Consumer complaint received 2020-02-28
Company: Arcadia Holdings, LLC
State: PA
Product: Debt collection
Sub-product: Medical debt
Issue: Attempts to collect debt not owed
Sub-issue: Debt was paid

Complaint:
On XX/XX/XXXX, I went to the Emergency Room at XXXX Hospital in XXXX, PA. XXXX Hospital later sent me a bill for {$250.00}. For approximately a year and a half I have contacted XXXX Hospital billing about the error as the services were paid in full by my primary and secondary insurance companies up to the contracted allowed amount with no patient responsibility. I had sent them the Explanation of Benefits ( EOBs ) and had my secondary insurance company contact them via phone and provider education letter. A representative from my secondary insurance company advised XXXX Hospital that it was a contract violation to bill me, the member. Every time I thought that the situation was resolved, a few months later I would again receive a bill in the mail, starting the process all over. Note that I was advised by a billing representative from XXXX Hospital that in XX/XX/XXXX a new billing company took over since there were so many errors from the previous company. I was also advised that any debts sent to collections were being recalled due to the errors. However, shortly after, my account was indeed sent to collections by XXXX Hospital. 

Note that the secondary EOB shows that the contracted allowance for the services is {$660.00}, The primary insurance issued payment in the amount of {$400.00}, and the secondary issued payment in the amount of {$250.00} with no patient responsibility. Also note that there is a remark that states that this amount represents the copayment required for emergency room services for which the secondary insurance paid. This statement is incorrectly being interpreted by Arcadia representative XXXX XXXX to mean patient responsibility. Because the insurance is secondary, it pays the co-payment leaving a {$0.00} patient balance. Also note in one of the bills from XXXX Hospital that I attached, they acknowledge total payments of {$660.00}, the contracted allowance. 

Below is a timeline of my contacts and attempts to resolve this matter after it had been sent to collections. 

XX/XX/XXXX Date of correspondence from Arcadia Recovery Bureau , LLC informing me that creditor XXXX Hospital, XXXX sent my account to collections for the amount of {$250.00}, reference number xxxxxxxxx [ omitted per direction ]. 
XX/XX/XXXX I called Arcadia and explained that this was an error with XXXX Hospital and secondary insurance paid that balance. Representative requested that I email the EOB to them at XXXX. 
XX/XX/XXXX I emailed EOB as PDF to Arcadia. 
XX/XX/XXXX I called Arcadia and spoke with XXXX who confirmed receiving email. XXXX stated that they will reach out after coordinating with XXXX Hospital. 
XX/XX/XXXX A representative called from Arcadia stating that there was no attachment in my email and to resend. I confirmed that email was indeed sent with attachment. I forwarded original email stating such and also included EOB as JPEG format. 
XX/XX/XXXX I contacted Arcadia. A representative confirmed receiving EOB but said that it states co-pay so this is patient responsibility and that XXXX Hospital is stating that payment was not received from secondary. I explained that the EOB is being misinterpreted and that insurance did pay. I was advised to have insurance call Arcadia. I contacted insurance. A representative assured me it was paid on XX/XX/XXXX and there was no member responsibility. Insurance called with me on 3-way and was transferred to XXXX XXXX who was not at desk. Later in day I called insurance company to try again. Representative XXXX spoke with XXXX XXXX who requested for the insurance to submit the EOB. When XXXX relayed this information to me, I explained that Arcadia has EOB. XXXX called back with me on 3-way but it went to XXXX voicemail ( VM ). XXXX left a message advising XXXX that they do indeed have EOB. I then called XXXX Hospital billing and spoke with XXXX, extension XXXX. She was sending the case to a supervisor who would call me back but never did. 
XX/XX/XXXX I called XXXX Hospital billing and spoke with XXXX. Call was disconnected while on hold for supervisor. I called back again later in the day. I was indeed connected with a manager who informed me that I must go through Arcadia since the file has been sent to them and they no longer have access to the records. However, she did tell me that there was a note from XX/XX/XXXX from Arcadia that they were waiting for the EOB. 
XX/XX/XXXX I called Arcadia and spoke with XXXX XXXX. She stated that they need the remit from the insurance company showing proof of payment and to fax to XXXX at XXXX. I called insurance company and spoke with XXXX who informed me that the EOB serves as proof of payment and that this was the first time she had heard of a collection agency requiring additional proof of payment. She called XXXX XXXX with me on 3-way again. XXXX stated that they did not have EOB. I told her where it was emailed to and she retrieved it. She reiterated that she needed proof of payment. I advised that insurance will not provide that, that she is misinterpreting the EOB, and that this should be reported to the Federal Trade Commission. XXXX at some point disconnected the phone call when at no time did myself or the insurance representative speak inappropriately. 

I have spent many hours trying to resolve this matter first with XXXX Hospital and now with Arcadia without success. I want to make a formal complaint regarding how this was handled by both entities. I need help resolving this matter as I have exhausted everything that I can possibly do. Thank you for your time. 

Regards, XXXX XXXX XXXX

Company response to consumer: Closed with explanation