Insurance question...

[Stitchfans]

Please be patient and I will explain what has happened to my oldest DD to the best of my ability.

A while ago she was ill and was at a clinic to see the doctor. They had called an ambulance take her to the hospital from the clinic. Six/seven months later she got a phone call from a collection agency saying the ambulance co sent her bill there. She told them she never recieved a bill and assumed her insurance had paid it. She did recieve her final bill from the hospital and is making payments on that, but this is another story. (all is well there)

Well she discovered the reason she never got the bill was because the ambulance co didn't have her address right and that is why she never recieved any bills. She asked them why they never called her and they said that isn't their policy they don't have the time to call all their patients.

Any way the orginal bill was $549.00. With late fees and the collection agencies fees it is well over $2000.00.

DD called her insurance and they said that they wouldn't of covered the ride, but since she hasn't met her deductable she has to pay the ambulance co the orinigal $549 plus $600 in fees but not the collection agencies fees.

What does the deductable have to do with it? And why should she have to pay that fee when it wasn't her fault in the first place?

In other words. Had she recieved the bill of $549.00 she would of paid it and be done with it, but now since it didn't add up to her deductable she has to pay extra? None of this is making sense to me. Is this normal practice????


If not, who can she go to for help? Thanks for sticking with and reading this,if you did.

 

[CajunDixie]

I do ambulance billing and I have to say that's BS! If I have a patient I can't find I call not only the phone number of the patient but also any family members listed on the hospital's facesheet (which is where I get my insurance information most of the time). If I still can't find the patient I call the hospital and ask them for whatever information they have on file. If that doesn't help I then start searching on internet address searches like Ultimate White Pages. Granted we have a small town service but I do everything I can to help people.

In you DD situation I'd advise her to write a very short simple to the point letter (keep a copy) to the collection agency demanding that they return the account to the original creditor (the ambulance service) because it had not been properly filed with her insurance. Send it Certified Mail, Return Reciept Required...this will cost about $4.60 I think. Do not let her mention that the insurance company told her they wouldn't pay....that's not the point.

Once it is sent back to the ambulance service provide them with the insurance company name, policy number, group number and employer. Have them file a claim for the original charges.....they can't add the late fees! IF the insurance company sends them (and she should get a copy too) a denial stating it's been added to her deductible then she should be able to pay them the original amount only. But they should at the least be able to show her an Explanation of Benefits (EOB) showing it's been applied to her deductible. If they refuse to file this for her demand a copy of her ambulance report with the diagnosis codes (these will be 4-5 digit numbers such as 725.6) and an itemized bill (should list out each charge such as ALS or BLS base rate, mileage, oxygen, monitor, procedures, and all meds). Then forward a copy of all that information to your claims department (address should be on the back of her insurance card) or I can send you an actual insurance form with directions on which boxes you will need to fill out. I promise it's not hard at all!

The collection agency should back down quickly when they receive the information that this was not filed with insurance and the fact that you sent it CMRR because you'll have proof you contacted them. If the ambulance service refuses to do anything work your way up the ladder from employee to supervisor to even the Dr. that oversees the ambulance service for the hospital it is affilated with. The ambulance service has no proof they notified her of the bill and since they made no effort to do so they are in error.

If you need me to answer any more questions you can ask here or send a PM.

 

[snowwite]

I do ambulance billing and I have to say that's BS! If I have a patient I can't find I call not only the phone number of the patient but also any family members listed on the hospital's facesheet (which is where I get my insurance information most of the time). If I still can't find the patient I call the hospital and ask them for whatever information they have on file. If that doesn't help I then start searching on internet address searches like Ultimate White Pages. Granted we have a small town service but I do everything I can to help people.

In you DD situation I'd advise her to write a very short simple to the point letter (keep a copy) to the collection agency demanding that they return the account to the original creditor (the ambulance service) because it had not been properly filed with her insurance. Send it Certified Mail, Return Reciept Required...this will cost about $4.60 I think. Do not let her mention that the insurance company told her they wouldn't pay....that's not the point.

Once it is sent back to the ambulance service provide them with the insurance company name, policy number, group number and employer. Have them file a claim for the original charges.....they can't add the late fees! IF the insurance company sends them (and she should get a copy too) a denial stating it's been added to her deductible then she should be able to pay them the original amount only. But they should at the least be able to show her an Explanation of Benefits (EOB) showing it's been applied to her deductible. If they refuse to file this for her demand a copy of her ambulance report with the diagnosis codes (these will be 4-5 digit numbers such as 725.6) and an itemized bill (should list out each charge such as ALS or BLS base rate, mileage, oxygen, monitor, procedures, and all meds). Then forward a copy of all that information to your claims department (address should be on the back of her insurance card) or I can send you an actual insurance form with directions on which boxes you will need to fill out. I promise it's not hard at all!

The collection agency should back down quickly when they receive the information that this was not filed with insurance and the fact that you sent it CMRR because you'll have proof you contacted them. If the ambulance service refuses to do anything work your way up the ladder from employee to supervisor to even the Dr. that oversees the ambulance service for the hospital it is affilated with. The ambulance service has no proof they notified her of the bill and since they made no effort to do so they are in error.

If you need me to answer any more questions you can ask here or send a PM.

Very good advice. I would also add contact your attorney general and file a complaint.Chances are she is not the only person affected by this questionable billing practice. They may be able to help.

 

[Stitchfans]

Thank you so much! I am printing all this out and giving it to my daughter. I can't tell you how much I appreciate all this information!