Action: Medical bill may be owed to agency

I had a medical procedure performed on an out-patient basis at Largo Medical Center on April 5, 2000. I am disabled and therefore Medicare is the primary insurance. My husband is retired military, and Tri-Care Prime is the second payer. Largo Medical Center is a Medicare and Tri-Care provider, and under those circumstances accepts what it is paid.

At some time around June 2000, I received a call from Largo Medical Center collections department. I mailed it a copy of the Tri-Care explanation of benefits. Tri-Care had told me to have the billing department send a request for payment -- something had been coded incorrectly -- and it would pay.

My husband and I were away for several months. My daughter was very ill, as was my son. I did not follow up with Largo Medical Center to see if it had resubmitted the bill to Tri-Care.

We returned to our Florida home. I was here approximately 10 days when my daughter passed away on Sept. 15. My mother passed away in October. When I returned from my daughter's funeral, I had this collection letter in the mail. I called the toll-free number to explain, and I was talked to in a very rude manner and told that I would pay $519.66. I had to hang up. I then called the Largo Medical Center billing department, but it never returned my call.

Eventually I was able to reach someone who checked and told me the bill was not in its records. Obviously Largo Medical Center and Tri-Care were able to reconcile the matter. A clerk from the medical center called me and told me it was resolved. She said nothing about the collection agency.

I was recently turned down on a credit application, so I requested a copy of my credit report, and the $519.66 was listed as a non-paid debt. About five weeks ago I received a second notice from the collection agency asking for 50 percent of the bill.

I need help in getting this straightened out and off my credit history. I had major surgery on April 6, and I just cannot call the collection agency; I don't think I can argue with these people. I would be most appreciative for any help you can give in resolving this. Judith Ammons

Response: Our condolenceson the loss of your daughter and mother. We can certainly understand that keeping track of medical bills would not have been foremost on your mind at that time. Now that you are turning your attention back to such matters, however, it appears there is some more work ahead of you. Karen Fry with patient account services with the Largo hospital's corporate parent, HCA-The Healthcare Company in Palm Harbor, said that HCA's records indicate that Medicare paid its portion and the remaining balance was your 20 percent coinsurance portion.

She said Tri-Care was contacted after your complaint letter was received, and it verified that you did not have coverage during the period in question. Tri-Care's records apparently indicate that your coverage with it terminated in May 1998, June 1999 and November 1999. Your benefits did not come into effect again until Feb. 1.

The balance due is therefore still owed, and your account is currently being handled by Attention LLC, for collection effort on behalf of Largo Medical Center. If you are unable to pay the account balance in full, you need to contact Attention to discuss a possible payment arrangement.

You did not send us any explanation of benefits from either Medicare or Tri-Care. All we have are the collection letters from Attention. If you feel your coverage with Tri-Care was in effect when you had the procedure at Largo Medical Center, we would be happy to investigate this for you. However, we will need documentation of your coverage and copies of any correspondence you received from Tri-Care concerning this claim. It is not clear to us why your coverage terminated on three separate occasions, but of concern to you now is whether you were covered on April 5, 2000.

With regard to Largo Medical Center's not having a record of the balance on your account in its system, accounts are often zeroed out once unpaid balances have been sold or turned over to collections. On a final note, it appears this unpaid debt legitimately belongs on your credit report. If it turns out that you did have coverage with Tri-Care on the date in question, then of course you may dispute it. If the dispute is not resolved to your satisfaction, then you have the legal right to add a summary explanation to your credit report.

-- Action solves problems and gets answers for you. If you have a question, or your attempts to resolve a consumer complaint have failed, write: Times Action, P.O. Box 1121, St. Petersburg, FL 33731, or call your Action number, 893-8171, or, outside of Pinellas, (800) 333-7505, ext. 8171, to leave a recorded request for Action. Names will not be omitted except in unusual circumstances. Letters may be edited for length and clarity.

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