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DON'T BE HAMMERED BY YOUR DEBT

DON'T BE HAMMERED BY YOUR DEBT

Tuesday, January 02, 2007

MEDICAL DEBTS - MY INSURANCE WAS SUPPOSED TO PAY THAT

A large portion of my debt collection practice is made up of the collection of past due medical bills. Unfortunately, the vast majority of the people I end up suing for past due medical bills are not the large numbers of uninsured about which congress is constantly concerned. They are people who actually have health care insurance, but their insurance has denied the claim or failed to pay. Despite any number of modern myths, this is the bottom line everywhere in the United States when you go to the doctor's office, you will be asked to sign a Patient Financial Responsibility document, which in layman's terms says you are responsible for your own bill whether you have insurance or not.

When you go to the doctor, the doctor provides you services and you are responsible for paying for those services. You may have a contract of insurance, but that is a contract between you, as the insured, and the insurance company. It is not a contractual relationship between the doctor and the insurance company. The doctor's office files your insurance claim as a courtesy to you. Even your policy of medical insurance will state that you, and not your doctor's office, are responsible for filing the claim. So the first great truth that every patient must understand in today's modern world is that they are first and foremost responsible for payment of the doctor and hospital bills, even if they have insurance.

The second myth widely held by the public today is that unless you receive a bill from a doctor's office, you don't owe them anything. I cannot tell you the number of times I hear during the day "well, they never sent me a bill." A bill or a dunning letter is not a pre-requisite to establishing or enforcing a contractual debt. The instant the service is performed, the debt is incurred and is owed. The mere fact that you don't have to pay the full bill when you leave the doctor's office or are discharged from hospital is a courtesy to you. That is not a courtesy that you can take advantage of by not paying. This leads me to the second great truth of the modern world of medical bills and insurance. It is entirely the patient's responsibility to keep track of whether or not their insurance company has paid a claim or not. This is a difficult truth for many busy self-absorbed, distracted Americans to take to heart. What it essentially boils down to is that if you go to the doctor and you do not receive an EOB (Explanation of Benefits) from your insurance company showing where they have paid that doctor, you need to pick up the telephone and call your insurance company and find out why they have not. Likewise, if you receive an EOB showing that your insurance company has denied a claim, you need to file a dispute in writing with your insurance company and do everything necessary to appeal that decision and have the claim paid. If you do not, more than likely, you will not receive a bill from the physician's office, but rather you will receive a collection letter from a collection agency stating that your bad debt has been turned over for collection. The doctor's office will not fight with your insurance company to make them pay your bill for you.

The third hard truth of the modern world of medical billing and medical insurance is that if you drop the ball, you have to pay. The reason for this is what is known in legal and insurance circles as "timely filing." All insurance companies have in their policies a requirement that a claim be timely filed, and that phrase is defined in each individual policy as a specific period of time. The standard is ninety (90) days; however, there may be variations. What this means is that if you have services at a physician's office or hospital, and no claim is filed within that 90 days, the insurance company is relieved of their contractual obligation to pay your medical bill. This is a horrible trap for the unaware consumer. If you go to the doctor and the doctor's office fails to file your insurance claim through their own negligence or oversight and 90 days passes, and you receive a letter from a collection agency saying you owe a doctor's bill, then you owe a doctor's bill. I reference you to cold hard truth number 2; it is your responsibility to make sure your insurance company pays your medical bills. If you go to the doctor and you don't receive an EOB within 90 days, you must contact the doctor's office and find out if they have filed the claim and your insurance company and find out why they have not processed the claim. If you fail to do so, then you will be contractually responsible for full payment of that bill, even if you had valid insurance at the time of the treatment.

Now, I know as you read this you are saying to yourself, "that's not fair." Well, I hope by now you have learned as an adult that life simply is not fair and if you intend to stand before a judge in opposition to a suit I filed and plead the "it ain't fair" defense, then be prepared for the Judge to agree with you and summarily rule against you.

The fourth truth of the modern world of medical insurance and medical bills is that your wife's bills are your bills; your children's bills are your bills, regardless of whether you knew about them or authorized them. In most states, a spouse in a marriage is responsible for his or her spouse's medical bills. This normally comes up where the service or treatment was provided before a divorce and the now ex-spouse is being sued for his hated former companion's medical bills. Regardless of divorce, in most states, a mother or father is responsible for the medical bills and debts of their minor children, regardless of the circumstances. This most frequently arises where the ex-wife takes the child to the doctor without telling her ex-husband and runs up a large medical bill and does not pay. Then the ex-husband, who never knew anything about the bill, that has the better job, is sued. I realize this once again falls under the heading of life is not fair. However, it is perfectly legal and if you have a good divorce lawyer when you are divorced, your Marital Dissolution Agreement should allow you to recover those funds or at least one half of those funds from your ex-spouse. Your Marital Dissolution Agreement should also have a provision that requires both parties to notify the other party of any medical treatment and to provide medical bills and records within a certain period of time. Failure to do so may get a former spouse cited for contempt in Divorce Court. All of that, though, has no effect on the collection of the medical bill.

Now having painted a very dismal picture for the common patient, I will provide the one sword the patient can pick up and fight with. In today's modern medical insurance world, the vast majority of insurance policies are in fact not insurance policies, but Preferred Providers Organizations or Health Maintenance Organizations or some other alphabetic variation of a PPO or HMO. In order to be a member of the "network," the healthcare provider (i.e., your doctor) must sign a contract with the insurance company agreeing to provide his or her services at a certain rate for network members. This usually represents a discount from what the man on the street would receive. More importantly, these agreements often contain contractual requirements that the medical services provider submit the claim to the PPO and not take action against the member (i.e. you). If a doctor's office drops the ball and does not file a claim and then files suit against you, that PPO or HMO agreement may be used in your defense.

In conclusion, when and if a medical debt collection attorney sues you, do not expect to pick up the telephone and call his office and tell him "but I had insurance" and have everything be made alright.

31 comments:

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Anonymous said...

I recently went to the Dr. and the new secretary filed my claim with old insurance...I got a bill and then I sent a copy of my new insurance along with a note that I gave her my insurance card on my visit and that she told me it was accepted prior to my visit. My new insurance did not pay the entire amount owed but they say on the claims that I should not pay the rest, and that if I already have that I should demand reimbursement. I have not paid the rest, what can I do?

michelle said...

Being a recovering debt collector myself and having collected many medical debts over the years, I found your post to be very well done. I am going to share your post with my blog readers at www.BizCreditPolicy.com, thanks for the helpful and much needed information!
Michelle Dunn

Doug said...

I just stumbled across this post. Nicely done. When you were getting to the part about paying for spouses' bills, I thought you might bring up (and you did come at it from the other side) the old "my ex is supposed to pay" dodge as the debtor holds up a divorce decree.

Often times, after I explain that, if the person ends up paying something that the ex-spouse was supposed to pay under the decree, they can try to recover that amount from the ex-spouse.

Them: "He doesn't have any money."

Me: "Then you can see my problem."

Anonymous said...

I was scheduled to have a procedure done. Prior to doing so however, I requested the Doctor's office contact my insurance company to see how much I would be obligated to pay. After they had supposedly contacted my insurance, the personnel at the Doctor's office informed me that my portion of the procedure would be $60.00. Based upon this representation, I agreed to the procedure, as I could financially afford this cost. Unfortunately, after the procedure was done, I received a bill for $300.00. Apparently, the insurance company "changed their mind" about what they were going to cover. I cannot afford to pay $300.00, and had I been properly informed, I would have declined the procedure. What can I do?

Anonymous said...

I keep hearing "the law is" or "the law says", but no one has actually cited for me what statute covers any of this.
My situation - divorced in 2002. She remarried in 2003. I remarried in 2006.
The divorce decree and child support order state I provide insurance and she pays incidentals and co-pays. Problem is she doesn't pay the co-pays. She signs the forms with the doctors stating I am the guarantor, tells them we are still married and that I live at her address.
Now that things are in collections and show up on my credit report - that is when I learn about them.
Explain to me how this is legal and I am legally and financially responsible. I do have a court order that states what I pay and what she pays. Why isn't that a legal document that protects me from my ex-wifes actions?

Anonymous said...

I live in NY. If I'm legaly separated with my husband, am I responsible for his medical bills?

Anonymous said...

I live in NY. If I'm legally separated with my husband, am I responsible for his medical bills? Thank you.

Robert Lowes said...

Dear Mr. Herrin,

I'm a reporter for a physicians magazine called Medical Economics and I'd like to talk to you about medical collections and medical debt. This is one of my specialties. Would you please give me a call at 314-727-4917 in St. Louis or email me at rlowes@advanstar.com to arrange a convenient time to talk?

Thanks.

Robert Lowes

BAM said...

Here's a scenario for you. My business partner and I have a small company formed as an LLC in Texas. My business partner got married to his third wife about one year ago, sometime around the summer of '06. He and his wife began having marital problems just a few months after that, and it turns out that she had suffered from depression and perhaps some mental disorders before they met. They had a big fight in the Spring of '07 and he moved out while they worked on the marriage in counseling. Apprarently the counseling wasn't doing the trick, because a month ago she met another guy and he moved in with her. Now is where it gets interesting. One day her parents pay her a visit and find this new guy in her house and somehow show their dissaproval. After they leave, in a state of depression, she decides to take an entire bottle of Tylenol, 50 or 60 tablets. Later that day, feeling very sick her new boyfriend takes her to the hospital where doctors inform her that her liver has failed completely, and that she'll need a liver transplant immediately. Luckily, she has excellent insurance with a new employer and everything will be covered. Two days later she gets a liver transplant. Now, from what my partner tells me she was only placed so high on the transplant list and received one so quickly because my partner and her parents denied that she had overdosed. However, he also told me that her medical bills had already topped $300,000. That got me thinking that maybe they didn't say anything about the O.D., not because they were afraid she'd get low priority on the transplant list, but because they didn't think her insurance would cover it if it were caused by a suicide attempt. By the way, she is 28 years old. So, here's my question. If the above assumptions hold true and the insurance company finds out from lab tests of the old liver that she attempted suicide, do you think her insurance company will try to sue her? If so, since they were still technicaly married, are my partner's assets exposed, and if so does that put my assets that are blended with his in the LLC company in danger?
Thanks -Brad

Traci said...

Great information. Just received papers from the sheriff tonight where my ex didn't pay my son's hospital bill and now they want to attach my home, cars or salary to pay for the debt. Pitiful thing is that I offerred to add my son to my insurance when my ex lost his job and he swore to me he had it covered with Cobra. Then my son got hurt and he allowed my son's stepfather (my husband now) to sign the hospital paperwork knowing he had no insurance and it would come back on me. Now instead of a $50 bill it is about a $1200.00 bill. All he had to do was allow me to put my son on my insurance. I have now paid a tax bill and now will have to pay this bill all because my ex is a dead beat and sad thing is that he makes three times what we make. My husband now is on disability from a stroke and I am the only provider. One question I didn't see any explanation about is what is acceptable for payment plans between a patient and a medical provider? I can't afford to pay 10 different bills $25.00 each a month. We couldn't eat.

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Geoffrey said...

Hello-

I live in Oregon. Recently my wife needed some medical care. The account went to collections due to the fact our 1 year old son has an illness and is in and out of the hospital (20K in bills and counting). The collection company now wants to Garnish my wages even though we just received the letter from them recently and jsut had the first call today. Any advice? Can they Garnish?

linde said...

My insurance denied a claim for a surgery that cost around 40k, We are at the stage of an appeal now, what can I do? Will I lose my house? I live in California.

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vinz said...

There are so many HEALTH INSURANCE COMPANIES but only few can be trusted. Look for an insurance that can be trusted and cost-effective.

Anonymous said...

Your article was helpful, husband was just turned into a collection agency for bills not paid by workers comp. insurance and I,m just finding out that there are a total of four bills from as far back as last January, yet we have never recieved a bill. I would be courious to know what agency to contact to change the way medical providers do billing. They should be accountable for at least sending the bill. I cannot get them to give me an itemized bill, deon't I have a right to at least know what I'm paying for? I will pay the bill but need the itemized bill to collect from the workers comp company, in which I have found out that I can turn them in for this. I guess you can say that we have learned our lesson about this situation. I also learned that the statue of limitations on workers comp cases in Michigan must be billed within one year to the insurance company. So if that is the case why should I pay this if I will not get reembursed due to the physicians neglegence. It is too bad that medical providers do not take more responsibility in their billing practices.

Kleidung Klamotten said...
This comment has been removed by a blog administrator.
Arginin said...
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Anonymous said...

ONe thing that is not mentioned here is that if your medical debt is a workers compensation case, at least in FLorida, the debt collectors cannot come after you personally.

Anonymous said...

So just curious-- have you deleted the comments that informed the world just what type of a lower life form that debt collectors and debt collection attorneys truly are? That's my guess. When did you decide you would scrape the bottom of the barrel and harass poor people who try to pay but cannot? Who by some misfortune or serious illness are stuck in a position of barely making ends meet when some larvae such as yourself winds your slime trail to their door? Hopefully there is justice in this world and bottom dwellers such as yourself will get what you so dearly deserve.

Gina said...

Folks,

I live in Maryland and my husband is being sued by a debt collection lawyer. My name is NOT on the accounts he is being sued for-BofA and Cap One Visa. does anyone know if they can come after me for the $$? he acquired the debt after we got married.

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Anonymous said...

Hi,

Thanks for sharing the link - but unfortunately it seems to be down? Does anybody here at debtcollectionlawyer.blogspot.com have a mirror or another source?


Thanks,
John

Anonymous said...

You're noting but another bottom feeding scumbag that gives the legal profession a bad name; suing patients for hospital charges which probably contain 'mistakes' in the form of overcharges. Even have the gall to say the a hospital actually giving a patient a bill is a courtesy, eh? You say it's the patient's responsibility to figure out what they owe and make sure it is paid. Guess every patient should just sell their home and empty all their assets, giving everything to the hospital when admitted just in case they 'drop the ball' and miss paying something they might or might not owe later (when they are sick and supposed to be recovering, NOT worrying about hospital charges!) God I hate people like you and your clients. Everything that is wrong with America, which you obviously hate. After all, it's all about YOU and your hospital clients getting MONEY, isn't it. GREEDY PIG.

We need a comprehensive, single-payer health care system in this country with strong laws to prevent overbilling and misbilling and pigs like you getting rich on the sickness and misfortune of your fellow human beings.

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Folks,

I live in Maryland and my husband is being sued by a debt collection lawyer. My name is NOT on the accounts he is being sued for-BofA and Cap One Visa. does anyone know if they can come after me for the $$? he acquired the debt after we got married.

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Anonymous said...

I hope people do not take this clowns/laywers advice to heart! I strongly suggest you seek advise elsewhere and in your state.

Joey Constanza said...

I think that we will find that more often than not, our insurance companies do this to us. We think they have a bill covered and it ends up on us. That's where the collection people come into play. Their job is to make sure that the hospital gets their money. If you have a problem with something, then you might want to contact your insurance company or the collections agency. http://www.alacritycollections.com/markets-served.html