In 2022 I was denied full insurance payment of a routine, preventative echocardiogram at Stanford Healthcare to monitor my heart issues. I was balance billed $5000+. The insurance company was HealthNet. The policy clearly indicated full coverage of preventative procedures, without a deductible. They said they did not recognize the procedure as preventative. Fuck them, I know better about what's preventative and what's not than them.
I argued the shit out of it, dozens of e-mails, hours of phone calls, and it was eventually sent to debt collectors. I wrote back to the debt collectors that it wasn't my debt and to stop contacting me. I reported it to a couple of government agencies as well to give them more headaches. I did not pay.
In 2024 it was written off as uncollectible.
(a) Use a virtual mailbox with your health provider so that they don't send debt collectors to your residence. Do not give them your residential address.
(b) Use a virtual phone number with your health provider so that the debt collectors can't call you. Their only option will be mail and that leaves a paper trail which you DO want. NEVER communicate with a debt collector by phone.
(c) Freeze your credit reports with all 3 bureaus so that they cannot use your mailing address to find your residential address.
(d) If they do somehow find your residential address, do NOT answer. Only communicate by mail.
Disclaimer: IANAL, account of personal experience only
Under the Affordable Care Act (Obamacare), there is a very limited and specific definition of preventive care services which health plans are required to cover. An echocardiogram is not on the list.
In your particular case it might have been medically necessary, but not legally classified as preventive. This is a huge hassle for patients because the nuances aren't obvious or clearly documented. It's likely that Stanford Healthcare erred by failing to obtain the necessary prior authorization from HealthNet before performing the procedure.
Since 2022 there are some legal protections against balance billing. Although those might not have helped in your case.
The insurance companies don't have medical training either. I know far, far more about my body's medical situation than them.
Doctors and medical research may supply me with additional medical knowledge, but the insurance company can go to hell. They don't know a damn thing about any of this.
(a) I believe medical debts don't affect credit scores for a long time.
(b) I believe medical debts are required to have complete erasure from a credit report if cleared so if I actually needed my credit score to buy a house or whatever I could take the $5K hit to restore the credit score at that time.
(c) I sent them a formal letter disputing the debt, which I assumed means they can't just take it to the credit agency, they'd have to go to court with me first. (Again IANAL, I don't know how accurate this is.) In any case I was mentally prepared to spend $10K on lawyers and court and give them a absolute hell of a time than pay $5K to pay for healthcare I shouldn't need to pay for. I made it VERY CLEAR to the debt collectors that I was ready to pay for lawyers.
(d) For the forseeable future I don't think I need my credit score for anything. I don't plan to borrow money.
Fwiw, in New York state, medical debt is prohibited from being reported on the credit report or from affecting the credit score. California has also passed such a law that takes effect soon.
New York's law focuses on prohibiting healthcare providers and related entities from reporting medical debt, while California's law directly restricts credit reporting agencies from including medical debt in credit reports.
In 2022 I was denied full insurance payment of a routine, preventative echocardiogram at Stanford Healthcare to monitor my heart issues. I was balance billed $5000+. The insurance company was HealthNet. The policy clearly indicated full coverage of preventative procedures, without a deductible. They said they did not recognize the procedure as preventative. Fuck them, I know better about what's preventative and what's not than them.
I argued the shit out of it, dozens of e-mails, hours of phone calls, and it was eventually sent to debt collectors. I wrote back to the debt collectors that it wasn't my debt and to stop contacting me. I reported it to a couple of government agencies as well to give them more headaches. I did not pay.
In 2024 it was written off as uncollectible.
(a) Use a virtual mailbox with your health provider so that they don't send debt collectors to your residence. Do not give them your residential address.
(b) Use a virtual phone number with your health provider so that the debt collectors can't call you. Their only option will be mail and that leaves a paper trail which you DO want. NEVER communicate with a debt collector by phone.
(c) Freeze your credit reports with all 3 bureaus so that they cannot use your mailing address to find your residential address.
(d) If they do somehow find your residential address, do NOT answer. Only communicate by mail.
Disclaimer: IANAL, account of personal experience only