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MTBC Medical Transcription Billing Corp Complaint - MTBC violates prohibitions on balancing billing

Review by kapka1 on 2008-05-24
SOMERSET, NEW JERSEY -- Despite repeated attempts to get MTBC customer service to provide the HMO with the information needed to process the claims I was instead sent numerous bills, which in my opinion constitutes a violation of the New Jersey state balancing billing law and the contractual obligations the provider had with the HMO.

Additionally in my opinion MTBC violated Public Law 95-109, Section 805-C when I received another bill after I and the provider requested no further bills be sent to myself or my daughter.

Additional information:
New Jersey HMO Law.
Pursuant to New Jersey law, an HMO must limit its members' liability for services rendered at an in-network hospital to the amount of the co-payment, deductible and/or coinsurance. See N.J.A.C. 11:22-5.6(b). Likewise, an HMO cannot require a member to pay more than his or her co-payment, deductible and/or coinsurance with regard to emergency care rendered at non-participating hospitals. See N.J.A.C. 11:24-5.3(b). Finally, a member cannot be obligated to pay any amount in excess of his or her co-payment, coinsurance and/or deductible obligation for services rendered by a non-participating provider if the HMO referred the member to said provider. See N.J.A.C. 11:24-5.1(a).

Collectively, the above-referenced regulations provide that a member cannot be compelled to pay anything above-and-beyond the member's co-payment, coinsurance and/or deductible relative to care rendered by a participating provider or a non-participating provider if the member was referred to the provider by the HMO or the care constituted emergency services. With regard to such services, a payer must pay the non-participating provider's reasonable and customary fees. Balance billing is not permitted.
Comments:13 Replies - Latest reply on 2012-06-05
Posted by madconsumer on 2008-05-24:
had it ever occured to you, YOU can send the information to the insurance company? i do not think it violates any laws. take matters into your own hands and deal with it.
Posted by Anonymous on 2008-05-24:
Primary responsibility for payment of charges rests exclusively with the patient, regardless of insurance coverage. This is almost universally stated on admissions forms or new patient forms. That one has insurance, does not mean one will not get a bill. Often, healthcare organizations will bill the patient when the HMO or insurance company fails to pay promptly...doing so 'encourages' the patient to pester the insurance company to pay the bill.
Posted by kapka1 on 2008-05-24:
Madconsumer, If you bothered to read my post carefully I stated I have an HMO not insurance, there is a differennce. MTBC would not provide the information needed in order for the HMO to process the claims. My requests for the required information were repeatedly denied by MTBC. Just because you don't think it violates any laws does not mean MTBC did not. Are you an attorney? Despite what you think I have documentation which supports my assertions. Why don't you check out http://www.state.nj.us/dobi/mcprovrights.htm which highlights New Jersey state law that prohibits balancing billing. Next time you should take the time to ask questions before you jump to conclusions.
Posted by kapka1 on 2008-05-24:
Ghost of Doc J, I would agree with you if I traditional insurance and could decide who I would take my daughter to see, but when the HMO directs me to an in network provider I disagree. I have specific documentation that in network providers contractually agree not to bill patients even if the claim is denied. In addition NJ state law prohibits the practice of balancing billing patients that were seen by an in-network provider. The problem with the Health care industry in the US is not 40 million Americans who don't have coverage, instead the problem is putting the patients in the middle of an adversal situation between the HMO's and medical billing services. I'm not suggesting HMO's don't always play by the rules, but the patient should not be responsible for the failure of a billing service or provider to submit a claim properly. MTBC wants to leverage the patient to try to get prompt payment but failed to provide copies of claims submitted to validate the correctness and timeliness of the claims.
Posted by Anonymous on 2008-05-24:
Kapka, I see your points very clearly and agree with you 100%. Have you talked to the NJ Insurance Commisssioners Office yet about what is going on?
Posted by kapka1 on 2008-05-24:
Additional information:
New Jersey HMO Law.
Pursuant to New Jersey law, an HMO must limit its members' liability for services rendered at an in-network hospital to the amount of the co-payment, deductible and/or coinsurance. See N.J.A.C. 11:22-5.6(b). Likewise, an HMO cannot require a member to pay more than his or her co-payment, deductible and/or coinsurance with regard to emergency care rendered at non-participating hospitals. See N.J.A.C. 11:24-5.3(b). Finally, a member cannot be obligated to pay any amount in excess of his or her co-payment, coinsurance and/or deductible obligation for services rendered by a non-participating provider if the HMO referred the member to said provider. See N.J.A.C. 11:24-5.1(a).


Collectively, the above-referenced regulations provide that a member cannot be compelled to pay anything above-and-beyond the member's co-payment, coinsurance and/or deductible relative to care rendered by a participating provider or a non-participating provider if the member was referred to the provider by the HMO or the care constituted emergency services. With regard to such services, a payer must pay the non-participating provider's reasonable and customary fees. Balance billing is not permitted.
Posted by madconsumer on 2008-05-24:
huh, well then .....
Posted by Anonymous on 2008-05-24:
Thanks for the additional info, poster. Your statement is 100% correct. Unfortunately, the current system pits the provider against the patient. This, as superbowl observed from the Monday morning quarterback's position, is the case with this complaint. Thanks for the additional info! The current situation needs to be resolved with both the provider and the patient in mind. Best of luck.
Posted by kapka1 on 2008-05-24:
I faxed off a 29 page complaint to the New Jersey Department of Banking and Insurance. I'm not looking for any monetary gain from this, instead my goal is to bring enough attention to the unlawful practices I experienced by MTBC so that medical billing corporations might be held accountable. Idealistic maybe, but it does no good to have a bill of rights if you don't exercise them. Besides this is my way of sticking it to the man!
Posted by pissedoffchicka on 2010-10-26:
i work for bcbsnj, balance billing can only be stoped when there is a contract and it is infact a medical emergency. if the provider is non participating, they don't have to accept anything as payment in full. even DOBI (department of banking and insurnace) can make them stop balance billing you. a lot of other HMO policy have to stay with in net and can't be balance billed. but check fine print your benefits are only valid if you still have some left. if you have a $500 max that horizon will pay for er visits a year. after that's up, they can balance bill you what ever they want as it no longer matters that you have horizon, because that's now a non covered service and horizon says they have nothing more to do with it. which is why Obama is putting through this new health care reform law, but doesn't care that providers who are not contracted will still bill what ever they want. and monthly payments will get higher for everyone to make up for those who can't afford it, and quality of care drops so much because of the health cut dr's have to take. drs will still do what ever it takes to pay for thei boats and bill houses, even if it means blaming insurnace and taking your money. funfact horizon bcbsnj is actually non profit. your group's monthly payments pay for your clms, we just manage who gets what and cut the dr's a deal for telling our members to see them. they get client-tell and you get a dr who won't balance bill until you run out of benf...sorry if you can't tell i hate my job. yet i still go in everyday to fix what corporate f**ks up.
Posted by pissedoffchicka on 2010-10-26:
super bowl person is a moron, bill marino sits in a big chair and makes sure nothing's on fire. one person believed he had a pull and could do something about claims, this person actually chained himself to bill marino's front yard over $4! because bill wouldn't do anything, the man can't. he can't even name one claim system! he sits in a chair, he has no way to change claims.
Posted by kapka1 on 2010-12-29:
pissedoffchicka thank you for your input but in my particular case the HMO benefit is a federal one. The participating provider did sign a contract that prohibited balanced billing even for non emergency treatment. I don't agree with your comment about super bowl being a moron, but I do agree that the DOBI is a worthless agency for the consumer. I'm sorry you don't like your job. I'm not convinced that the new healthcare law will make things better, just different. For all the grief I have gotten about what I should have done to resolve this sooner from people who think they know the law and don't, it has not been worth sharing this story. MTBC's response to DOBI suggests that after a year of trying to resolve this that I somehow made it impossible to resolve. All I can say is that when a billing department failed to file a claim properly I don't think the patient should be responsible. I realize to many ignorant people this is a crazy concept but I have no problem admitting that I'm a crazy dude who is sick of putting up with stupidity.
Posted by GrimacePCH on 2012-06-05:
I used to work for a billing company that got bought out by MTBC. I watched as they ran every provider into the ground by botching claim after claim. The problem is that their billers are ALL located in Pakistan! Literally! They don't know how to read EOBs, they don't write off for subscribed providers, they don't adequately respond to insurance requests for more information or for updated information. They just go on claiming they're great, spending money and buying up smaller billing companies and putting people out of work by shipping all the jobs overseas.

I know with an HMO you don't really have a choice on where you go, but I would suggest that in the future you find out which billing company a provider uses and avoid any that use MTBC. Be sure to tell the provider that you refuse to go to them while they use MTBC. If you can't get away from doing that because of your HMO, I can only say I feel your pain.

I did medical billing for a company that not only did what they could to help the providers, but they also did what they could to help the patient. Sadly that company no longer exists.

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