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pnbplus1
Family
Member since 5/09 5751 total posts
Name:
Mommy
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Update 1: Need law/lawyer help, recommendations for my parents
Ugh. I am so upset and I'm don't know how to help my parents.
My dad got a hospital bill this past summer for a hospital stay ($6600). His insurance should have covered bc in-network provider it but because it was coded wrong in their system, the processed it incorrectly. HIs responsibility is $585. I noticed when I looked at the claim that they didn't list the hosptial as provider and that was error. Contacted insurance in writing via their messaging system and told them issue and they confirmed it was an error and needed to be reprocessed. Confirmed that his responsibility was only $585. Called hospital told them. This kepy going on for months. I'd contact insurance in writing, they'd say sorry takes 45-60 business days to reprocess, would call hospital and update. In November, my dad got a notice that said bill was going to collections - I called insurance, upset, told them, they again said sorry, we're taking care of it, they asked me for debt collections number, put me on hold, and said they called them and left message saying that it's an error and my dad's not responsible for amount.
I think all's fine, tell my dad all resolved. Fast forward to end of last week and my dad got served with a paper that it was going court! He has to "answer" the paper and I don't even know what that means. My dad is older and he's very sick and he's not going to get better, and he doesn't need this stress. I live OOS but help him with all his stuff.
I guess we need a lawyer since I don't even know what or how to "answer" and only have a few days to do it. Does anyone have recommendations for a lawyer? Also, cost is an issue-he's on fixed income with lots of medical expenses this past year, so do any programs like with law school exists where they take things on for lower cost?
I'm at a loss for what to do and just so upset about this whole thing. I feel like I let my dad down. I mean, he's the one who never pays a bill late. 
Message edited 2/8/2019 10:53:33 AM.
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Posted 2/6/19 11:21 AM  |
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NYCGirl80
I love my kiddies!
Member since 5/11 10413 total posts
Name:
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Re: Need law/lawyer help, recommendations for my parents
I'm sorry this is happening to you. Something similar happened to us and the only way we resolved it was to write to the President of the Hospital. At this point, since it's in collections, you're likely passed working directly with the hospital, but it can't hurt to try. You have a few other options, too.
There are free healthcare patient advocates who can help you navigate insurance issues, though I'm not sure if they will be helpful with the courts.
Next you can (and should) file an official complain with the Attorney General's Office.
And lastly, you can look for advocacy and consumer protection organizations who may be able to assist.
Good luck!
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| Posted 2/6/19 1:25 PM |
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angelicd77
LIF Adolescent
Member since 12/13 794 total posts
Name:
Kim
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Need law/lawyer help, recommendations for my parents
I had an issue similar to this with Stony Brook after my c-section with my son. For 2 years I was getting bills from SBU for over $40k for my hospital stay and whatnot. I had to keep going back and forth between my insurance company and the hospital because they refused to speak with one another. Its such a sh!t show. Its ridiculous that they can get away with this stuff. I hope you get your situation straightened out soon!
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| Posted 2/6/19 2:58 PM |
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tray831
Dee-licious!
Member since 3/06 5355 total posts
Name:
His Baby
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Re: Need law/lawyer help, recommendations for my parents
They're taking him to court for $585?
Something doesn't sound right.
It could possibly be a scare tactic also.
Did you see the actual letter he received by chance? Did the letter come in the mail? Or he was served by a private person who handed it to him at his home?
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| Posted 2/6/19 4:20 PM |
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jm2010
LIF Infant
Member since 8/10 241 total posts
Name:
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Need law/lawyer help, recommendations for my parents
I'm not sure about elsewhere but if it's in NYS, I know that you have to file an answer with the court or they will issue a default judgment to the creditor. I can't help you with exactly what has to be filed but I do know that the state has resources online to help you with the filing.
Most bar associations have referral programs where you can contact them with your issue and they can set you up with a consultation with an attorney for a small amount (usually like $25 or $35). If you choose to hire the attorney, the fee is negotiated directly with the attorney.
And like NYCGirl80 said, if you search, there are insurance advocates who might be able to help you.
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| Posted 2/6/19 4:23 PM |
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NervousNell
Just another chapter in life..
Member since 11/09 54921 total posts
Name:
..being a mommy and being a wife!
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Re: Need law/lawyer help, recommendations for my parents
Posted by tray831
They're taking him to court for $585?
Something doesn't sound right.
It could possibly be a scare tactic also.
Did you see the actual letter he received by chance? Did the letter come in the mail? Or he was served by a private person who handed it to him at his home?
I think she said the bill was for over $6k and he should only have been responsible for the $585 through his insurance.
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| Posted 2/6/19 4:23 PM |
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KarenK122
The Journey is the Destination
Member since 5/05 4431 total posts
Name:
Karen
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Need law/lawyer help, recommendations for my parents
Make sure you have documents from the insurance company saying he only owes $585. Make copies and send one to the collection agency and to the hospital. We had the same issue and also got a letter saying they were going to court. It was bull crap and just a scare tactic from the collection agency posing as a lawyer. Take a good look at the letter.
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| Posted 2/6/19 7:21 PM |
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Mushesgirl
Too blessed to be stressed
Member since 4/09 6691 total posts
Name:
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Re: Need law/lawyer help, recommendations for my parents
contact his congressman, maybe Peter King? And contact the State senators and assemblyperson. call the local news like 7 on your side. Then call the hospital and tell them you are getting the politicians and the news involved too.
This is in addition to the lawyer
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| Posted 2/6/19 7:44 PM |
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Mill188
LIF Adult
Member since 3/09 3073 total posts
Name:
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Re: Need law/lawyer help, recommendations for my parents
If he got served with a summons and complaint he needs to file an answer within 20 days (if personally served) or within 30 days if served by nail and mail.
If you go on the New York courts website there is a form answer. I would contact the local bar association ASAP though for a referral for a collections attorney - maybe one that would work pro bono.
Don’t delay speaking with an attorney though. the clock is ticking and they will enter a default judgment if no answer is served within the time allowed by law.
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| Posted 2/6/19 8:14 PM |
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pnbplus1
Family
Member since 5/09 5751 total posts
Name:
Mommy
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Re: Need law/lawyer help, recommendations for my parents
Thanks everyone. I printed out all my communication with the insurance. I'm so glad I communicated with them via their "message center" because it means I have everything in writing. I am going to file the answer and contact attorneys and also a state representative/Congressman. And I'm going to report this to the insurance board.
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| Posted 2/7/19 1:15 PM |
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Re: Need law/lawyer help, recommendations for my parents
Posted by Mill188
If he got served with a summons and complaint he needs to file an answer within 20 days (if personally served) or within 30 days if served by nail and mail.
If you go on the New York courts website there is a form answer. I would contact the local bar association ASAP though for a referral for a collections attorney - maybe one that would work pro bono.
Don’t delay speaking with an attorney though. the clock is ticking and they will enter a default judgment if no answer is served within the time allowed by law.
If it is $6,000ish it is civil court. Things are slightly different
OP, although I haven't seen anything, I don't think it is a lawsuit based on your timeline. I agree that you should call the collection agency and the law firm (if there is one) and the hospital and show the proof from the insurance company
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| Posted 2/7/19 4:49 PM |
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Aries14
Can't plan life...
Member since 8/08 2860 total posts
Name:
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Need law/lawyer help, recommendations for my parents
what "court" is it coming from?
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| Posted 2/8/19 9:53 AM |
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pnbplus1
Family
Member since 5/09 5751 total posts
Name:
Mommy
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Re: Need law/lawyer help, recommendations for my parents
Update:
I spoke to the law office handling the "debt" and they put it on hold for now. I sent them info showing what the insurance sent me. They called me back and told me they spoke to insurance company and that ins is saying my dad has a $6700 deductible/OOP and that claim was originally processed correctly. This is wrong! I have their benefits document and the deductible is $0 and his OOP max for the year is $6700. It's not that they only start covering once $6700 is met, it's that once he has paid co-pays etc of $6700, they then cover 100%. Law office said insurance stands by their decision. WTF!
Am I crazy? Am I wrong? Am i reading this stuff incorrectly? Either I'm wrong or the people who work at his insurance don't know what they are doing.
Is anyone here an insurance that can provide me some guidance? Ugh!!!
To answera PP's question, it's the District court of Nassau Co, 2nd district
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| Posted 2/8/19 10:53 AM |
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KarenK122
The Journey is the Destination
Member since 5/05 4431 total posts
Name:
Karen
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Update 1: Need law/lawyer help, recommendations for my parents
You need to call your insurance company to clarify what the deductible is. We also have a plan like this and we have to pay the 6700 first before they begin to pay. There is also another max, I think 10,000 that we stop paying co pays after we hit that. If his plan says 6700 deductible then you are liable to pay that amount before insurance kicks in.
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| Posted 2/8/19 11:08 AM |
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ave1024
I Took The Wrong Road
Member since 12/07 6153 total posts
Name:
That Led To The Wrong Tendencies
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Re: Update 1: Need law/lawyer help, recommendations for my parents
Posted by pnbplus1
Update:
I spoke to the law office handling the "debt" and they put it on hold for now. I sent them info showing what the insurance sent me. They called me back and told me they spoke to insurance company and that ins is saying my dad has a $6700 deductible/OOP and that claim was originally processed correctly. This is wrong! I have their benefits document and the deductible is $0 and his OOP max for the year is $6700. It's not that they only start covering once $6700 is met, it's that once he has paid co-pays etc of $6700, they then cover 100%. Law office said insurance stands by their decision. WTF!
Am I crazy? Am I wrong? Am i reading this stuff incorrectly? Either I'm wrong or the people who work at his insurance don't know what they are doing.
Is anyone here an insurance that can provide me some guidance? Ugh!!!
To answera PP's question, it's the District court of Nassau Co, 2nd district
It's a little bizarre that the insurance has 0 deductible and $6700 max, especially in this insurance high cost climate.
All you need to do is pull the explanation of benefits form for this claim. This form will show what his current balances were at the time of the claim. What does this form say? This is the form insurance uses to figure out who pays.
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| Posted 2/8/19 11:16 AM |
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NYCGirl80
I love my kiddies!
Member since 5/11 10413 total posts
Name:
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Re: Update 1: Need law/lawyer help, recommendations for my parents
Posted by ave1024
Posted by pnbplus1
Update:
I spoke to the law office handling the "debt" and they put it on hold for now. I sent them info showing what the insurance sent me. They called me back and told me they spoke to insurance company and that ins is saying my dad has a $6700 deductible/OOP and that claim was originally processed correctly. This is wrong! I have their benefits document and the deductible is $0 and his OOP max for the year is $6700. It's not that they only start covering once $6700 is met, it's that once he has paid co-pays etc of $6700, they then cover 100%. Law office said insurance stands by their decision. WTF!
Am I crazy? Am I wrong? Am i reading this stuff incorrectly? Either I'm wrong or the people who work at his insurance don't know what they are doing.
Is anyone here an insurance that can provide me some guidance? Ugh!!!
To answera PP's question, it's the District court of Nassau Co, 2nd district
It's a little bizarre that the insurance has 0 deductible and $6700 max, especially in this insurance high cost climate.
All you need to do is pull the explanation of benefits form for this claim. This form will show what his current balances were at the time of the claim. What does this form say? This is the form insurance uses to figure out who pays.
I'd agree with this. The best insurance I've ever had still had a deductible for $5k or $10k. Take a closer look at the insurance paperwork or maybe call the insurance company again.
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| Posted 2/8/19 11:33 AM |
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NervousNell
Just another chapter in life..
Member since 11/09 54921 total posts
Name:
..being a mommy and being a wife!
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Re: Update 1: Need law/lawyer help, recommendations for my parents
Posted by NYCGirl80
Posted by ave1024
Posted by pnbplus1
Update:
I spoke to the law office handling the "debt" and they put it on hold for now. I sent them info showing what the insurance sent me. They called me back and told me they spoke to insurance company and that ins is saying my dad has a $6700 deductible/OOP and that claim was originally processed correctly. This is wrong! I have their benefits document and the deductible is $0 and his OOP max for the year is $6700. It's not that they only start covering once $6700 is met, it's that once he has paid co-pays etc of $6700, they then cover 100%. Law office said insurance stands by their decision. WTF!
Am I crazy? Am I wrong? Am i reading this stuff incorrectly? Either I'm wrong or the people who work at his insurance don't know what they are doing.
Is anyone here an insurance that can provide me some guidance? Ugh!!!
To answera PP's question, it's the District court of Nassau Co, 2nd district
It's a little bizarre that the insurance has 0 deductible and $6700 max, especially in this insurance high cost climate.
All you need to do is pull the explanation of benefits form for this claim. This form will show what his current balances were at the time of the claim. What does this form say? This is the form insurance uses to figure out who pays.
I'd agree with this. The best insurance I've ever had still had a deductible for $5k or $10k. Take a closer look at the insurance paperwork or maybe call the insurance company again.
Just on the other side- we have PBA insurance and we have no deductibles at all.
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| Posted 2/8/19 11:38 AM |
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Mill188
LIF Adult
Member since 3/09 3073 total posts
Name:
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Re: Update 1: Need law/lawyer help, recommendations for my parents
Regardless of what the insurance company is saying, please call back the law firm handling the debt and ask them for an extension of time to answer IN WRITING.
Collection firms are notoriously shady, and if the summons and complaint isn't answered within the time period (regardless of what you may been told over the phone), the law firm can file a default judgment against your father. Just ask them for something in writing - even if it's through email.
I'm not saying the firm you are dealing with is like this, but you do need to be careful.
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| Posted 2/8/19 12:02 PM |
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loveus
LIF Adolescent
Member since 9/13 684 total posts
Name:
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Update 1: Need law/lawyer help, recommendations for my parents
For my hospital insurance I have a deductible that includes my co-pay ($250) and 10% of the accepted rate. Once that is met for the year I don’t need to pay the 10%. When I had my children I never met my deductible or had to pay the full amount. It sounds like your dad has something similar.
How does your dad have insurance? Was he in a Union bc if so I would contact them.
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| Posted 2/8/19 1:27 PM |
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pnbplus1
Family
Member since 5/09 5751 total posts
Name:
Mommy
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Re: Update 1: Need law/lawyer help, recommendations for my parents
Posted by ave1024
Posted by pnbplus1
Update:
I spoke to the law office handling the "debt" and they put it on hold for now. I sent them info showing what the insurance sent me. They called me back and told me they spoke to insurance company and that ins is saying my dad has a $6700 deductible/OOP and that claim was originally processed correctly. This is wrong! I have their benefits document and the deductible is $0 and his OOP max for the year is $6700. It's not that they only start covering once $6700 is met, it's that once he has paid co-pays etc of $6700, they then cover 100%. Law office said insurance stands by their decision. WTF!
Am I crazy? Am I wrong? Am i reading this stuff incorrectly? Either I'm wrong or the people who work at his insurance don't know what they are doing.
Is anyone here an insurance that can provide me some guidance? Ugh!!!
To answera PP's question, it's the District court of Nassau Co, 2nd district
It's a little bizarre that the insurance has 0 deductible and $6700 max, especially in this insurance high cost climate.
All you need to do is pull the explanation of benefits form for this claim. This form will show what his current balances were at the time of the claim. What does this form say? This is the form insurance uses to figure out who pays.
With my insurance I go to the doctor or the ER and pay a co-pay, even though I have a deductible. My deductible only comes into play for labs, imaging, and then it's $500.
For my dad, he has $0 deductible and inpatient hospital stays are billed at $195/day for days 1-9 and after this $0/day; this is his co-pay. So for a covered in-network provider, which the hospital is, in this case he pays $195 x 3. He has a Medicare Advantage plan.
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| Posted 2/8/19 2:01 PM |
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MsSissy
xoxoxo
Member since 3/07 39159 total posts
Name:
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Re: Update 1: Need law/lawyer help, recommendations for my parents
Posted by pnbplus1
For my dad, he has $0 deductible and inpatient hospital stays are billed at $195/day for days 1-9 and after this $0/day; this is his co-pay. So for a covered in-network provider, which the hospital is, in this case he pays $195 x 3. He has a Medicare Advantage plan.
Do you have paperwork from the insurance company stating this? If so, where is the insurance company getting their information from?
Can you send the information that you have from the insurance company stating the information above to the lawyer?
ETS: Did you send the information to the insurance to confirm? Sounds like information is being missed or crossed.
Maybe one was an old policy?
Message edited 2/8/2019 2:26:21 PM.
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| Posted 2/8/19 2:24 PM |
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alli3131
Peanut is here!!!!!!
Member since 5/09 18388 total posts
Name:
Allison
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Update 1: Need law/lawyer help, recommendations for my parents
I have a question....if it was coded wrong why deal with the insurance company? The codes come from the hospital billing. You should be dealing with the hospital to change coding.
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| Posted 2/8/19 7:08 PM |
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