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What to do if your medical bills are turned over to collections

Q. I received a collection notice for a medical bill.  How is this even possible when my health insurance should have paid it?  What should I do now?

A. Medical bills are a serious concern for many Americans.  In fact, a 2017 Gallop Poll revealed that 54% of US adults are concerned that they may not be able to pay their medical costs following a serious illness or accident. So while you are not alone, it is important that you take action now to resolve this debt. 

As a consumer, it is your responsibility to provide your health care provider with all your insurance information so your claim can be filed accurately. If the claim isn’t processed correctly, it is your job, not the health care provider’s job, to resolve it. As a consumer, you are responsible for knowing what kind of insurance you have and what it covers. 

Because the insurance belongs to you, you have the burden of handling this situation. If you ignore a bill, hoping it will go away, nothing will happen to resolve the problem. When a bill goes unresolved or unpaid, it usually ends up in collections.  If it goes to collections and remains unpaid, a provider may opt to file a judgement. You don’t want to go into collections or receive a judgment simply because of an error or a misunderstanding.

To handle this problem, start by contacting the collection agency and asking for a detailed statement of the bill. Next, pull out your health insurance policy and read it carefully. Is the bill for a service that should have been covered? Do you have a co-pay, and the bill you received represents this amount?  Perhaps you had not met your deductible and therefore you owed the medical provider. Did you use an out-of-network provider and incurred higher costs a result? Is the bill for a service you did not receive?  Or is it possible that your health care provider or insurance company did not have all the information they needed for your claim? 

If you’ve kept your “explanation of benefits,” or EOB, from your insurance company, then pull it out and review it for accuracy. If you can’t find your EOB, contact your health insurance company to get a new one. With your EOB in hand, ask to speak to an insurance representative who can help you sort through what happened to your bill and ask them to explain why it wasn’t covered. Does this explanation match what your health insurance policy states?

If there was an error in processing your bill, ask for it to be processed again. It’s possible you may need to submit an appeal to the insurance company to resolve the bill. If you make an appeal, you must follow the appeal’s process. If it turns out you rightfully owe the amount, contact the collection agency and make arrangements to pay what you owe.

Bonnie Spain is the executive director of Consumer Credit Counseling Service of the Black Hills, a United Way member agency. For more information, email credit@cccsbh.com.

The material in this transmission is provided for personal, non-commercial, educational, and informational purposes only. ACCE makes no representations or warranties with respect to the accuracy or completeness of the contents of this transmission and assumes no responsibility for errors, inaccuracies, omissions, or any inconsistency herein. You should consult a professional where appropriate.


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