Consumer complaint received 2022-10-28
Company: Healthcare Collections-I, LLC
State: AZ
Product: Debt collection
Sub-product: Medical debt
Issue: Attempts to collect debt not owed
Sub-issue: Debt is not yours

Complaint:
I became a patient at XXXX XXXX in XXXX, XXXX after challenges I had with my previous dentist. The XXXX was so severe, my extractions required an XXXX XXXX and then dentures. I was referred out to a surgeon for extractions and XXXX was going to provide a lower immediate denture as it was a covered benefit under my insurance plan. 
XXXX submitted a claim for an exam and XXXX-XXXX  which was only partially allowed and paid by XXXX, leaving a balance of {$55.00}. I was unaware of the prohibition against balance billing and I was told I had to pay my balance in full or I wouldnt be treated, so I charged the {$55.00} on my credit card when it was a prohibited practice by XXXX. After an initial denial for dentures because of the wrong coding applied in XXXX, they resubmitted for preauthorization and received a preauthorization on XX/XX/XXXX ( XXXX ). Impressions were taken for immediate denture then extractions were performed by another provider and I self paid because I chose to have implants at the same time on XX/XX/XXXX. I returned to XXXX and had denture fitted and claim was filed on XX/XX/XXXX ( Claim # XXXX ). That claim was denied on XX/XX/XXXX because insurance had no proof extractions were performed ( I had self paid another provider who performed additional work not covered by my plan ). I was made aware of non payment by XXXX and stated I would not pay as it was a covered service with preauth obtained, but I did contact my insurance carrier and requested an appeal. The XXXX billing statement from XXXX clearly shows a patient portion due of {$0.00} which is consistent with what the XXXX XXXX states. On XX/XX/XXXX, I returned to XXXX XXXX who performed extractions for next phase of implants and XXXX shows extractions completed however these were not submitted by XXXX  to XXXX because they wanted me to come in to their office and pay them to take XXXX to submit with claim. So, the original decision to deny claim was upheld on appeal and letter was sent out on XX/XX/XXXX. I then received another Bill from XXXX on XX/XX/XXXX showing balance of {$770.00}, the full amount of a covered service, and then a letter not dated threatening to send bill to collections. 
This constitutes balance billing as I have a XXXX  Advantage HMO ( XXXX XXXX XXXX XXXX ) and providers are prohibited under Federal law which bars providers and suppliers from billing an individual enrolled in the QMB program for Medicare  Part A and Part B cost-sharing under any circumstances ( see Sections 1902 ( n ) ( 3 ) ( B ), 1902 ( n ) ( 3 ) ( C ), 1905 ( p ) ( 3 ), 1866 ( a ) ( 1 ) ( A ), and 1848 ( g ) ( 3 ) ( A ) of the Social Security Act [ the Act ] ). The QMB program provides Medicaid coverage of Medicare Part A and Part B premiums and cost sharing to low income Medicare beneficiaries. QMB is an eligibility category under the Medicare Savings Programs. Providers and suppliers may bill State Medicaid agencies for Medicare cost-sharing amounts. However, as permitted by Federal law, States can limit Medicare cost-sharing payments, under certain circumstances. Regardless, persons enrolled in the QMB program have no legal liability to pay Medicare providers for Medicare Part A or Part B cost-sharing. Medicare providers who do not follow these billing prohibitions are violating their Medicare Provider Agreement and may be subject to sanctions ( see Sections 1902 ( n ) ( 3 ) ( C ), 1905 ( p ) ( 3 ), 1866 ( a ) ( 1 ) ( A ), and 1848 ( g ) ( 3 ) ( A ) of the Act ).

This bill should not be my financial responsibility when the provider failed to adequately complete claim process for a procedure that received preauthorization. 
The matter has been sent to collections and is now on my credit report which I just learned when pulling my credit report on XX/XX/XXXX. It is a negative item that potentially can keep me from obtaining housing and therefore a matter of considerable importance to have removed from my credit report. 
I have submitted a corrected claim on XX/XX/XXXX which included the documentation requested by XXXX that the extractions had been performed ( XXXX, treatment plan and receipts for payment of extractions ) in hopes the claim can be resolved.

Company public response: Company has responded to the consumer and the CFPB and chooses not to provide a public response
Company response to consumer: Closed with explanation