Errores de facturas médicas y tus derechos en West Virginia

Ley estatal de West Virginia

West Virginia itemized statement of hospital charges on request

West Virginia directs licensed hospitals and similar institutions to supply, on a patient's request, one itemized statement describing with specificity each service or medication for which a charge is assessed, at no additional cost, for both inpatient and outpatient services.

Lo que puedes hacer: Send the hospital a written request for one specifically itemized statement of charges; the hospital must provide it at no additional cost.

Cita: W. Va. Code § 16B-3-9 · vigente 2024-01-01

Ley federal

No Surprises Act good-faith estimate & patient-provider dispute

Uninsured and self-pay patients are entitled to a good-faith estimate of expected charges before scheduled care. If the final bill from a provider exceeds the good-faith estimate by at least $400, the patient may initiate the patient-provider dispute resolution (PPDR) process.

Lo que puedes hacer: Compare the good-faith estimate to the final charges; where the bill exceeds the estimate by $400 or more, dispute the coding and charges and, if applicable, initiate the federal patient-provider dispute resolution process within 120 days of the bill.

Cita: No Surprises Act, PHS Act § 2799B-6; 45 C.F.R. § 149.610–.620 · vigente 2022-01-01

Ley federal

Section 501(r) financial-assistance & charity-care policy

Tax-exempt nonprofit hospitals must maintain a written financial-assistance policy (FAP), limit amounts charged to FAP-eligible patients to no more than amounts generally billed (AGB) to insured patients, and refrain from extraordinary collection actions before making reasonable efforts to determine FAP eligibility.

Lo que puedes hacer: Apply for financial assistance under the hospital's FAP within the application period (at least 240 days from the first post-discharge billing statement) and require charges be limited to amounts generally billed.

Cita: 26 U.S.C. § 501(r); Treas. Reg. § 1.501(r)-4, -5, -6 · vigente 2016-01-01

Ley federal

Fair Debt Collection Practices Act — debt validation

When a debt is with a third-party collector, the consumer may dispute the debt and request validation. On a timely written dispute, the collector must cease collection until it mails verification of the debt.

Lo que puedes hacer: Send a written debt-validation request disputing the debt; the collector must cease collection activity until it mails verification of the debt.

Cita: Fair Debt Collection Practices Act § 809, 15 U.S.C. § 1692g · vigente 1977-09-20

Dónde reportar un problema de facturación en West Virginia

Si un hospital o asegurador no corrige una factura que viola las reglas de arriba, puedes reportarla a las oficinas del gobierno que las hacen cumplir. Presentar una queja es gratuito, y estas oficinas pueden detectar patrones incluso cuando no pueden resolver una factura individual. Reportar no es garantía de ningún resultado, y esto es información general, no asesoramiento legal.

Agencias de West Virginia

• West Virginia Attorney General — File a Consumer Complaint
• West Virginia Offices of the Insurance Commissioner — Consumer Services

Ayuda federal

• Consumer Financial Protection Bureau (CFPB) — submit a complaint about medical bills or debt collection
• No Surprises Act help (federal CMS) — surprise bills and good-faith estimates

¿Crees que la ley en sí debería ser más fuerte? Puedes encontrar y contactar a tus legisladores estatales de West Virginia para compartir tu experiencia.