Adrianna Gatlin is facing a $2,450 debt after Pediatrix Medical Group bills her directly for medical services. Why didn't it send her the correct form to process her claim?
Q: After my daughter’s hospitalization, Pediatrix Medical Group sent me a bill instead of billing my medical sharing group, Medishare.
Each time I called, they promised to send a Health Care Finance Administration (HCFA) form so I could submit the claim myself, but it never arrived -- even after six months of calls, emails, and letters.
Now they’ve sent the $2,450 bill to collections. I did everything I could to resolve this. Why won’t they provide the paperwork they need to get paid? -- Adrianna Gatlin, Loxahatchee, Fla.
A: Medical providers have a responsibility to bill insurers -- or in your case, a medical cost-sharing group -- correctly and promptly. Federal law requires providers to submit claims in a timely manner, typically within 90 to 180 days of service, depending on insurer agreements.
While Medishare isn’t traditional insurance, Pediatrix’s initial willingness to bill them suggests it acknowledged their obligation. In reviewing your correspondence with Pediatrix, it looks as if the company was having some trouble finding your membership information through Medishare. But this should have resolved this quickly. Instead, you endured months of empty promises followed by a referral to a debt collector. It should have never gone that far.
Under the Fair Debt Collection Practices Act, you have the right to dispute the debt in writing, which you did. The collections agency must cease collection efforts until they validate the debt. Pediatrix’s refusal to furnish the HCFA form likely violates its own billing policies and potentially the Health Insurance Portability and Accountability Act, which mandates that providers cooperate with patients to resolve billing disputes.
Here’s what should have happened: Pediatrix should have either billed Medishare directly or provided the HCFA form immediately after your first request. Instead, it appears to have stonewalled you -- a common tactic to pressure patients into paying out-of-pocket.
You did almost everything right. You didn't have an extensive paper trail, which suggests you tried to resolve this by phone. Escalating to executives earlier could have helped. Pediatrix publishes the names of its executives on its website. Email addresses at Pediatrix follow the format firstname.lastname@pediatrix.com.
To keep this from happening, always confirm a provider’s status before treatment and request written confirmation of billing agreements. If it refuses to cooperate, escalate your case immediately -- don’t wait for a referral to collections.
I contacted Pediatrix on your behalf. The company dismissed your debt and made arrangements to process your claim with Medishare.
Christopher Elliott is the founder of Elliott Advocacy (https://elliottadvocacy.org), a nonprofit organization that helps consumers solve their problems. Email him at chris@elliott.org or get help by contacting him at https://elliottadvocacy.org/help/