unjust medical charge
Country relating to Question: United States
State (if USA): Texas
Hello. My name is XXXXX XXXXX X will be happy to answer your question.Can you please provide with more details about your situation?
I recieved a medical bill in September less than $5000 on medical service performed on me on July 2011.
Thank you for your follow up.1) Did you receive medical treatment for which you are being billed now?2) Did you have medical insurance that might or should have covered this medical expenses?3) Why do you feel the bill in unjust? Can you please clarify?Thanks.
3) Before the procedure, I confirmed with my insurance company for preauthorization. Before I checked in the hospital, which is billing me wrong balance, I made sure the hospital has preauthorization for my procedure. When I received the bill for the first time, I contacted my insurance and was told that the hospital submited and was paid under "incorrect code." The hospital billing department, so I told by my insurance company, simply need to resubmit with the right code. However, the hospital insisted that they are charging me correctly. I requested numerous time to speak to a manager but never received a phone call back. Physician's office sent the correct form to the hospital a couple of time to show that my procedure is "inpatient" instead of "outpatient." By hospital billing department putting my procedure under "outpatient" my insruance only covers my procedure as "unauthorized procedure."
Ever since the first bill I received, my objective was simple; to have the hospital to file correct claim to my insurance company with the right code.
In October, I had my physician's office to send the preauthorization forms and correct forms to hospital; there were three fax transactions. The hospital shows no record of receiving this document. On November, my physician even wrote a letter stating that the procedure should be under "inpatient."
Now the hospital is saying that I pass the deadline of "within three months" to change the status; the information that was never disclosed to me prior to May of this year.
Thank you for your follow up.Do you have the copy of the letter that was sent to the hospital and also fax confirmations?
Yes, I do have the copy and the fax transaction of multiple tries to send the physician's letter via fax.
During this process to have the hospital to correct the code, I received phone calls and statement of bills although the account was supposedly under review. I was told by the hospital billing department that I need to call what they call " bill collecting agency" separately. I have done so fatefully. But I discovered two weeks ago that the hospital and the billing collection company use the same data base.
During this time, I was given several ultimatums and was urged "you pay or else."
Thank you for your follow up.Basically, you would need to dispute this medical bill and if the hospital/medical provider does not make the proper adjustment you might have to consult a local consumer protection law attorney in your area who will be able to file a lawsuit against the hospital for failure to properly and timely bill your insurance company.
You can find a reputable and experienced local consumer protection law attorney, by using these well established and reliable attorney information/referral websites:www.martindale.comwww.lexmundi.comwww.justia.comwww.lawyers.com
What is my chance if I decide to take this to small claims court?
What information I'd need to represent myself in the small claims court?
Specific answer would be appriciated.
Because I was already aware of the inital answer you gave me :-D
Thank you for your follow up.You can also file a lawsuit in the small claims court and dispute this charge, but you would have to prove that the only reason your claim was denied is due to the hospital's negligent mistake and failure to properly bill your insurance company and if it wasn't for this mistake your claim would be paid in full, in order to have a good chance of winning your lawsuit.If you can provide clear evidence of the facts above and it sounds that you might have a good chance proving the required facts, since you do have pre-authorization for this procedure and also you can prove that you did try to correct this error while the hospital simple failed to take any action to provide your insurance company with a correct bill which would have corrected billing code.
Would I need to request a copy of internal fax transition record from my physician's office of their effort to send the correct form in October?
How can I prove without any voice recording of the phone conversation?
I see the high possibility of "he said, she said" because the hospital conveniently erased the record of me contacting them in September; the hospital billing department has a customer service record dating back only to November.
If this affects my case of proving that I'm speaking the truth, how do I go by requesting phone call communication from my cell phone provider? Would this have any effect on strengthening my case on dispute?
Thank you for your follow up.The more evidence you can obtain, such as fax confirmation pages or even if you can get your physician to testify in court as your witness that he did fax the correct information and mailed letter in his attempts to correct situation, it would help you tremendously.Simply records of phone calls to the hospital numbers would not prove much, but if you have names of the hospital employees you have spoken to and details of your conversations, that would help.
I kept all the records of phone call conversation and representatives names.
So it does not matter that the hospital does not recognise the representatives names?
How do I go about requesting my physician to be my witness?
She may not agree to be involved since she needs to use the hospital for her other patients.
Thank you for your follow up.You might be able to subpoena the doctor as a wittiness, however the court would have to approve this third party subpoena if you are not represented by an attorney.Also, you will be able to request certain records from the hospital as part of the lawsuit discovery stage, as long as this records are relevant to your case.
Are you familiar with procedures relating to small claims court?
I found several websites explaining the situation but I feel I need some guidence on overall picture of filing a suit in small claims court. Please help.
i.e. how do I include the court fee or suit filing fee into dispute?
Is the defendant going to be addressed as hospital or the billing department?
How do I increase my chance of having the court approving third party subpoena?
Although I'm confident that my record keeping is strong enough, how do I prove the conversation record is true and information I needed from the very beginning was not disclosed?
Thank you for your follow up.I have already answered your original questions and several follow up questions.I will be happy to answer your additional new questions once my previous answers are accepted and also the new questions will need to be posted in separate posts according to JustAnswer.com Terms of Service.
Experienced Licensed Attorney
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