Re: CA calling about PAID medical bill, can I stick it to THEM?

Posted by Jane Terry (209.94.140.9) on October 21, 2003 at 18:51:46:

In Reply to: CA calling about PAID medical bill, can I stick it to THEM? posted by pablo on October 20, 2003 at 18:18:48:

What you need to do is the following:

I assume that since the hospital had a contract with your insurer to take an adjusted payment (this is very common, most HMO's and PPO's only pay a percentage of a visit/procedure as you are only supposed to pay at the most a copayment/small deductible). It is against the law for the hospital to balance bill you for a service that was contracted paid in full. If you are a member of a HMO/PPO, write to them via certified letter about the problem and their contracting department will very likely be all over them. I wish I could tell you this is uncommon, unfortunately it is not and the burden is on you to notify your insurer and get it straightened out, but here is a sample of what to write:

Policy#
Group#

Date of Service:

Facility where service was rendered:

Dear Sir or Madam:

My child/spouse received treatment at this facility on 09/09/1999 for a concussion. My insurance was billed and I received and EOB (explaination of benefits) stating that they were a contracted facility and that they were paid in full per contract fee (payment $550.00, contracted write off $400.00 and patient copayment $50.00, or something to this effect). The facility is attempting to charge me for the portion of the fee which should have been written off as a contractural adjustment for $400.00. I have attached a copy of the EOB for your reference as well as copy of the bill from the facility for the $400.00. Thank you in advance for your assistance. I can be reached at 919-999-9999 or callme@consumer.net or whatever you want to put in for contact information, you get the idea.

Chances are the insurer will solve this quickly for you but as I said, send a certified letter to the manager of customer service at your insurer.

Likely it will end there but you can also file a complaint with your state's consumer affairs division if that does not work.

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