Credit dispute with Ambulance Company - Powder Springs, GA

[u/Crafty-Reception9470]

Hi All - I need advice. Long story.

Backstory:
Back in November of 2022 my son was diagnosed with Rhino virus. We took him to the closest hospital which was Wells Star about 7 miles from my house. After 4 hours of treatment they exhausted their efforts and stated he needs to go to Children’s Hospital Atlanta. This was classified as a medical necessity transport. The Ambulance company transported him there on 22nd of November and everything went well. When my son was discharged from the hospital 4 days later, they provided him some pills and stuff to take for a week. The pills ended up making my son really sick and we went back to Well Star on November 29th. They were unable to treat his symptoms and they called the same ambulance company to take him to Kennestone Hospital in Marietta. This trip was also deemed medical necessity transport. Everything went well and my son is doing great.

Issue:
My insurance paid for Nov 22nd transport with no issue. However, the ambulance transport on Nov 29th was denied. Both trips were deemed medical necessity by the hospital and ambulance company. 2023 comes around and the ambulance company is threatening me about going to collections. I called my insurance company and they said if the Ambulance company provides proper documentation and reasoning they will pay. I called the ambulance company again and they said they were going to appeal and keep trying. By end of Summer 2023 I have a collection from them for $2300. I had no idea as it’s only being reported on Experian. I only frequently check transunion and equitax. 2025 comes around and I dispute the collection. Called my insurance company and the ambulance to resolve the issue. At this point since it’s a dispute, they removed it from my credit. Fast forward present time, I am applying for a Heloc, I check all 3 bureaus and it’s now being reported on all 3 reports -25pts. , I got denied the Heloc, along with minor other factors, but my wife and I are extremely upset. We called my insurance company to research the issue and they said the ambulance company has been filing the claim to the wrong account/claims department which is why they are asking for more information. I don’t understand how could they screw up when they sent the first claim correctly which was paid. Since the claim is over 3.5 years old my insurance will no longer pay even though the ambulance company finally has the right information.

Everyone I have spoken to, said I should sue the Ambulance Company for negligence, emotional distress, false credit reporting, FRCA etc… there are so many things that have happened to me due to the collection, loss of high credit limits, denied top rates, denied Heloc etc..

Do you think I can get a FRCA or credit lawyer to take my case? Any suggestions would be helpful.

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[u/kamikidd]

You can sue the ambulance company for damages. They were negligent in their claims processing.

I am very familiar with the claims/documentation requirements for non-emergency transport. It’s difficult for professionals to grasp never mind a layperson.

While the claim is out of timely, the insurance need to send an EOB denying payment and making the provider responsible; this is how they are failing you. You paid for them to protect you from such circumstances of liability.

[u/Crafty-Reception9470 → u/kamikidd]

Thank you so much for the information and for responding.

[u/kamikidd → u/Crafty-Reception9470]

My pleasure. I hope it works, it always sounds better in theory. Just remember the ambulance company had a duty to submit your claim properly since they accepted your insurance (it’s part of conditions of payment and participation if not directly contacted with the insurance).

Then your insurance failed you, because at some point they denied this as patient responsibility.

Wait. Please confirm that there was an EOB issues saying patient responsibility in the first place. If they denied for more info, that is NOT a patient responsibly disposition code. Without that determination, the ambulance company had zero right to hold you responsible for this amount.

Call bot today asking for copies of all EOBs sent or received for the claim/date of service not paid.

After further noodling, the ambulance had the wrong info but successfully got the other claim paid? This makes me think that the insurance company may be fibbing on the part or maybe just lazy to look at the real reason!!!