to pay because it is outside their 180 day claim submission period (something they told me is negotiated by dh's company?)  We can appeal that and will be sending a letter off to them this week.  

 

The scam part I wonder about is that ds received a collection's notice today for an amount that doesn't match the total bill, but could be for one part of the care he received (he saw multiple drs), but the invoice number on the bill from the hospital does not match the invoice number from the hospital.  It is close, but one digit is different.  I called the hospital to question why it went to collections when it was under review (being sent to proper insurance company).  The guy I talked to said that their records do not show that it went to collections and usually once an unpaid bill is sent to collections, the account is flagged - nothing shows on the hospital's records that it was sent to collections.   Ds called collections and they were zero help, other than to put a dispute flag on his account.

 

Ds is worried that his credit score will be affected and he has worked hard to get good credit.    

 

Any advice for how to deal with either issue?

Thanks!

 

[TrixieB]

Regarding the hospital claim - if this happened:

* the hospital billed Wrong Insurance Company within that insurance company's timely filing window

* the claim was denied for no coverage

* you then provided the correct insurance information

the hospital should be able to bill your 2019 insurance, even though it is outside the 180 day window - they must provide proof of timely filing with Wrong Insurance Company together with the claim, and they may need to write an appeal - and your insurance company would then process the claim.

Regarding the collections account:

Did your ds ask the collection agency what doctor or facility the account is for?  Also, the collection agency should be able to provide the original account number.  The dollar amount on the collections account may not match an EOB from earlier in 2019; late fees may be added to an unpaid medical account for some period of time before the account is sent to a collections agency.

[beaners]

Our hospital bills are separate from our doctor bills. So a clinic visit results in a bill from the hospital clinic, a bill from the university hospital where the doctor is employed, a bill from the lab company that did testing, a bill from the radiology department, and so on. But the billing office of the hospital where the care took place doesn't have the records for any other billing. I think you are correct that it might be something like that.

Could the collections office tell you who the original bill was from? If it is a real bill then your best bet is to call the original office and pay them.  Then they pull the account out of collections and it doesn't ding your credit. We get a lot of medical bills and we miss ones here and there. We have had to do this too many times, and it never stays on our credit if we do it this way.

 

[jen3kids]

12 hours ago, TrixieB said:

Regarding the hospital claim - if this happened:

* the hospital billed Wrong Insurance Company within that insurance company's timely filing window

* the claim was denied for no coverage

* you then provided the correct insurance information

the hospital should be able to bill your 2019 insurance, even though it is outside the 180 day window - they must provide proof of timely filing with Wrong Insurance Company together with the claim, and they may need to write an appeal - and your insurance company would then process the claim.

Regarding the collections account:

Did your ds ask the collection agency what doctor or facility the account is for?  Also, the collection agency should be able to provide the original account number.  The dollar amount on the collections account may not match an EOB from earlier in 2019; late fees may be added to an unpaid medical account for some period of time before the account is sent to a collections agency.

 

Yes, that is exactly what happened.  I will call the hospital back and ask if they will provide proof of timely filing with incorrect insurance company.  They are very nice to talk to and have been very helpful.  When I spoke with them just now, they still don't see any billing by them or the providers with the account number being referenced by the collection's agency.   

The facility listed on the collection's agency's notice is the hospital, but it definitely did not come from the hospital.   It may have come from one of the physicians, but that is not who is named on the notice.   I have sent a letter to the collection's agency asking them to provide us with a Debt Validation Letter that states who they bought the bill from.  

 

50 minutes ago, beaners said:

Our hospital bills are separate from our doctor bills. So a clinic visit results in a bill from the hospital clinic, a bill from the university hospital where the doctor is employed, a bill from the lab company that did testing, a bill from the radiology department, and so on. But the billing office of the hospital where the care took place doesn't have the records for any other billing. I think you are correct that it might be something like that.

Could the collections office tell you who the original bill was from? If it is a real bill then your best bet is to call the original office and pay them.  Then they pull the account out of collections and it doesn't ding your credit. We get a lot of medical bills and we miss ones here and there. We have had to do this too many times, and it never stays on our credit if we do it this way.

 

 

Yes, we get bills from the hospital and the drs as well, and it can be hell to keep track of them all.  For this issue, DS was in one hospital overnight, sent to outpatient's at a different hospital who couldn't do the tests in a timely manner, so he was re-admitted to the original hospital in order to force the insurance company to authorize the tests immediately.  He saw 3-4 different drs., plus had a few different scans done.  

[happi duck]

When my sister died I handled her bills.  We received a bunch of very official looking collection letters for several of her utilities (and I think a couple medical things).  I ignored them and went straight to each utility etc. and not a single one had been sent to collection.  Each one got paid directly and some even just zeroed out her account since she had died.  Definitely nothing had gone to collections.

I have no proof but assume it's a scam.  I'm assuming some sort of information is available and being exploited.