Consumer complaint received 2024-11-19 00:00:00
Product: Debt collection — Medical debt
Issue: False statements or representation — Attempted to collect wrong amount
Company: North American Credit Services
State: IL

Complaint narrative:
XX/XX/2024 Consumer Financial Protection Bureau XXXX XXXX XXXXXXXX XXXX XXXX XXXX XXXX Dear CFPB : I am writing to request the CFPBs help to resolve a disputed medical bill of {$5500.00}. The health care provider in this disputeXXXX XXXX XXXX XXXX XXXX XXXX XXXX XXXX XXXX, XXXX, IL XXXXmisrepresented to me that my health insurance providerXXXX XXXX XXXX cover all but about {$2300.00} of the cost of XXXX  XXXX. In XX/XX/2024, XXXX XXXX XXXXXXXX XXXX XXXX XXXX recommended that I have XXXX  XXXXXXXX XXXX XXXX XXXX  XXXX She provided an estimate, which showed that the total cost to meafter my health insurancewould be approximately {$2300.00} ( including surgeons fee and facility fee ). ( The total cost was in fact {$2200.00}. ) XXXX XXXX office assured me they had checked with XXXX and XXXX XXXX ( part of the XXXX XXXX XXXX XXXX, and where the XXXX was performed ) and that it was in network and covered. 

A few weeks after the initial meeting with XXXX XXXX XXXX XXXX XXXX woman named XXXX me and scheduled the XXXX for XX/XX/2024, at XXXX XXXX. A few days later, XXXX telephoned again and said that she had spoken with XXXX XXXX XXXX. XXXX assured me that XXXX XXXX had confirmed that the XXXX was in network and covered by XXXX. Through XXXX, XXXX XXXX confirmed that my total responsibility for the XXXXafter coverage by XXXX XXXX {$2200.00}. Only later did I learn that all of XXXX XXXX  XXXX  were false, and that XXXX told me they had in fact told XXXX XXXX  that my XX/XX/XXXX XXXX was outside my network, and that the cost to me after insurance would be an additional {$5500.00}, on top of the {$2200.00} already paid. 

I first learned of XXXX XXXX misrepresentations six weeks after the XXXX, when I got a second bill for {$5500.00} from XXXX. This was the first time I was told that my XXXX was not in network as XXXX  XXXX had originally ( and falsely ) assured me. ( By this time, I had already paid the {$2200.00} XXXX  XXXX had told me was my total responsibility. This included {$650.00} to XXXX XXXX for the XXXX  fee and {$1500.00} to XXXX. ) I ask that the CFPB intervene on my behalf and direct XXXX and/or XXXX XXXX XXXX XXXX its claim for {$5500.00}. That claim is the result of XXXX XXXX misrepresentations to me. 

Had XXXX  XXXX told me that any part of my XXXX  XXXX was outside my network with XXXX, I would have canceled the XX/XX/XXXX XXXX and sought treatment at an in-network provider. It was reasonable for me to rely on XXXX XXXX assurances as to in-network coverage. Further, it is unreasonable for XXXX XXXX to perform XXXX  XXXX on me after it knowingly provided me with false information as to insurance coverage and cost. This is particularly true where, as here, XXXX XXXX knew that XXXX XXXX had told them the procedure was outside my network, and XXXX XXXX knew the cost to me would far exceed the {$2300.00} estimated before XXXXXXXX XXXX XXXXXXXX, and XXXX all knew about the scheduled XXXX beforehand, and none of them told me it was possible anything would be out of network and not covered. 

I relied on XXXX XXXX assurances regarding health insurance coverage and cost to my detriment. 

Attached is a detailed timeline of the procedure, communications, and billing, along with accompanying documentation. Please let me know if you need any additional information. Thank you for your help. 

Sincerely, XXXX complaint Timeline for CPFB XXXX XXXX XX/XX/2024 XXXX. XX/XX/XXXX, XXXX saw XXXX XXXX XXXX I was referred to by my XXXX, XXXX XXXX XXXX ( both are part of the XXXX XXXX XXXX XXXX ) in her office at XXXX XXXX XXXX XXXX XXXX, XXXX, IL XXXX. She said I definitely needed XXXX XXXXXXXX XXXX XXXX XXXX XXXX was becoming quite constricted. We scheduled a follow up for Monday, XX/XX/2024, to have all the measurements done on the eye and to go over the details. 

XXXX. I saw her again on XX/XX/XXXX, and all the pre-op measurements were done, and she gave me a sheet with the costs. For basic XXXX with no upgrades, which is what I chose, it said the fee was {$370.00} XXXX XXXX -- {$170.00} to the hospital and {$200.00} to the XXXX XXXX Document XXXX ). It sounded like there would be some cost from the facility and that my total out of pocket with my insurance would be around {$2300.00}. While it said these were estimates, I was also told the scheduler would call to collect payment one week before XXXX. 

XXXX. A couple weeks after this appointment, XXXX, the scheduler in XXXX XXXX XXXX, called me and we scheduled the XXXX for XX/XX/XXXXXXXX XXXX XXXX XXXX XXXX XXXXXXXX XXXX XXXX, at XXXX XXXX XXXX, XXXX XXXX, IL XXXX. 

4. A day or two later XXXX called me back and said she had checked with both XXXX and my insurance, XXXX ( Document XXXX, XXXX insurance card ), and that the facility and procedure were in network and were covered. 

XXXX. I received a bill from XXXX  ( Document XXXX ) showing a total bill from the XXXX  side of {$2300.00}, of which {$1600.00} was covered by XXXX, and I would owe {$650.00}. I set up a payment plan for that, which I completed XXXXXXXX XXXX XXXX 

XXXX. Prior to XXXX I also received a bill from XXXX for {$1500.00}, which said it needed to be paid prior to XXXX, and I did. It appeared that would be the entirety of my cost. ( Document XXXX ). The last several times I tried, I could not log on to the XXXXXXXX XXXX site. It appears to be down. 

XXXX. About XXXX weeks after the XXXX, out of the blue, I received a bill from XXXX saying I owed {$5500.00}. ( Document XXXX ). It said the total bill was {$19000.00}, and that Insurance paid {$11000.00}, that I had already paid the {$1500.00}, so I owed {$5500.00}. In a couple messages through XXXX, I asked what insurance they were referring to as XXXX claims they did not pay anything towards that {$19000.00}. I never got an answer on that. 

XXXX. After receiving the bill, I checked my XXXX website and just posted was a claim denied ( Documents XXXX & XXXX ), saying that XXXX was out of network, and it was not covered. 

XXXX. I emailed XXXX XXXX through XXXX XXXX  and explained what had happened, and she forwarded it to her scheduler, XXXX, who replied to me that she had called both XXXX and XXXX and was told it was in network and it was covered. ( Document XXXX ). 

XXXX. So I sent XXXX an appeal ( Document XXXX ), and also emailed XXXX  customer service through their XXXXXXXX ( which I now can not access ) explaining the mix-up and that I was appealing to XXXX ( XXXX XXXX ). 

XXXX. On XX/XX/XXXX I got a letter from XXXX saying my appeal had been received and that I would hear from them within 15 days ( Document XXXX ). 

XXXX. On XX/XX/XXXX, I filed an appeal with the Illinois State Board of Insurance and got an email saying it was received and I would hear from them soon ( Document XXXX ). 

XXXX. On XX/XX/XXXX, I again got the same bill in the mail from XXXX saying I owed {$5500.00} ( Document XXXX ). 

XXXX. On XX/XX/XXXX, I emailed XXXX  billing department through XXXX  with an update and explaining I also filed an appeal with the Illinois State Board of Insurance Document XXXX ). 

XXXX. On XX/XX/XXXX, I received a letter from XXXX saying that my appeal was denied, and that they had listened to a recording of the phone call XXXX referred to, and it was never said that XXXX was in network or that anything at XXXX was covered ( Document XXXX ). 

XXXX. On XX/XX/XXXX, I received an answer from the State Board of Insurance denying the appeal, saying they has also listened to the recording of the phone call ( Document XXXX, XXXX, XXXX ). 

XXXX. I emailed XXXX XXXX again through XXXX XXXX Document XXXX ) and explained that XXXX had denied the appeal and was basically told good luck. I have not heard from her office again. 

XXXX. On XX/XX/2024, I got the same bill from North American Credit Services ( Document XXXX ). I guess it had been sent to a collection agency. I have not paid anything on the bill yet, wanting to get this straightened out. I have paid the full amount I was quoted as an estimate before the XXXX. An additional {$5700.00} ( which would make the total cost to me more than XXXX times the estimate ) is not reasonable.

Company response to consumer: Closed with explanation