Mom's medical insurance decided she was in the wrong plan and took back all the money paid to the hospital. We filed an appeal and it was denied and will not allow another appeal because the mistake was found after over a year. She had Tricare through her ex-husband.
The hospital billed her for the entire amount which she ignored and now it is in collections. Is there any way to negotiate the amount of the bill once it has gone to collections? She could pay the bill, but it will wipe out the majority of her savings.
She is getting so many notices that I don't know if any of them are scams and which ones are real.
What is her next step?
We probably will need a lawyer.
What I would do is contact the hospital and try to make an arrangement to (a) either pay monthly, in installments, or (b) negotiate the outstanding amount down for a complete payoff. This is assuming the charges are legitimate. Then the hospital can claim success in getting the bill resolved, and it doesn't have to pay a collection agency.
Collection agencies are difficult to deal with; their staffs of collectors in my experience are aggressive and focus on getting someone to admit guilt.
First thing you should do though is familiarize yourself with the Fair Debt Collection Practices Act. It might take several readings, but you need to know what your mother's rights are and stand up for them, as debt collectors will trod over someone's rights if they can intimidate and get someone to commit to payment.
Do not admit to ANYTHING, and your mother should take the same position.
Equally important, if I remember correctly (and I haven't reread the FDCPA statute recently), a 30 day period is allowed for the debtor to respond. Failure to do so allows the collection agency to assume the debt is valid. So respond, don't admit obligation for the debt. You don't have to advise them anything else especially if you do initiate negotiations with the hospital.
Send the letter certified mail, return receipt requested, so that you have proof of response to the collection agency's notice.
Unfortunately, some portion of the debt will likely have to be paid. But if there's a way you can use the COVID-19 pandemic as an excuse, try that.
Something else I would investigate: the timing of Tricare's discovery of the payment. If it took a year for them to discover that, it's not your mother's fault that their audit function, or whatever, wasn't working properly. You probably could find an attorney to challenge that, but I don't know if it would be worth the cost.
I do think there are grounds for challenge though as your mother assumed and therefore relied on the presumption that Tricare would cover. It's up to Tricare or the hospital to dispute that, so there really was nothing you could do until your mother was notified.
In terms of determining whether the notices are real or fake, you'd probably need to check the data against your mother's medical records to verify the treatment providers, and more than likely you'd also have to pay for the records.
Has anyone mentioned or suggested applying for Medicaid to adapt to the fact that she may lose much of her savings?
It wasn't until after a year that they realized they moved her but didn't seem to know it was a mistake until after she had an accident and needed emergency care. Prime doesn't care if it is an emergency or not and would have required her to go to another state to get to a military base.
They didn't tell her about the mistake until it was too late to back date anything (over a year).
We filed an appeal but it was refused and were told we couldn't refile.
She has too much in savings to qualify for Medicaid.
She let this go for almost two years before I got involved so I think the best we can do is try to negotiate a lower bill, but I don't know how to do that. I need some suggested scripts to get me started.
Worried raised the issue of garnishment; she's right that SS can't be garnished, but what about your mother's savings? W/o researching and based on memory, assets including savings can be garnished. Your house can't be garnished if title is in your name only, but if your mother has a house, it can definitely be garnished, and not only that, interest accrues a the state rate until the debt is paid off.
Anyway, around $30,000 ended up being written off by the hospital and we can handle the rest.
My mom hasn't been sleeping well for over a year because of this. She has been afraid to open the letters she got. The lesson is, Open Your Mail Before Throwing It Out and don't be afraid to ask for a reduction when your insurance won't pay.
I can't be mad at her, though. She has been through a lot because of my dad and her mother and sisters and government agencies. She's been abused by all of them and is afraid to trust people because most people seemed to enjoy causing her trouble. Getting this dealt with has been a chance to see that there are good people in the world.
There are some other issues with her pension, but she is much more hopeful now about getting them fixed.
Or perhaps go in person to hospital billing office & speak to Mgr Billing? Explain she has little $$$ & the mistake made. I know with me, I’d probably lose my temper...& make bad situation worse...can you remain calm ? Or bring someone with you for support? Hugs 🤗
What I am saying is you always deal with the entity billing you. Does Mom pay anything towards her Tricare. Maybe she would be better finding a supplimental that covers her doctors in her area. Office of aging can help you with this. Be wary of Medicare Advantages. The word "Medicare" is deceiving. Medicare contracts out to these companies. You now use their network doctors. With my friend, a specialist who took Medicare was right down the street, problem was the MA she had didn't list him in network. Thats where you save money when you use their network.
Ignore the Hospital Bill.
The Hospital knows what happened and they admitted your mom and accepted your moms Insurance, when they admitted her.
If you want. You can call the Hospital nit any of the Collection Agency and let them know the best your mom can afford is $100 a month if they won't accept that, then pay nothing at all or set up Auto Bill Pay and pay $25 a month. At least it'll show that she's trying.
Keep your mom's savings as she will need that for her Care.
Mare sure she has the right Insurance now in case she needs treatment or has to go in the Hospital.
2) ignoring it would be the WRONG thing to do
Although they can't garnish SS, they CAN garnish savings and/or put a lien on property such as a house. Keeping mom's savings for the future IS a good idea, but it is also fair game in the collections world. It is better to deal with it to protect any assets one has. If no assets, fine.
Also, this has been impacting her mom's well-being for 2 years now! Better to negotiate, pay it off and help mom be calm again.
Her “day in Federal Court” will happen months from now, if at all. Depends on how much $$ the lawyer charges for billable hours.
As soon as her new status appears in the legal papers, the harassment stops 100%.
If not, simply call the attorney & report the offender.
Get a new phone number on a land line, & shut down the computer, WiFi, etc.
keep the electric bill paid if you need it.
Its been a while. You can keep your home & car usually after the case is heard in Federal Court. That’s up to the judge.
contact the hospital patient liaison. Most don’t know it exists but they advocate for the patient.
My Mom went to collections when they didn’t bill my Moms 3rd insurance. I called and it was to late for them to bill the insurance so they turned it over to collections.
fight this. They’re insurance companies are so greedy.
It was the insurance company's mistake and even though we appealed it, they wouldn't fix it and won't allow another appeal. She was able to get back into the correct plan, but they wouldn't backdate the fix.