by hanleyhansen » Tue Aug 24, 2010 03:26 pm
My insurance company lied to my medical provider by telling them that they sent me a check. Now i have collections breathing down my neck. Since January 2010 i've been told by the insurance company that this claim is being processed and they just keep telling me the same thing. It's been 8 months and now collections is involved. What can I do to clear this issue? What actions can I take against my insurance company? And how can I get collections off my back and this issue resolved as elegantly as possible? Thank you for your help.
Posted: Tue Aug 24, 2010 03:48 pm Post Subject:
First, is this an auto accident claim... as you posted this in that forum.
Have you asked your carrier why the delay? This is the _first_ thing I'd be asking and the answer clears up many issues that might be in play. If you've asked and they have only told you it's being processed, asked to speak to a supervisor. Ask for a time frame on what it will be paid. Each week it's not paid, speak to that person's supervisor.
None the less, you can also file a complaint with your state Dept of Insurance and they can find out the status and see if your carrier has done anything wrong.
Posted: Tue Aug 24, 2010 04:09 pm Post Subject:
Thank you very much for your quick reply. I'm sorry for posting in the wrong forum. This is a health insurance claim.
In order to clarify let me fill you in on the details. I had knee surgery back in October 2009. On October 28th I received a CPM machine (ordered by my surgeon) that was going to be used to increase mobility of my knee. I used the machine until November 23, 2009. The company providing the medical service collected the machine at that point. Mid-December I received a bill from the company providing the CPM machine. Late December I received a denial from my insurance company on the basis of not medically required. I contacted my insurance company and they told me I needed to provide a doctors note deeming the CPM machine as essential. I contacted my surgeon and he had to send two letters because the insurance company had not received the first supposedly. So as of mid-January this claim is being "reviewed" and "processed". Every few weeks or so I would receive a letter from the CPM company asking for a payment and threatening with collections. Whenever I received the letter I would call my insurance company and inform them and inquire the status of my claim. Every time I called it was being"escalated" and being "reviewed". This went on about 6 or 7 times. Last week I received a phone call from the CPM machine company stating that my insurance company informed them that they sent the payment. The insurance company did send me a payment but the payment was for a totally different issue and it was meant for a different provider all together. I don't know if this was simply a lie from the insurance company or pure negligence. Today I received a phone call from IC Systems, a collections agency. Immediately I called my insurance company and threatened them with legal action due to this ongoing issue. They put me on hold and escalated my call to a supervisor. The supervisor assures me that the claim is now being pulled and being handled by a supervisor in the medical policies department. They said they would call me back later on today with a status update. I called the collections agency back and they told me they will only give me 24hrs to make a payment. I can't have this issue affect my credit. I'm young and I just got out of school and I can't get out into the real world on the wrong foot. What course of action do you recommend?
Posted: Tue Aug 24, 2010 06:46 pm Post Subject:
I called the collections agency back and they told me they will only give me 24hrs to make a payment.
Or....? Collection companies will tend to say just about anything. I'm doubting that they are going to do much in 24 hours.I'd certainly file a complaint with your states Dept of Ins regardless of anything else. The DOI will find out if there was a good reason for the delay and if not, they can fine the insurance company or in the least, make a note of the complaint. When the DOI gets several complaints on one insurance company they may just audit many claims from that company to see of this is a trend. Trust me... insurance companies _do not want this_ as there _will_ be problems found with many claims. They then get fined for all of those errors. This is why insurance companies take DOI complaints very seriously. When a complaint is received they usually kick it up to a very high person in the claims dept (usually a manager for the entire claims dept or for an entire region). So file this regardless. If you don't hear from a supervisor today, call either at 4:30pm or the following morning. Ask for that person's supervisor as you were promised a call and it was not done (if they give you a problem, simply ask them if the company holds employees responsible for promises that they made. Use this as a reason for speaking to a person higher up). You also need to inform them that you _have_ filed a DOI complaint.
If they tell you its being paid, thank them and ask if they will make up for their ongoing error by faxing a letter to either you (best) or the collection company stating that payment is being made. If they will fax it to you, you can then fax it to the collection company. Note that the collection company will probably still tell you that this does not matter but I'd simply tell them that you understand their job but that that they need to be realistic about the situation.
Posted: Tue Aug 24, 2010 06:55 pm Post Subject:
Thats excellent info. Thank you very much. I highly appreciate your input.
Posted: Wed Aug 25, 2010 11:54 am Post Subject:
Tcope's advice about making a complaint with your state's Dept of Insurance is the first thing you need to do. But the business with the collection agency is not unimportant.
I called the collections agency back and they told me they will only give me 24hrs to make a payment.
This is entirely BS from the collection agency. Under the Fair Debt Collection Practices Act (FDCPA), the collection agency is required to send you a demand letter, they cannot contact you by telephone alone. If you have not received anything in writing, although the debt may be in collections, they have no right to demand payment simply by phone -- how do you know who you're talking to?
To protect yourself under the FDCPA you need to do a couple of things that are very important. First, call the collection agency, ask to speak to a supervisor only (the person you first talk to will not be one). Demand that a collection letter be sent as required by the FDCPA and inform the supervisor that no additional telephone contact is to be made by any representative of the collection agency prior to receiving your written response to their collection letter. Inform them that you are NOT to be contacted at any telephone number(s) other than the one(s) you authorize. You must be sent the required letter within 10 days of the first contact (which was the first telephone call), or the collection agency is in violation of the FDCPA. Let the supervisor know that you know that and you are willing to complain to the Federal Trade Commission if they fail to follow the requirements of the Act. If possible, record the phone call (making any disclosures of the recording required by your state's laws). At the very least start keeping a record of all telephone contacts (date, time, and names) with the collection agency. Receiving and making calls to/from a cell phone will enable you to have a record of each contact. A collection agency is not supposed to block their telephone number ID.
When you receive the collection letter, you have 30 days to submit a written response. DO NOT FAIL to respond! Send that letter via USPS Certified Mail with a Return Receipt -- it will cost you about $4.50 to do that. In your response letter, indicate that you DISPUTE the validity of the debt since it was supposed to be paid by an insurance company, and that to the best of your knowledge it was (since the insurance company has told someone they sent a check) and that you will provide documentation to that effect if necessary. Demand written verification of the debt.
That alone will put off things for up to 30 additional days, during which time you should be on the phone on a DAILY basis with the insurance company's claim department making their life miserable by demanding to know when, where, and to whom payment for the claim was made. Demand written documentation of the payment, including a copy of their cancelled check so that you have the documentation to submit to the collection agency if they persist in attempting to collect on the debt.
Understand that the collection agency probably does not OWN the debt (having purchased it from the doctor). They are simply providing a service to the doctor for a fee. If they collect, the doctor gets the payment minus the collection fee. So the collection agency cannot threaten to take any action (such as suing you in court, sending the sheriff to take possession of any of your personal property, etc) that they do not have the ability to take. If they don't own the debt, they can do nothing other than demand payment. Keep copies of all correspondence to and from the collection agency.
If at any time you want to put an end to the collection agency's contact (written or oral), then you send a CEASE AND DESIST letter telling them to stop all communication other than to advise you that collection activity is ceasing or some other action is being undertaken. If they fail to heed your demand, they are in violation of the FDCPA and subject to state or federal prosecution. But understand that sending a CEASE AND DESIST letter can immediately elevate your matter to small claims or civil court, which will be additional trouble for you, but not a problem if the insurance company is supposed to have paid the bill but hasn't. You just drag them into the suit and let them explain it to the judge.
Just don't give in or give up!
Posted: Wed Aug 25, 2010 04:02 pm Post Subject:
Great! Thanks for the info. I called the collections company and they told me that their records show that a letter was sent on the day of the first call. In the meantime they said that collection proceedings will continue. I told them that the issue was with the insurance company not with me and that failure to cooperate to a reasonable degree will result in a cease and desist letter which I have no problem with because I'll let the insurance explain it to the judge. I told them I would fax them a status update about the claim when I received one from the insurance company.
I also filed a complaint with the DOI because I didn't receive a phone call from the insurance company with an update. I'm actually on hold now with them. I'm going to request an immediate update via fax that way I can forward it to the collections company.
Posted: Sat Aug 28, 2010 04:12 pm Post Subject:
Phone calls are insufficient!! Must conduct business by mail or email. US Mail is preferred.
If you did not get the first collection letter, if you have a contact address, write and demand a copy -- notice them that they are in violation of FDCPA for not sending the letter and only contacting you by telephone. If they claim a letter was sent, you have 30 days from the day you receive the letter to respond in writing. It's not unheard of that a letter was never sent, yet a copy exists in "the file". If it went to court, they would argue that they sent the letter, but you're lying about not receiving it. So protect yourself by sending the letter anyway.
You can also file a complaint with your local district attorney's office against the debt collector for violating the FDCPA.
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