About LASHUNDA Expertise Billing,Claims, and resolutions to the following insurance agencies: Medicare, Medicaid, Coordination of Benefits, Most Managed Care such as HMO's, PPO's, Medicare Advantage Plans, Governmental Agencies such as Work Comp and Veteran's Administration. I would like questions that are in regards to Billing and Collections from Insurance Companies. I can also accept some questions regarding accounts sent to Medical Collections. Please be advised that I reside in Texas and most of my knowledge is based on how it works in Texas.
Experience I have worked in the Medical field for 15 years. I currently help to coordinate contracts for a physician group in Texas. I am extremely good with resolving issues with commerical insurance companies. I'm an expert in coordination of benefits between Medicare and Commercial insurance companies.
Question QUESTION: OKay, so I am stressed to the max. I was seen by the foot doctor 2/3/07. On June 15, 2009 I was contacted by collection agency saying I owed 305.00 because of an unpaid account. On this date I found out through AHK+ (Medicaid HMO) that I only had straight Medicaid. I called the doctors office on Monday and let them know I had just got off the phone with Medicaid and they said I did have coverage on that date of service. They said there was nothing that they could do because it was already in collections. I am fit to be tied because not only did they bill the wrong insurance (I would have notified them of the change if I was aware) but they failed to update my demographics! They had an address from over a year ago. So needless to say I never received a bill from them. And over 2 years later I get a call from collections trying to collect the debt. I went to the doctor and explained it to them to see if they could get it out of collections and they were unwilling to comply. I just don't think that this is right. I want to get input from another person. I work with insurances daily, and I have always been told you cannot bill a Virginia Medicaid patient. Can you please help? Medicaid will not pay this because it is over a year old.
ANSWER: Hi Samantha. Thanks for the question. Mail the collection agency a copy of your Medicaid card and tell them that's who they should bill. Under normal circumstances the provider is not supposed to bill the Medicaid member however they are using that they never received the correct information.
Make sure you keep a copy of what you send to the collection agency. You'll need those documents to get it off your credit.
You can also make a complaint to the Virginia Department of Health and Human Services. I would also ask to speak to the doctor and let him know what's going on. Most likely you will get an office manager but demand to talk to the doctor directly.
If you want to know where to file a complaint with the state office that oversees Medicaid then I suggest you either go to the website for the Virginia Department of Health and Human Services or to the Virginia Department of Insurance website. Either one of those should tell you how to file a complaint.
Hope this helps.
Thanks,
LaShunda
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QUESTION: Hey thanks for your quick response! I have trrriiiied to talk to the doctor and they wont let me. Even when I went up there they wouldn't let me. So if I file complaint, will this go after the doctor or the insurance? The insurance is not a problem, however the office itself is! Collections is harrasing me with this saying I only have until the 30th of this month to pay it back or it will go on my report. I have worked so hard for my credit and don't want anything like this to effect it. No, I am not trying to get anything (house, loans) but I still worry. If you dont have credit you cant get anything. I am a nursing student and to be asked to pay 305.00 along with all my other bills is something that is going to take time to pay. I just need to know, do you think there is ANY way Medicaid will pay this 2 year old claim?
Answer Hi Samantha. Thanks for the question. I'm not sure how it works. They may very well go after the physician office because they are not supposed to bill Medicaid recipients. I also don't know if Medicaid will cover the claims from two years ago. Under normal circumstances they will not if the physician office never filed it or if they did file it they never kept the claim alive.
I would call the state because they might be able to provide some direction on what to do. You can get a free credit report each year from all three credit bureaus. Log onto annualcreditreport.com and request them. Anything you see on there that shouldn't be (especially that bill) you can dispute it online or by writing a letter. It depend upon what the creditor (collection company) says if the credit bureau will remove it or not. It also depend upon what you say after the creditor if it can be removed.
