Two bills for same procedure, but different charges on each bill...

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MystiB

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I am going to court Thursday regarding a hospital bill I supposedly owe. The service was 04/05/2010, and just TODAY I received what the lawyer is considering the validation of the debt (that I have been requesting in writing and by phone since 02/2011). (Note - my first bill showed my portion at just under $400, which I paid and no one is disputing. The second bill shows my portion to be over $2000) However, this "validation" is just a fax cover requesting a review of the claim (a particular code) for a higher reimbursement rate. There is nothing to show that this fax cover sheet was not just created today. I have paperwork showing that the "mistake" was in the billing and coding from the hospital, but this "validation" is supposed to show that the mistake was caught by the insurance company. Also - I have TWO different bills for the service - one provided to me on 04/10/10 and another that the lawyer for the hospital provided to me dated 10/10/10. On bill #2, not only is my portion due higher (that's what I'm being sued over), but the names of the medications have changed, different medications have been added, some medications have disappeared, and the quantity has been changed on the medications and services rendered that do match! It looks like they screwed with the billing to make my portion owed increased. Do I have any defense when I walk into court?? Please help!
 
A question or two, and I really am going somewhere specific with this: Was the bill ever submitted to your insurance company, and did they pay any portion of it?
 
MystiB said:
I am going to court Thursday regarding a hospital bill I supposedly owe.

The service was 04/05/2010, and just TODAY I received what the lawyer is considering the validation of the debt (that I have been requesting in writing and by phone since 02/2011).

(Note - my first bill showed my portion at just under $400, which I paid and no one is disputing. The second bill shows my portion to be over $2000)

However, this "validation" is just a fax cover requesting a review of the claim (a particular code) for a higher reimbursement rate.

There is nothing to show that this fax cover sheet was not just created today. I have paperwork showing that the "mistake" was in the billing and coding from the hospital, but this "validation" is supposed to show that the mistake was caught by the insurance company. Also - I have TWO different bills for the service - one provided to me on 04/10/10 and another that the lawyer for the hospital provided to me dated 10/10/10. On bill #2, not only is my portion due higher (that's what I'm being sued over), but the names of the medications have changed, different medications have been added, some medications have disappeared, and the quantity has been changed on the medications and services rendered that do match! It looks like they screwed with the billing to make my portion owed increased. Do I have any defense when I walk into court?? Please help!
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I suggest you defend the case on its merits.

You paid your portion of the bill, based upon the invoice received form the provider and your insurer's statement indicating the payment of their portion.

If you prove those two elements, a bill from a collection agency is useless.

I suggest you prove up your case based upon original documents provided from your insurer and your medical provider.

Now, it isn't your job as defendant to prove the plaintiff's case.

It isn't your job to seek "validation" from the THIEF that is trying to pick your pocket, unless its the IRS. But, I digress, sorry.

You can present the "validation documents - meaning DOCTORED) to contrast and compare them to your original documents received from the medical provider and the insurer along with PROOF of what you paid.

This case is a bottom feeding debt collector scam.

Don't help the thief PROVE what he's alleging you owe, force the THIEF to disprove your assertions (and PROOF) that this matter was closed three years ago when it was paid in full by you and the insurer.

Finally, the THIEF'S assertions are for more.

That's how he gets paid for NOTHING.

Whatever you do, don't agree to settle to avoid going to court.

If he moves for dismissal, counter that for dismissal with prejudice.

That way he can't bring this zombie lawsuit back to life to scam you again.
 
Thanks, army judge. That's what I thought - if they pull out this "second bill" and try to enter it into evidence, then I will start asking the questions of where did that charge come from? Why did this charge go away? Why did the quantities change for these charges?
 
cbg - yes, the original bill was submitted to the insurance company. They paid their portion and sent me an EOB that showed my portion owed. I then received an original bill from the hospital showing my portion owed being the same as on the EOB, so I paid it. Supposedly, six months later the insurance company found that they did not reimburse the hospital correctly, so they contacted the hospital to resubmit the bill. Note - the grand total of the bill did not change by one penny! The only thing that supposedly changed was what my portion owed to the hospital was. They are now suing me for that difference. When I received the validation of the debt (that's what their lawyer is calling it), it was a fax cover sheet requesting a review of one of the codes. I have the itemized copy of the first bill, and an itemized copy of the second (supposedly corrected bill) was sent to me after the lawsuit was filed. I just compared the two bills (remember - same grand total) and found that over 50% of the charges are different. There are drugs on the first bill that are not on the second bill; drugs on the second bill that are not on the first bill; the quantities of drugs that appear on both bills (such as saline and lactated ringers) are different; and the quantities of the services that are on both bills (OR time, Recovery time) are different.
 
Okay, so the question is, where did those extra charges come from? Did the hospital re-bill the insurance company with the new charges and that's what triggered this?
 
Yes - supposedly per the insurance company's request, the hospital re-billed (six months after the initial billing and payment). However - the total charge did not change by one penny. What changed were: different medications had been added to the new bill that were not on the initial bill, some medications were not on the new bill that were on the initial bill, and the quantity of some medications and services had been increased on the new bill. The charge that increased from this new bill was my portion (supposedly). I have NO new hospital bill that was sent to me (the lawyer provided it to me citing that it was validation of the debt yesterday) and NO new EOB from my insurance company (neither does the lawyer, the hospital or the insurance company itself). I now question the validity of the debt even more as the new bill has been manipulated.
 
Here's the entire story:

I had a medical procedure 04/05/2010. Received notice on 04/11/10 of $16,226.00 for total charges from hospital being sent to insurance. Received EOB from insurance on 04/29/10 confirming $16,226.00 and my portion would be $396.71. Received bill from hospital on 05/17/2010 that I owed $396.71. Paid hospital $396.71 06/09/2010. I have ALL original paperwork and receipts for this.

Received bill from collections agency on 11/3/2010 that the amount I owed is $1611.98. I sent them all the above paperwork and asked for validation of debt. Received nothing.

Received bill from collections lawyer on 02/03/2011 that the amount I owed was $1803.47. I sent them also all the above paperwork and asked for validation of debt. Received nothing.

Received bill from the same collections lawyer on 12/13/2012 that the amount I owed was $2190.03. Again, I sent them all of the paperwork and asked again for validation of the debt. Received nothing.

Was served 03/11/2013 with a civil suit from the collections lawyer for $1611.98 + 376.13 interest + $250 attorney fees + all costs to date and all future costs of the suit.

I've spoken to the lawyer and asked again for the validation of the debt. All I have received from him was a print out (NOT from the hospital) showing $16,226.00 total and $2008.69 as Co-Insurance charges. I played Devil's advocate on myself and called the insurance company and they have absolutely no paperwork whatsoever supporting the supposed change in the amount I owed. Ditto for the hospital. No one, anywhere, can tell me why my portion of the payment went from $396.71 to supposedly $2008.69 (or the other three amounts I've received letters stating that I owe).

The collections lawyer has already asked for and received three continuances, so the absolute court date is next Thursday. I cannot afford to hire a lawyer, and want to know: Should I file for a motion to dismiss? If so, how would I go about filing that motion?

BTW - I have a THREE INCH BINDER absolutely stocked FULL of all the various medical bills and EOBs and my payments from this time frame of illness. I can PROVE that I pay the bills as they are given (and proven) to me. Just like I paid this one.
 
When you called your insurance carrier's Provider Relations office and reviewed the situation with them, what did they say?
 
That there were no records at all that they could give me. There was no new EOB that they could send to me, there was no formal request for the change that they could send to me, all they had was some notes in their computer system that a code was changed and therefore my portion was increased. Yet somehow, after two years of asking and two days before trial, the lawyer was able to get a fax cover sheet that shows a request to review the codes that was supposedly from the insurance company.
 
That sounds like you were talking to the claims department. I'm speaking of the area that relates to the contracts between the hospital and the insurance carrier. Did you talk to them at all?
 
Yes - I spoke to the claims adjusting department supervisor and the liaison for the insurance companies. Got the same response from both - no records to be found.
 
I'm still not quite sure you talked to the department I mean, but never mind. In any case, it would seem to me that if they can't provide any records that HELPS your case.
 
Yes - I agree. But now what I'm concerned with is this new bill with all these different charges on it (even though the total is still the same). Can I ask to have that bill thrown out of evidence as it was changed?
 
MystiB said:
Yes - I agree. But now what I'm concerned with is this new bill with all these different charges on it (even though the total is still the same). Can I ask to have that bill thrown out of evidence as it was changed?
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You don't have a clue, do you?
Don't play his game. Don't treat his bill as anything more than a scam. Who knows, maybe this scavenger created the bill? Who cares?

Why? Because you are in possession of the ONLY bill that matters. That's the bill the hospital gave you. The bill upon which you paid your portion.

You don't owe anything. Who cares if he says you owe $1,000,000,000? Make him prove his case. You already hold the smoking gun.

I bet he doesn't show. If he doesn't, and you stop yapping, except to request a default judgment, you'll prevail.


Sent from my iPad3 using Tapatalk HD
 
Update!
Today was my court date. I represented myself, and the hospital's lawyer had a witness.

I WON!!!

The judge actually has worked with this particular attorney a lot (it appears that the hospital sues A LOT) and he made the statement that he normally doesn't rule against the lawyer, but in this case they did not show enough evidence to prove their case.

The judge3 himself questioned their witness, and commented that he was just as confused as I was.

Sometimes David can still beat Goliath in today's age.

Now I just have to worry about them appealing it to State court... The lawyer said that he was obligated to appeal. Really? The total cost is less than $2000, and they are now on the hook for lawyer's fees and court costs from today. The want to go all the way with this? I assume that I will be able to get a lawyer now on contingency as I have already won by myself. Any thoughts?
 
Received the Appeal in the mail today...Please help.

Yep - received the Appeal in the mail today. I didn't even get 48 hours of peace. You would think that with being beaten in court by a person representing themselves that you wouldn't want to go to State Court for a $1600 principle. How do I go about getting a good lawyer that will work on a contingency basis, and how do I get the press involved? This is a supposed non-profit hospital and I'm finding A LOT of complaints against them on line. Please help.
 
MystiB said:
Yep - received the Appeal in the mail today. I didn't even get 48 hours of peace. You would think that with being beaten in court by a person representing themselves that you wouldn't want to go to State Court for a $1600 principle. How do I go about getting a good lawyer that will work on a contingency basis, and how do I get the press involved? This is a supposed non-profit hospital and I'm finding A LOT of complaints against them on line. Please help.
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First off, no lawyer wants this case in contingency.
It's a waste of time, and there's no money here.
Contacting the media might help, assuming it piques their interest.
It can't hurt.

The lawyer isn't interested in $1,500. He's representing a debt collector who likely bought old paper for 2¢ to 5¢ on the dollar. So, he wins, he recoups a very good profit. I also suspect they forged what they're calling the "REVISED BILL". I'd call it the "FORGED BILL".


This is simply wash, rinse, and repeat.
On Monday make an appointment to speak with the manger of hospital billing.
Then visit the hospital, meet with the manager, explain what's been transporting, and request they give you a letter indicating that your copy of the bill is valid and that you owe no additional monies.
You should also share with them the 'REVISED BILL".
See what they say about this.
See if they know what's being perpetrated in their name.
 
army judge said:
First off, no lawyer wants this case in contingency.
It's a waste of time, and there's no money here.
Contacting the media might help, assuming it piques their interest.
It can't hurt.

The lawyer isn't interested in $1,500. He's representing a debt collector who likely bought old paper for 2¢ to 5¢ on the dollar. So, he wins, he recoups a very good profit. I also suspect they forged what they're calling the "REVISED BILL". I'd call it the "FORGED BILL".


This is simply wash, rinse, and repeat.
On Monday make an appointment to speak with the manger of hospital billing.
Then visit the hospital, meet with the manager, explain what's been transporting, and request they give you a letter indicating that your copy of the bill is valid and that you owe no additional monies.
You should also share with them the 'REVISED BILL".
See what they say about this.
See if they know what's being perpetrated in their name.
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Thanks! There have been a few updates since I received the Appeal..
First - my boss is an acquaintance of the hospital administrator (my boss is a state rep). After receiving the appeal, I let him speak to her about what had happened. She was adamant that they had sold the debt, but my boss also saw the lawsuit and the appeal with the hospital's name as the Plaintiff, not another company. Also, the lawyer kept referring to "my client" in court, and the judge also referred to "the client."
Second - since I am so fortunate to work for someone who knows people, I was able to get a lawyer to represent me for no charge. He called their lawyer and told him that if they wanted to proceed with the appeal, he wanted to depose the Administrator of the Hospital, the Supervisor of the billing Department and the Supervisor of the Insurance Department for starters.
Third - It's been a week since my lawyer talked to their lawyer. He said that the ball is now in their court and that they have to file the paperwork in State Court for it to go through.
Fourth - If they do decide to go through with it, he is going to counter sue.

My questions:
1. How long does he have to file the paperwork in State Court? My lawyer says that he thinks they will just drop it and not file the papers.
2.. If it does go to trail, what would be a good counter sue amount?

I know my lawyer could answer both of these questions, but I wanted to get a third-party opinion, especially on #2.

Thanks again for your time with this.
 
MystiB said:
Thanks! There have been a few updates since I received the Appeal..
First - my boss is an acquaintance of the hospital administrator (my boss is a state rep). After receiving the appeal, I let him speak to her about what had happened. She was adamant that they had sold the debt, but my boss also saw the lawsuit and the appeal with the hospital's name as the Plaintiff, not another company. Also, the lawyer kept referring to "my client" in court, and the judge also referred to "the client."
Second - since I am so fortunate to work for someone who knows people, I was able to get a lawyer to represent me for no charge. He called their lawyer and told him that if they wanted to proceed with the appeal, he wanted to depose the Administrator of the Hospital, the Supervisor of the billing Department and the Supervisor of the Insurance Department for starters.
Third - It's been a week since my lawyer talked to their lawyer. He said that the ball is now in their court and that they have to file the paperwork in State Court for it to go through.
Fourth - If they do decide to go through with it, he is going to counter sue.

My questions:
1. How long does he have to file the paperwork in State Court? My lawyer says that he thinks they will just drop it and not file the papers.
2.. If it does go to trail, what would be a good counter sue amount?

I know my lawyer could answer both of these questions, but I wanted to get a third-party opinion, especially on #2.

Thanks again for your time with this.
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They won't appeal. Let it go, it's over.

You have no damages. Without damages, you don't hit the lawsuit jackpot.
 
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