Consumer complaint received 2019-12-08
Company: CMRE Financial Services, Inc.
State: IL
Product: Debt collection
Sub-product: Medical debt
Issue: Written notification about debt
Sub-issue: Didn't receive enough information to verify debt

Complaint:
XX/XX/XXXX

XXXX XXXX
XXXX XXXX
XXXX XXXX, Il XXXX

XXXX XXXX XXXX XXXX XXXX XXXX  XXXX
XXXX XXXX XXXX XXXX
XXXX XXXX XXXX XXXX
XXXX, IL XXXX
http://XXXX

Attention: Claims

Subject: XXXX XXXX: Request to Retract XXXX Additional Fees

On XX/XX/XXXX, at XXXX XXXX I had XXXX as scheduled at the hospital below:

XXXX Hospital
XXXX XXXX XXXX XXXX XXXX
XXXX, Il XXXX
Phone:(XXXX) XXXX
Re: Patient Account XXXX
Dr. XXXX XXXX XXXX, XXXX 
XXXX
XXXX XXXX XXXX


On the day of the procedure before being admitted, the cashier informed me that I would have to pay $XXXX as a co-payment.  Being that I had gone through the preparation process, but startled of the charge, I agreed to proceed and accepted the payment plan that consisted of $XXXX per month. Payments were paid as agreed on a monthly basis. See Attachment A Patient Account XXXX, XXXX Payment Plan.

I am now in receipt of collection letter from CMRE (collection agency representing XXXX Hospital) demanding an additional payment of $XXXX for the same XXXX procedure conducted on XX/XX/XXXX. CMRE Account #: XXXX. See Attachment B.  The initial letters from XXXX stated that my insurance said I was responsible for the additional charge.

My insurance under the Affordable Care Act’s website, https://XXXX, was with  XXXX XXXX XXXX XXXX Plan (XXXX).  During the time of the XXXX the XXXX Plan was as follows:

XXXX XXXX XXXX XXXX XXXX Coverage ended XX/XX/XXXX
XXXX   
Coverage dates XX/XX/XXXX - XX/XX/XXXX  

If I had been informed at the time of my appointment that additional fees beyond the $XXXX would be required, I would have cancelled the appointment as my income at that time and subsequently could not accommodate such additional fees.  I was not employed but XXXX and receiving social security benefits. Any additional amounts would have caused a financial hardship.  Given that I was not given the opportunity to make that financial decision, the additional charge of $XXXX should be retracted.  Also based on my research, the fee should not have been incurred for the following additional reasons:
1)	According to the Affordable Care Act, preventive screening* XXXX  are to be covered free with no co-insurance or co-payment under the Affordable Care Act. 
2)	CDC supports screening for XXXX  (XXXX  as recommended by the U.S. Preventive Services Task Force because XXXX  XXXX  almost always develops from XXXX  XXXX  (XXXX  XXXX) in the XXXX  or XXXX. Screening tests can find XXXX  XXXX, so they can be removed before they turn into XXXX.
3)	In 2004 the IRS specified that screening XXXX  was a preventive service eligible for first-dollar coverage under these plans and specifically noted that the “removal of XXXX  during a diagnostic  XXXX  is preventive care.”
4)	Provider coding practices and insurance claims processing systems don’t use consistent methods to identify procedures for which cost-sharing should be waived. As a result, insurers have not consistently applied the new ACA preventive care benefit to screening XXXX  if a XXXX  is removed, if the procedure follows a positive FOBT, or if a person is at increased risk for such reasons as a family history. 
5)	In response to the ACA’s new preventive services requirement, the XXXX XXXX XXXX, which maintains the CPT coding system, developed CPT modifier “XXXX” to indicate when a procedure is initiated as a preventive service. Modifier XXXX  can be added to the procedure code; so for a patient who sought a screening XXXX  that resulted in XXXX  XXXX, the service would be coded as XXXX. The doctor’s payment is increased when the XXXX  is removed to reflect the added work, but modifier XXXX  signals the insurance claims processing system to waive the deductible or other cost-sharing that might otherwise apply to the procedure. 
6)	Provider coding practices and insurance claims processing systems don’t use consistent methods to identify procedures for which cost-sharing should be waived. As a result, insurers have not consistently applied the new ACA preventive care benefit to screening XXXX  if a XXXX  is XXXX, if the procedure follows a positive XXXX, or if a person is at increased risk for such reasons as a family history. 

SUMMARY
•	XXXX  are covered by insurance — with no copay, thanks to the Affordable Care Act — when the main purpose of the test is to screen for XXXX  in a person  who is at average risk for XXXX. Private insurance should cover the procedure, called a screening XXXX, in full even if a XXXX  is XXXX, according to XXXX XXXX, a XXXX  fellow at XXXX XXXX and policy expert for the XXXX XXXX XXXX, which issues guidelines for XXXX. The lab work on the XXXX  should also be covered because it is related to the same episode of care, she said, though some insurers may not follow that.
•	When the Affordable Care Act mandated coverage for screening XXXX, some patients got caught in a loophole that allowed patients to be billed if a XXXX  were found, turning what had been a screening test into a diagnostic one. The government in 2013 issued  clarification requiring the procedure be covered in full so long as the initial intent was to scan for XXXX  in a patient who is not considered at high risk for XXXX XXXX.
From a prevention perspective, a screening test would not be considered successful if the follow-up XXXX were not performed to identify XXXX  and/or XXXX  XXXX  that may have caused the positive XXXX  in the first place 

*Definition of screening – According to medical experts, screening is defined by the population to which a test is applied (i.e., individuals who are asymptomatic), not the findings that result from the test itself.XXXX  In the context of XXXX  XXXX, this definition indicates that “screening” would describe a XXXX  that is routinely performed on an XXXX   person for the purpose of testing for the presence of XXXX  XXXX  or XXXX XXXX. Whether a XXXX  or XXXX  is ultimately found should not change the screening intent of that procedure.

This definition of screening is widely accepted in the medical and public health arenas, but is not consistently captured as such within the current medical billing and coding system and is not necessarily embraced by all health plans. Several insurers interviewed reported that cost-sharing should be determined by whether patients were asymptomatic at the time they underwent XXXX—i.e., the procedure was for screening – even if a XXXX  was XXXX. Other insurers said while they consider screening XXXX  to be a preventive service regardless of XXXX  XXXX, their claims payment systems apply cost-sharing depending on how providers code the procedure.

Most XXXX  XXXX  result from XXXX  XXXX  (“XXXX  XXXX”) in the XXXX  of the XXXX  that become XXXX  over time. Because most of these XXXX can be identified and removed during a XXXX, in many cases, XXXX  XXXX  is preventable through timely screening. 

XXXX XXXX is a routine part of screening taking place in approximately half of screening XXXX  for patients who are at average risk of developing XXXX   XXXX. Of the XXXX  XXXX, about half are XXXX  XXXX, which have the potential to become XXXX. Physicians cannot reliably distinguish XXXX   XXXX  from harmless, XXXX XXXX during XXXX, and so typically remove all XXXX  identified during a screening XXXX.

I hereby request XXXX XXXX XXXX XXXX XXXX XXXX  XXXX 
1)	To contact XXXX Hospital to accept the claim and/or recode the service as XXXX   The additional charge of $XXXX for the XXXX services provided on XX/XX/XXXX.  Patient Account XXXX should be rescinded.

2)	Issue to me a direct and detailed statement stating that the charges have been recoded and accepted by XXXX XXXX XXXX XXXX XXXX  and that XXXX XXXX, XXXX   Hospital Patient Account XXXX has been paid in full and that I am not responsible for any additional fees.  

This email is addressed to XXXX  in hopes that the matter is addressed directly.  However, the contact entities below have been sent this same correspondence.  All responses to this request should be snail mail to me at the address above or respond to this email at XXXX.  Phone calls are not an option.

CONTACTS:
XXXX XXXX XXXX XXXX XXXX  XXXX  XXXX
XXXX XXXX XXXX XXXX
XXXX XXXX XXXX XXXX
XXXX, IL  XXXX
http://XXXX
Attention: XXXX XXXX XXXX, XXXX, XXXX, XXXX, XXXX
XXXX

XXXX Hospital
XXXX XXXX XXXX XXXX XXXX
XXXX, IL XXXX
XXXX
XXXX 
Patient Account Services Department
XXXX Hospital
Toll Free Number: XXXX) XXXX-XXXX
https://XXXX
XXXX XXXX XXXX
Chief Financial Officer
XXXX
XXXX


XXXX. XXXX XXXX XXXX, XXXX. 
XXXX
XXXX XXXX XXXX


CMRE Financial Services, Inc. (Collection Agency for XXXX  Hospital)
XXXX XXXX XXXX XXXX XXXX XXXX
XXXX, CA  XXXX
XXXX XXXX XXXX
www.XXXX
XXXX
CMRE Account #: XXXX

Consumer Financial Protection Bureau
XXXX XXXX XXXX
XXXX, IA XXXX
(XXXX) XXXX-XXXX
https://www.consumerfinance.gov/about-us/contact-us/
‎info@consumerfinance.gov

Sources: 
https://XXXX
https://XXXX
https://XXXX
https://XXXX
https://XXXX
https://XXXX
https://XXXX

Company response to consumer: Closed with explanation