General Category > General Questions
Independent Review- Assistance needed (original issue in the 'No Preauth' thread
PippiT:
--- Quote from: Michele on October 19, 2017, 01:36:04 PM ---First of all, congratulations on getting them overturned! Good work!
So basically they did overturn and pay but the provider does not want to accept the amounts, correct? If the provider is out of network they can bill the patient for the amount above what the insurance carrier allowed. I'm not familiar with CollectRX in particular but it appears they are a revenue cycle management company. Since you already did the work of getting the claims overturned it seems like you might not need a full service like them. Have you tried billing the patient yet? I would try billing first on my own. If the patient indicates they aren't going to pay, or doesn't respond, then I would do something more like collections. We use a soft collection agency that has great results.
--- End quote ---
Thank you! It was hard and I learned a lot. Even the rep at the AG's office was surprised at the outcome.
Yes, that is correct. We are billing the patient for the ded and coin. we can balance bill but the provider wants a larger allowed amount. In the past, Viant has negotiated with us, this time they are basically saying if it's covered under ERISA, try your luck there or bill the patient. We have used Collect RX to get larger payments for past out of network claims. The provider will not use a collection agency, I am the collector and if it gets to a point, we take delinquents to small claims. I would much prefer a collections agency!!
Thank you for your response. I wanted to see if there were any options other than billing the patient before presenting the bad news to the provider.
Michele:
I get it. Just curious, why will the provider not use a collection agency? I'm assuming it's for the same reason many don't and it's that they don't seem to be effective. We experienced the same thing for many years. We used many different collections agencies but not one had any kind of results. It was a total waste. Honestly I wasn't sure how they stayed in business. They only got paid on what they collected and for us it was always nothing!
But we have found an agency that has amazing response rates. They are soft collections and are kind of in between regular billing and collections. They have a couple of different options including Rapid Recovery and Accelerator. I believe their collection rate under Accelerator is in the 90% range! THey are great to work with. Full disclosure: I get nothing for referring people to them. I just truly love the results we get and our rep (who can handle any account in the US) is wonderful to work with. The name of the company is Transworld and our rep is Richard Neary. I can get anyone his contact information if desired.
PippiT:
--- Quote from: Michele on October 21, 2017, 03:38:55 PM ---I get it. Just curious, why will the provider not use a collection agency? I'm assuming it's for the same reason many don't and it's that they don't seem to be effective. We experienced the same thing for many years. We used many different collections agencies but not one had any kind of results. It was a total waste. Honestly I wasn't sure how they stayed in business. They only got paid on what they collected and for us it was always nothing!
But we have found an agency that has amazing response rates. They are soft collections and are kind of in between regular billing and collections. They have a couple of different options including Rapid Recovery and Accelerator. I believe their collection rate under Accelerator is in the 90% range! THey are great to work with. Full disclosure: I get nothing for referring people to them. I just truly love the results we get and our rep (who can handle any account in the US) is wonderful to work with. The name of the company is Transworld and our rep is Richard Neary. I can get anyone his contact information if desired.
--- End quote ---
Viant has decided to negotiate with us on all but 2 claims, so I am waiting to see if we come to an agreement and if so I will try to have them reopen the two claims. They have assigned them to 4 different reps, so this has been fun.
I'm not sure the entire reason, as they stopped using collections long before I came along, but they never followed through with small claims until I came along. I'm assuming they want the entire bill paid and not have to share or pay someone else. We have taken the first round of delinquents to small claims and it has been effective to get them to pay before court and the ones who came to court we entered into a court ordered agreement for monthly payments that includes interest and rebilling fees. I guess this is an experiment to see how this goes since they have never followed through on their threats until now!
I am always open to resources to make my job easier. I will reach out to Richard and see what I can find out thanks! Just out of curiosity, how long do you give patients to pay before turning over to collections?
Michele:
Our standard rule is send three notices. We send the first bill once we receive payment from the insurance carrier. Then we send a 2nd notice 30 days later. If no response to the 2nd notice we send out a final notice 30 days after the 2nd notice. If they don't respond to the final notice within 10 days we send to collections. However, we do have some providers who like to send anyone over $100 to Accelerator at 60 days.
PMRNC:
I would remind them that to "threaten" collection actions w/out follow-through is a violation of the FDCPA. You would be amazed at how many consumers have become very savy when dealing with a lot of medical debt. ONE slip can cause you to lose the entire debt owed!
I was ready to sign a client a few years ago who had his OM always include the "stickers" saying it was going to collection after 90+ days, when I was reviewing the practice policies I had asked where the info was on their collection process and the OM simply responded "Oh we don't actually send them, the doctor doesn't want to get into that". Their bills did not even include the mini-Miranda. I didn't sign them as they decided to stay in-house but that same OM called me about 6 months later telling me she should have listened to me as they had a patient with a $7000 debt have it dismissed for violating the FDCPA because they 1) did not follow-through with threats 2) accepted a partial payment of $20 but demanded the full balance on the following statement and 3) Their bills did NOT include the mini-Miranda. This provider did not AUTOMATICALLY become a debt collector in the eyes of the FDCPA, they made themselves one by NOT having a collections practice in place.
If a practice does not have a policy in place when trying to collect patient balances, there are both state and federal laws that physicians and medical practices have to abide by in communicating with patients because those practices don't have collection agency or policy in place.
Patient's with a lot of medical debt are turning to experts to help them resolve and even wipe out these debts because of FDCPA.
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