Medical Debt Defense & Charity Care

Medical Debt Defense takes a different approach than normal debt defense.  There are many free, non-attorney options for charity care discharge, waiting for insurance to pay out, or defenses if your insurance was not billed properly.  This page is to help you explore these issues of how best to defend yourself from medical debt collectors.

Medical Debt Defense & Charity Care

This page is designed to help self diagnose and potentially self resolve medical debt issues.  If you would like our services, we will ask these questions as part of our analysis.

Simple flow of a medical bill (when there are no problems)

  1. Medical service rendered
    • If you scheduled the visit in the advance, your insurance information is required up front and a financial responsibility form is signed
    • If you were brought in via ambulance or emergency room unconscious, insurance information is usually obtained later and a financial responsibility form is signed later
  2. Medical provider sends a bill to your insurance (if you have insurance, skip if you do not)
    • If the injury was related to an auto accident, your PIP covers first, then major medical, and possibly the other driver’s insurance
    • If it was a workplace injury, L&I covers
    • In all other instances, your major medical covers
  3. If properly coded, your Insurance should pay their portion
    • You would receive an explanation of benefits (EOB) which would detail what the insurer paid and what your responsibility is
    • The insurer would remit their portion to the medical provider
  4. Your portion and charity care options
    • After considering for deductible and maximum out of pocket, you will need to pay whatever your portion is
    • You can apply for charity care, which covers most medical services at public hospitals.  Charity care does not apply to non-public medical providers and some third party providers.

 

Possible problems in the flow of a medical bill

  1. Medical service rendered
    • Were the services claimed actually rendered?  Sometime mistakes, double billing, or fraud occurs.
    • Were the services necessary?  You have a small cut that requires 3 stitches, they give you a CT scan.
  2. Medical provider sends a bill to your insurance
    • Failure to get pre-approval (by you or provider)
    • Improperly coded bill
    • Failure to send the bill within the allowed time
    • Failure to appeal a denial (especially if the provider made a coding or other mistake)
    • Balance billing (illegal in WA state)
    • Provider used the wrong charge (uninsured rate vs insured rate for example)
  3. Insurance acceptance or denial of claim
    • Denial because of error from medical provider (time frame, coding, etc)
    • Denial because of no pre-approval
    • Denial because it is deemed experimental or unnecessary
    • Other situations where it may be an unfair denial
  4. Your portion
    • You paid but they applied it to the wrong account
    • They won’t accept your payment
    • Violation of payment plan by medical provider
  5. Charity care
    • You were not told of charity care options by the provider
    • You are told you can’t apply (because you are in collections, too old, etc.)
    • You are qualified now, but were not at time of event (but they won’t consider current income)
    • You were qualified then, but not now (and they failed to consider you at the time of services)
    • They unfairly denied your by not considering your budget, losses, etc. (appeal it)
    • They will not let you appeal (wrong, you can)
    • They tell you that you can’t apply if you are in collection (wrong, you can)

 

What we need you to do prior to scheduling with us

  1. If you are wanting to resolve this and other debts with a Bankruptcy, just click to our scheduling page.
  2. If you are wanting to defend your case on the merits and look at non-bankruptcy options, we need you to complete steps 3-8 prior to scheduling.
  3. Make sure that if you have been served a summons and complaint, that you submit a notice of appearance.
    • Link to free notice of appearance form
    • Submit the NOA per the instructions on the form, this will buy you a month or two in order to get the below information and schedule with us without pressure
  4. Strategy: you are trying to determine if the bill is legit or if someone made a mistake
    1. Did the insurer handle it properly?  To determine this follow step 5
    2. Did the medical provider bill it properly?  To determine this follow step 6
    3. If you applied for charity care (or want to) was it handled properly?  Follow step 7
    4. If everything checks out, the bill is legit and we can discuss options to resolve
    5. If there is an error, you may have a defense that could lead to a counter claim, defense, or good leverage for a settlement
  5. Contact your insurer
    • The purpose of this call is to see if a claim was accepted or denied.
    • When you call, take notes.  Start with the time/date of the call.  When you speak to someone, get a reference number and their name.  Ask them to explain things to you.
    • If the claim was accepted and the insurer paid something out, it was likely billed properly and paid properly.  Get copies of your EOB’s but DO NOT send them to us at this stage.  We just need to know if your insurer paid.
    • If the claim was denied, we need to know why.  Get the EOB’s for each denial and have them on hand for when we talk.  DO NOT send them to us at this stage.  Ask for a verbal explanation from the agent for each denial.  Ask specifically if the medical provider did anything wrong or could have done something different for the claim to be approved.  Take detailed notes as to their explanations.
    • Use what the insurer provides to focus your records request below in step 6 with your medical provider
      • example: your claim was denied for lack of pre-authorization, ask your provider if they requested pre-authorization
      • example: your claim was denied for them not sending the bill within 1 year, ask for copies of the bills they sent to insurance with any confirmations
      • example: your claim was denied and the insurer sent them a letter to explain it was the wrong code, request evidence of what they sent to the insurance (to confirm the wrong code)
  6. Contact your medical provider (optional)
    • Getting your EOB’s will generally tell us what we need, if you do not do this step it is OK.
    • However, some medical providers will disappear information, so getting your medical records and bills are for your own protection.
    • If you think your insurer messed up, it is a good idea to start the process as it can take days or weeks to get records.
    • Be sure when you speak with your provider do not appear angry and make it seem like a routine request.  If possible, give a legitimate sounding reason for your request.
      • Example: explain your insurance is giving you the run around, so you want to get copies of the billing requests sent to them so you can appeal the denial, ask if the medical provider plans to appeal
      • Example: when you request your medical records (most people don’t), you may want to explain that a third party (like an unrelated medical practice) wants the records and you wanted a copy for your records as well
    • You will want copies of your medical records to ensure that if they claimed they performed a service, that they did (we had a client once who was billed for a full arm cast when it was just a thumb brace, the medical records supported her version).
    • Mainly we want the medical bills and evidence of them being sent to make sure the provider did their job.
    • If you are not sure what to ask your provider, that is OK, do your best.  We can always get the records in discovery if this goes to litigation.
    • DO NOT send us copies of your medical records or billings.  We will request them when the time is right, if they are necessary.
  7. Charity care
    • If you applied for charity care, let us know the result and when it was made (so either the approval or denial letter)
    • If you have not yet applied for charity care, that is OK, you can either apply for it or wait to talk to us.
  8. Once you can answer these questions, contact us to schedule

 

Did you have insurance and was it billed properly?

To know if it was billed properly,  you need to get the explanation of benefits that was sent to your insurer.  Compare this to any quotes or bills that you received to ensure there is no mark ups, repeat services, or other fraud.  Medical billing errors and fraud are extremely common.  If necessary, a medical billing advocate can be retained- you can call us for a recommendation if you feel this might be a necessary service.

 

Did you have insurance and was the bill rejected?

If the medical provider bill was rejected, the question is why?  Did the provider tell you it was pre-approved but your insurer said it was not?  That can be a defense.  Did the medical provider code the bill wrong or include repeat charges?  That can be a defense.  Did you appeal the rejection timely?  If not, you might be on the hook.  Get the detailed reasons why the bill was rejected from your insurer to find out what happened.

 

Did you apply for Charity Care?

Charity care is not just for the poor or for those who need a total write off of the debt.  Charity care also functions those making decent wages and just need a payment plan that collections agencies refuse to offer.  Washington State has laws requiring public hospitals to provide charity care options for patients.  See RCW 70.170.060 and WAC 246-453.

To help you to apply for charity care, please see the free charity care packet from Washingtonlawhelp.org

If a medical provider will not give you a charity care application, we recommend that you explain that pursuant to Washington Law you have the right to apply for charity care even if you are sent to collections.  If they still refuse, document the event by using your cell phone to record only yourself (selfie style) with no one else in the frame (privacy/consent issues) and say your name, time, date, and that you are at (name of hospital) and the staff (or name of person you are speaking with) is refusing to give you a charity care application despite your request.  In most instances, they will hand it over.  If not, call us.

Remember, you have the following rights:

If you need our help or would like a free consultation, call (206) 535-2559

If you have exhausted your insurance and charity care options and require a legal defense, give us a call to see how we can help.