What kind of attorney for this situation

[scholastica]

I have been struggling for six months to get Quest to properly file a claim with my insurance company. I have called and given the insurance information to their agents multiple times. The insurance company has never received a claim from them. My insurance company has even called them and given them the correct information. They are using a third party biller for this now. It is Zotec Partners. They claim to have filed claims and received no response. We have received a final notice that the account will be sent to collections. We called the insurance company and the billing department at the same time yesterday. We gave the fax number for the claim to be sent. No claim has been sent. The insurance company is contacting them again. What kind of attorney handles this type of situation?

[kbutton]

I would let the insurance company handle it for now--the kids had a pediatrician whose husband was also a physician in a different practice. Her practice sent us to collection twice because the pediatrician's husband kept getting the payment from insurance. I believe the problem was on the office's end, not the insurance end. For this and another big reason, we left the practice.

You probably can't avoid Quest, but it might be something like a duplicate name, a number written down wrong someplace, etc. 

If this is employer-based insurance, you might see if they offer someone who can call on your behalf. Oftentimes, those folks get farther than the insured person calling because the employer can make a stink to the insurance about Quest, and then Quest might lose business over time. 

Just some thoughts since I don't have attorney information, but I have had similar issues handled on of the ways listed above. 

Good luck!

[scholastica]

We have involved the insurance company to no avail. Zotec provides “revenue cycle management”, which means they maximize and expedite payment to the provider. Since providers make way more money when people pay charges before they are adjusted, I have a feeling they are doing the bare minimum to get those actually filed as claims and adjusted. They probably get a percentage of revenue collected and it benefits both of them to get people to pay the unadjusted fees.

[scholastica]

@kbuttonHow did you get out of the collections process?

Edited August 30, 2022 by scholastica

[kbutton]

3 minutes ago, scholastica said:

We have involved the insurance company to no avail. Zotec provides “revenue cycle management”, which means they maximize and expedite payment to the provider. Since providers make way more money when people pay charges before they are adjusted, I have a feeling they are doing the bare minimum to get those actually filed as claims and adjusted. They probably get a percentage of revenue collected and it benefits both of them to get people to pay the unadjusted fees.

That doesn't sound legal to me. If they collect more than the adjusted amount, I would assume they are required to issue a refund check. 
 

[scholastica]

1 minute ago, kbutton said:

That doesn't sound legal to me. If they collect more than the adjusted amount, I would assume they are required to issue a refund check. 
 

They never get an adjusted amount. They file a claim and don’t follow up if there is no response. I have followed up with both parties multiple times. My insurance company followed up on my behalf just three weeks ago. They are following up again today. Zotec Partners drags their feet on insurance claims and then bills for the whole amount. Win for them, win for the provider. Screw the patient. It’s not even my account. It’s my minor child and they have said minor child as guarantor on her account. 

[scholastica]

5 minutes ago, kbutton said:

That doesn't sound legal to me. If they collect more than the adjusted amount, I would assume they are required to issue a refund check. 
 

They do everything they can to avoid getting it adjusted in the first place.

[kbutton]

1 minute ago, scholastica said:

@kbuttonHow did you get out of the collections process?

I think I just paid the doctor's office directly and raised a stink with the office.

Another time we got sent to collections because the post office was not delivering all of our mail. We had two houses and were moving from one to another. Both houses were on the same mail route. We waited to do the change of address because we wanted to be able to see who had our new address and who had our old readily, so we hadn't filed a change of address, and we were literally at both houses every day doing work to get one ready to sell and one ready to live in FT. The carrier made unilateral decision to stop delivering some of our mail at both houses. If they had stopped entirely, we would've known because we wouldn't have had any mail at all. It was nuts. I told the provider that was sending us to collections that we would pay them directly, and we would NOT pay collections. It seemed to work. I paid over the phone and got confirmation codes. From that point on, I made sure to ask at appointments if we owed anything and if it had cleared insurance (it was for an ongoing therapy). I paid on the spot and got receipts.

[BusyMom5]

I had an issue with Quest about a year ago.  They had a number wrong on the insurance information.  Document who you talk to, escalate to a supervisor immediately.  I also had a bill go to collections bc a radiology consultant never sent me a bill!  They just sent it to collections without ever mailing a bill, calling, nothing.  I was really aggravated, and had to pay collections bc it was already transfered.  Our medical system is a mess, a scam,  snd hard to navigate!

[kbutton]

2 minutes ago, scholastica said:

They never get an adjusted amount. They file a claim and don’t follow up if there is no response. I have followed up with both parties multiple times. My insurance company followed up on my behalf just three weeks ago. They are following up again today. Zotec Partners drags their feet on insurance claims and then bills for the whole amount. Win for them, win for the provider. Screw the patient. It’s not even my account. It’s my minor child and they have said minor child as guarantor on her account. 

Are they purposefully screwing up the accounts to ensure that they don't get an adjustment? That's very odd. Do they have a reputation for doing this? Are they in litigation over it already? I am so sorry.

[scholastica]

1 minute ago, BusyMom5 said:

I had an issue with Quest about a year ago.  They had a number wrong on the insurance information.  Document who you talk to, escalate to a supervisor immediately.  I also had a bill go to collections bc a radiology consultant never sent me a bill!  They just sent it to collections without ever mailing a bill, calling, nothing.  I was really aggravated, and had to pay collections bc it was already transfered.  Our medical system is a mess, a scam,  snd hard to navigate!

I have done all these things. Talked to an "escalation specialist" yesterday.

[Jean in Newcastle]

I would call your state insurance commissioner’s office. Of course I can’t guarantee results but this is the kind of thing that they are there for. 

Edited August 30, 2022 by Jean in Newcastle

[scholastica]

7 minutes ago, kbutton said:

I think I just paid the doctor's office directly and raised a stink with the office.

Another time we got sent to collections because the post office was not delivering all of our mail. We had two houses and were moving from one to another. Both houses were on the same mail route. We waited to do the change of address because we wanted to be able to see who had our new address and who had our old readily, so we hadn't filed a change of address, and we were literally at both houses every day doing work to get one ready to sell and one ready to live in FT. The carrier made unilateral decision to stop delivering some of our mail at both houses. If they had stopped entirely, we would've known because we wouldn't have had any mail at all. It was nuts. I told the provider that was sending us to collections that we would pay them directly, and we would NOT pay collections. It seemed to work. I paid over the phone and got confirmation codes. From that point on, I made sure to ask at appointments if we owed anything and if it had cleared insurance (it was for an ongoing therapy). I paid on the spot and got receipts.

I do all this, too. My dh jokes that this is my part time job, dealing with providers and insurance for six people and multiple specialists. I check every bill against the EOB. I follow up with providers when necessary. I am very familiar with insurance and how to deal with it. I worked in HR pre-kids. I pity the people that don't have the time to deal with it. They end up paying more or in a world of hurt with collections, etc.

[kbutton]

2 minutes ago, scholastica said:

I do all this, too. My dh jokes that this is my part time job, dealing with providers and insurance for six people and multiple specialists. I check every bill against the EOB. I follow up with providers when necessary. I am very familiar with insurance and how to deal with it. I worked in HR pre-kids. I pity the people that don't have the time to deal with it. They end up paying more or in a world of hurt with collections, etc.

We usually have smooth sailing, but when something is a mess, it's a mess. Sometimes I think that one or two entities that are in the same geographic location do a poor job and can get away with it because the competition is non-existent, worse, or does the same stupid stuff.

[whitestavern]

A Litigation atty is what you’d need but I’m not sure you’ll find one willing to help. Hope you can get it resolved. 

[scholastica]

1 minute ago, whitestavern said:

A Litigation atty is what you’d need but I’m not sure you’ll find one willing to help. Hope you can get it resolved. 

Sometimes a letter is all it takes.

[scholastica]

21 minutes ago, kbutton said:

Are they purposefully screwing up the accounts to ensure that they don't get an adjustment? That's very odd. Do they have a reputation for doing this? Are they in litigation over it already? I am so sorry.

You know how "quiet quitting" is all over the news? Do the absolute bare minimum and keep your job and your paycheck. I feel like it's a lot like that. Like they do just enough for it to be on the right side of the law, but also leave room for the process to fail and them to be able to bill for the higher amount. Since we all sign that "financial policy" that we are ultimately responsible for the charges and they are doing us a big favor by filing with insurance, they can let the process fail and bill for higher amounts. 

ETA: Either that or every person at the company is grossly incompetent. Those are really the only two options left. The bill is for services rendered in November of last year. I've been dealing with it since January.

Edited August 30, 2022 by scholastica

[kbutton]

1 hour ago, scholastica said:

Since we all sign that "financial policy" that we are ultimately responsible for the charges and they are doing us a big favor by filing with insurance, they can let the process fail and bill for higher amounts. 

Ah, that sort of makes sense, but it's less than ethical if they aren't making any attempt to get it processed appropriately.

My son had PCR testing that was supposed to go to Quest so that he could go to camp. It's been almost a month, and we have no results. We don't know if the pharmacy dropped the ball and didn't send the test in, or if Quest screwed something up (they anticipated this at camp and did rapid testing for those whose PCR didn't come back--no cases of Covid at camp in case anyone wanted to know).

[melmichigan]

I had an issue with BCBS and our pharmacy provider.  It went round and round for months.  I finally called my husbands HR department and had them get involved and contact the insurance company.

[scholastica]

Just now, melmichigan said:

I had an issue with BCBS and our pharmacy provider.  It went round and round for months.  I finally called my husbands HR department and had them get involved and contact the insurance company.

My dh’s company is a start up and one of the partners is HR. It’s not his main focus and not his job.

[scholastica]

The insurance company called them today and gave them the information a second time. We’ll see if this works.

[melmichigan]

10 minutes ago, scholastica said:

My dh’s company is a start up and one of the partners is HR. It’s not his main focus and not his job.

I agree it isn't their job.  I had spent 27 documented hours.  The phone call resulted in someone assigned to the claim on the part of BCBS to work with their participating provider, who was billing me, to force them to fulfill their contract, file the appropriate claim, and charge me accordingly.

[Soror]

Long story short- I had a med provider lie to me about a bill and lie to the insurance company as well. They finally sent me collections after they'd said it was dealt with. I finally went to social media and called them out. I tagged them and was very blunt about them screwing me over. In addition  also sent a certified letter back to the collections detailing why this was not a valid bill. I got a message and a call after the posting and I gave them detailed info about who and when I was lied to. I was flipping hot.

[scholastica]

22 minutes ago, melmichigan said:

I agree it isn't their job.  I had spent 27 documented hours.  The phone call resulted in someone assigned to the claim on the part of BCBS to work with their participating provider, who was billing me, to force them to fulfill their contract, file the appropriate claim, and charge me accordingly.

 

21 minutes ago, Soror said:

Long story short- I had a med provider lie to me about a bill and lie to the insurance company as well. They finally sent me collections after they'd said it was dealt with. I finally went to social media and called them out. I tagged them and was very blunt about them screwing me over. In addition  also sent a certified letter back to the collections detailing why this was not a valid bill. I got a message and a call after the posting and I gave them detailed info about who and when I was lied to. I was flipping hot.

It’s crazy making! I am generally a very calm, patient person. It takes a lot to get me upset. This had me ready to rip someone’s throat out. 

 

[melmichigan]

1 minute ago, scholastica said:

 

It’s crazy making! I am generally a very calm, patient person. It takes a lot to get me upset. This had me ready to rip someone’s throat out. 

 

I can totally get that feeling. My DH kept saying they owe me money for all my time. It's ridiculous!

[Soror]

Oh yes, entirely crazy making. I refuse to use the one hospital or any affiliate clinics/offices due to issues with their billing. I tell everyone I can about all the ways they rip you off. Never again. 

[cjzimmer1]

I have no real advice but can offer sympathy.  I've got the opposite problems going with insurance denying they received anything and the doctors office having proof they have submitted it at least 5 times.  Procedure was done in April 2021.  Insurance denied receiving any claim at all until one day before the one year anniversary.  That day they acknowledged a claim but said it was lacking documentation.  When requested documentation was send the very next day, they denied the claim for untimely filing.  Claiming the doctor has a whole year to submit and make sure necessary documentation was turned in.   Insurance rep told me "you can appeal, but I've never seen an appeal overturned".  Doctor's office had submitted claim no less than 5 times, had documentation of every attempt, every person they talked to yadda yadda.  Way better documentation than I had because I knew none of this.  Thankfully the doctor's office is now handling the appeal and has been very gracious about not making me pay the whole bill (yet).  There was absolutely nothing I could do on either end but yet, I'm the one who is stuck covering the bill that the insurance company keeps trying to dodge responsibility for. 

[scholastica]

Just now, cjzimmer1 said:

I have no real advice but can offer sympathy.  I've got the opposite problems going with insurance denying they received anything and the doctors office having proof they have submitted it at least 5 times.  Procedure was done in April 2021.  Insurance denied receiving any claim at all until one day before the one year anniversary.  That day they acknowledged a claim but said it was lacking documentation.  When requested documentation was send the very next day, they denied the claim for untimely filing.  Claiming the doctor has a whole year to submit and make sure necessary documentation was turned in.   Insurance rep told me "you can appeal, but I've never seen an appeal overturned".  Doctor's office had submitted claim no less than 5 times, had documentation of every attempt, every person they talked to yadda yadda.  Way better documentation than I had because I knew none of this.  Thankfully the doctor's office is now handling the appeal and has been very gracious about not making me pay the whole bill (yet).  There was absolutely nothing I could do on either end but yet, I'm the one who is stuck covering the bill that the insurance company keeps trying to dodge responsibility for. 

That is horrible. I am so sorry. I hope it is resolved in your favor very soon. Our system is so messed up. 

[Bootsie]

I am sorry this is happening.  It is so exasperating!  When I had a somewhat similar situation a few years ago, I put the situation in writing.  I sent a letter asking that I receive copies of the request that they had sent to the insurance company, asking them to stop calling me about the situation, and stating that if they continued I would turn the matter over to my attorney.  Somehow they then managed to straighten out the problem.  There are a number of problems of trying to deal with a call center when things get messed up, but the often poorly trained employees have no real ability to do anything other than answer the phone and say that it will be looked into; they are rewarded for the number of calls they take per hour, so anything that looks like it may need to be escalated is quickly terminated.  

If it does come down to needing a lawyer, often a starting point is anyone who can write a letter on legal letterhead to get their attention rather than a lawyer who specializes in a particular area of law.