Consumer complaint received 2023-11-15
Company: TRANSWORLD SYSTEMS INC
State: NC
Product: Debt collection
Sub-product: Medical debt
Issue: Attempts to collect debt not owed
Sub-issue: Debt is not yours

Complaint:
In XX/XX/ my wife recieved a XXXX  vaccine from XXXX in the XXXX, NC XXXX at XXXX. Their address is XXXX XXXX XXXX XXXX, XXXX, NC, XXXX. We asked before getting the shot if they accepted our insurance ; the XXXX staff asserted that they did so we went ahead. A few weeks later we recieved a bill for {$170.00} from XXXX for the service. We asked for an explanation, and eventually learned that clinic is out of network for our insurer, XXXX XXXX XXXX of XXXX XXXX XXXX 

We made several calls to XXXX and XXXX, eventually getting representatives from both organizations on one conference call in late XXXX. The XXXX representative noticed that our insurance card indicated our plan was a PPO, but the XXXX agent was stating that our plan is an EPO. XXXX is part of the PPO plan but not the EPO plan. After some complaining on our part that XXXX had caused the problem by sending us the wrong insurance card, the carrier reluctantly agreed to pay for the service but warned us to always check with them before contracting with a new provider. At that time we held XXXX blameless in the matter, as XXXX had commited the original error. We assumed that XXXX would re-submit the claim, as the were on the call, and the notes in everyones records would result in timely payment. We heard nothing more on the matter for several months. 

On XX/XX/XXXX we began getting communications claiming we had an outstanding debt with XXXX / XXXX. We ignored the first text, assuming it was a scam, but my wife called after a follow up message. We learned, after a lengthly conversation, that XXXX had not re-submitted our claim. They had, instead, merely put it on " hold '' without informing us of their actions. Apparently when XXXX puts a bill " on hold '' they don't attempt to contact anyone until it is well past due. The hold was lifted XX/XX/XXXX and the bill was immediately sent to " collections ''. We had no contact with them after the end of XXXX, or we could have tried to sort this problem out before they sold the debt to a collections agency. 

The XXXX agent we talked to asserted that they do not bill insurance companies directly for shingles vaccination, but have the customer enter the claim to be reimbursed to them. The agent claimed this is because the shingles vaccine is somehow coded differently than other vaccinations. This is not true, as they submitted the original re-imbursement request in XXXX. XXXX denied the request because it was out of network, not as a coding error. As a result of XXXX not following the process the agent states is in place we will have to deal with a colletion agency and attempt to secure payment. We believe that XXXX caused these problems by first failing to follow their own processes ( if agent was correct that they don't submit these claims ) and second by not informing us of the steps they now claim are required. XXXX should clean this mess up themselves by re-submitting the claim as they did in XXXX. 

We did ask the agent to send us a copy of the bill so we could assist in getting reimbursement if necessary, but the agent stated that they can no longer send a copy of the bill because it has been sent to collections.

Company response to consumer: Closed with explanation