Florida Old medical bills and HIPAA question

[Vinny94]

Jurisdiction

Florida

Hello... I received 2 letters from a 3rd party billing and recovery company stating that we owe them money from lab work for 2 occasions, Nov 2018 and April 2021. I called them and asked them to provide the detailed invoices for these bills. Here is what they are for.

* In Nov 2018 I had a colonoscopy and the lab they used was out of network so there was a balance of $600.

* In April 2021 My wife had an upper endoscopy and the lab they used was out of network (same lab as above), her balance was $3125.

The lab that they used for both we will call LAB A. This lab was bought out by LAB B and they are using a 3rd party billing and recovery company to collect unpaid bills from LAB A.
We never received a bill from LAB A stating that there was a balance because an out of network lab was used nor did we receive an EOB from my health insurance company. I contacted my insurance company about the missing EOB's and they were able to provide me with the one from 2021 (balance of $3125), still waiting on the one from 2018.
The information that was emailed to us from this 3rd party billing and recovery company included what the insurance paid and what the remaining balance is. It also states
"You can see that you signed a financial agreement agreeing to pay the charges of LAB B".
We never signed any agreement to any lab. When we told them to provide this agreement they eventually said it was typed on that letter by accident (there is no such signed agreement).
Also in the email that they sent to us was very detailed doctor lab results. Should they have that in their possession ? Is that a HIPAA violation ?

With all I stated here, am I still legally obligated to pay these charges to them ?

TY

 

[Redemptionman]

You are responsible for all your medical bill outstanding, so yes you will need to pay them. Ask for them to put you on a payment plan. You can pay what you can as you go without them turning you over to collections sometimes.

 

[adjusterjack]

Should they have that in their possession ? Is that a HIPAA violation ?

With all I stated here, am I still legally obligated to pay these charges to them ?

Even if it was a HIPAA violation you still owe the money.

You can report the alleged violation to:

Filing a HIPAA Complaint | HHS.gov

Then it's between them and the government.

 

[Zigner]

Attempts at collecting payment are generally exempted under HIPAA, and having a detailed list of the procedures is a necessary part of the collection process.
268-Does HIPAA prevent health plans and providers from using debt collection agencies

 

[Tax Counsel]

Hello... I received 2 letters from a 3rd party billing and recovery company stating that we owe them money from lab work for 2 occasions, Nov 2018 and April 2021. I called them and asked them to provide the detailed invoices for these bills. Here is what they are for.

* In Nov 2018 I had a colonoscopy and the lab they used was out of network so there was a balance of $600.

* In April 2021 My wife had an upper endoscopy and the lab they used was out of network (same lab as above), her balance was $3125.

Is that a HIPAA violation ?

With all I stated here, am I still legally obligated to pay these charges to them ?

TY

Medical bills are contractual obligations. If these medical providers are in Florida, then the statute of limitations (SOL) for the creditors to file a lawsuit against you to collect what they claim is owed is 4 years for an oral contract and 5 years for a written contract.

Assuming that the November 2018 colonoscopy exam was done under a written contract then the medical provider has until November of this year to file the lawsuit to collect. It's pretty much certain that there was a written contract for this. All significant non-emergency medical procedures are done under written contract, and colonoscopy/endoscopy procedures would fall into that category. I've had many colonoscopies and endoscopies done over the last 30 or so years with different providers in several different jurisdictions. And all of them had me sign a stack of documents before they would start the procedure, including consent for treatment, an explanation of the procedure and its risks, my agreement to pay for the procedure, and an assignment allowing the provider to directly bill my health insurer for its portion of the bill. Unless your provider was careless, or didn't have a clue about medical billing (either because he/she skipped medical billing 101 in med school or didn't consult a lawyer before opening up shop) you would have signed similiar agreements, which would make it a written contract subject to the 5 year SOL. So for the 2018 bill, there would be just a few months to go.

You may, if you wish, just refuse to talk to the provider/collector about that bill and hope that they don't file a lawsuit before the SOL runs out in a few monnths. But be aware of the downside to that: if they do sue you and win, the cost to you will go up substantially since they'll get to tack on court costs and fees, and if the contract was written well, they'll be able to add their collection costs and attorneys fees to the judgment, too. That $600 bill could balloon up to several thousand dollars.

Note that the SOL has no effect on the reporting of the debt to credit bureaus. That is regulated by a federal law called the Fair Debt Collection Practices Act (FDCPA). In general, negative information can stay on your credit report for up to 7½ years. So even if they miss the chance to sue you, this could hang on to your credit report until spring of 2026 for the November 2018 procedure.

The same basic rules apply to your wife's bill. Being a lot more recent, she has a lot longer before the SOL runs out, so she has a longer time to wait if she hopes to use the SOL as a defense to a lawsuit. And the same risk applies to her, too: if the provider wins, the cost will go up signficantly with attorney's fees and costs tacked on.

HIPAA is a federal law that, among other things, restricts health insurance companies and most medical providers from disclosing your protected health information (PHI) to third parties without your consent except in certain situations. And there are a lot of exceptions. The one most significant here is that the medical provider may share what you owe for the medical work to collection agencies and lawyers to help collect what is owed for the procedure and they may disclose your PHI in a lawsuit where PHI is an issue. If they violate HIPAA your only recourse is a complaint to the U.S. Department of Health and Human Services (HHS). Some states have their own versions of HIPAA that give you a right to sue for wrongful disclosure. Last I checked Florida wasn't one of them. Indeed, Florida is notorious for having poor consumer protection laws in general and I'd be quite surprised if it enacted a HIPAA like bill.

 

[Vinny94]

Attempts at collecting payment are generally exempted under HIPAA, and having a detailed list of the procedures is a necessary part of the collection process.
268-Does HIPAA prevent health plans and providers from using debt collection agencies

Thanks for the reply. My question about HIPAA wasn't to try to get out of paying my bill, I was just concerned why a billing company has my private medical records/results. I understand they need my medical information, but to have such detailed private medical records/results doesn't seem right.

 

[Vinny94]

Medical bills are contractual obligations. If these medical providers are in Florida, then the statute of limitations (SOL) for the creditors to file a lawsuit against you to collect what they claim is owed is 4 years for an oral contract and 5 years for a written contract.

Assuming that the November 2018 colonoscopy exam was done under a written contract then the medical provider has until November of this year to file the lawsuit to collect. It's pretty much certain that there was a written contract for this. All significant non-emergency medical procedures are done under written contract, and colonoscopy/endoscopy procedures would fall into that category. I've had many colonoscopies and endoscopies done over the last 30 or so years with different providers in several different jurisdictions. And all of them had me sign a stack of documents before they would start the procedure, including consent for treatment, an explanation of the procedure and its risks, my agreement to pay for the procedure, and an assignment allowing the provider to directly bill my health insurer for its portion of the bill. Unless your provider was careless, or didn't have a clue about medical billing (either because he/she skipped medical billing 101 in med school or didn't consult a lawyer before opening up shop) you would have signed similiar agreements, which would make it a written contract subject to the 5 year SOL. So for the 2018 bill, there would be just a few months to go.

You may, if you wish, just refuse to talk to the provider/collector about that bill and hope that they don't file a lawsuit before the SOL runs out in a few monnths. But be aware of the downside to that: if they do sue you and win, the cost to you will go up substantially since they'll get to tack on court costs and fees, and if the contract was written well, they'll be able to add their collection costs and attorneys fees to the judgment, too. That $600 bill could balloon up to several thousand dollars.

Note that the SOL has no effect on the reporting of the debt to credit bureaus. That is regulated by a federal law called the Fair Debt Collection Practices Act (FDCPA). In general, negative information can stay on your credit report for up to 7½ years. So even if they miss the chance to sue you, this could hang on to your credit report until spring of 2026 for the November 2018 procedure.

The same basic rules apply to your wife's bill. Being a lot more recent, she has a lot longer before the SOL runs out, so she has a longer time to wait if she hopes to use the SOL as a defense to a lawsuit. And the same risk applies to her, too: if the provider wins, the cost will go up signficantly with attorney's fees and costs tacked on.

HIPAA is a federal law that, among other things, restricts health insurance companies and most medical providers from disclosing your protected health information (PHI) to third parties without your consent except in certain situations. And there are a lot of exceptions. The one most significant here is that the medical provider may share what you owe for the medical work to collection agencies and lawyers to help collect what is owed for the procedure and they may disclose your PHI in a lawsuit where PHI is an issue. If they violate HIPAA your only recourse is a complaint to the U.S. Department of Health and Human Services (HHS). Some states have their own versions of HIPAA that give you a right to sue for wrongful disclosure. Last I checked Florida wasn't one of them. Indeed, Florida is notorious for having poor consumer protection laws in general and I'd be quite surprised if it enacted a HIPAA like bill.

Thanks for the detailed explanation, but its not the surgical center (that performed the procedure) that is asking for payment, its the 3rd party LAB that is seeking payment.
You mentioned the agreement to pay for the procedure that we all sign before anything is done and I'm 100% sure that we signed it, but that was for the surgical center only. We contacted the surgical center and they confirmed that what we signed was for them only, no other facilities.
This is why I questioned LAB B's 3rd parties billing and recovery company when they stated that I signed a document of financial agreement agreeing to pay the charges of LAB B. This document does not exist with my signature.

 

[Tax Counsel]

Thanks for the detailed explanation, but its not the surgical center (that performed the procedure) that is asking for payment, its the 3rd party LAB that is seeking payment.
You mentioned the agreement to pay for the procedure that we all sign before anything is done and I'm 100% sure that we signed it, but that was for the surgical center only. We contacted the surgical center and they confirmed that what we signed was for them only, no other facilities.
This is why I questioned LAB B's 3rd parties billing and recovery company when they stated that I signed a document of financial agreement agreeing to pay the charges of LAB B. This document does not exist with my signature.

When it comes to labwork, generally the contract with the medical provider will include terms obligating you to pay for that. After all, the medical provider doesn't want to get stuck paying the bill for the lab with no recourse against the client. So read the contract with the provider carefully. If it has a section dealing with third party providers like labs, then the medical provider or the lab could sue to enforce that contract. Even if there is no mention of third parties in the contract, you might still owe the reasonable value of the lab work (which might be different than the billed amount) to the lab under principles of equity.