ANGRY BIRD

J responded back to me, from my email to her yesterday at 9:10pm.

This morning at 6:03am, she wrote, “Maybe you should get a life, job or hobby. A simple answer to a simple question BITCH”

SUCH an angry bird! What happened to her PEACEful place? LMAO….WOW

she responded to another email from yesterday at 6:05am and she wrote, ” FUCK YOU”

I wrote her at 7:33am and said, “Forgot to add Keith again, no worries, I added him 🙂 Boy, it’s only 605am when you wrote this~ I got that much power over you to get you so riled up so early in the morning? LOL. I hope your day gets better, for the public you deal with sake :-)”

At 7:34am I responded to the email she wrote and called me a BITCH- I said, “It was only 603am when you wrote this! LMAO, you are THAT cranky already!???????? I must SUCK to be you 🙂 Have a GREAT day! I plan on having one 🙂 “

GRACIOUS, and she BLAMED me for the cause of her second divorce…..LORDY.

My Response

At 6:56am, the ex wrote:

“Provider of service told me that the (denial) EOB was mailed to you, and that no EOB’s were sent to (provider of service) as noted by the email. Normally the EOB is sent to the insurance holder not to the clinic. How would I or (the provider) know what the EOB says if neither of us has received one. You must have received one to know what it says. You seem to remember what? (Provider of service) policy and procedure manual. Maybe you should stick your nose into this more and contact (provider of service) and tell them what to do just like everyone else. Again, I have never seen a (Reciprocity) EOB to see what they say should be billed or not but apparently you have seen them. AGAIN I HAVE NEVER SEEN A (RECIPROCITY) EOB AND APPARENTLY NEITHER HAS (PROVIDER OF SERVICE) OR (LOCAL) HOSPITAL BUT YOU HAVE. IT BECOMES DIFFICULT WHEN YOU ARE CONTROLLING MY INSURANCE AND WHERE WE HAVE TO GO TO THE DOCTORS. WHY CANT YOU JUST REMOVE (DAUGHTER) FROM YOUR INSURANCE THE SAME WAY YOU DID FOR (SON). THINGS ARE SO MUCH EASIER WITHOUT YOUR INTERFERENCE.”

At 9:10 pm, I wrote back: *(POS) aka Provider of Service*

” Well, sounds like you have contradicted yourself lol. If (provider of service) told you that the eob was sent to Keith, then (POS) gave you the wrong information, as proven by (Reciprocity) customer service and Visiting Members department conversations with (Rep she spoke to) and I. Maybe (POS) should check their eob’s closer, and document all transactions on them, denials, payments, etc. Maybe they should work off an aging report so they can keep track of which patients of theirs have had their claims paid and which one’s haven’t. (just a suggestion- aging reports are sooo helpful and great to work off of.) Some insurance companies send eobs to the provider only (especially if they are paying a claim, and as in this very case), and some send eobs to both. If (Reciprocity) (I meant *POS) would bill (home plan) like they have been told to do by (Reciprocity) then an eob would be produced and could be sent to you. Until they do, there is no eob. *POS would know because they know how the insurance companies they deal with work, they should know the procedures. Strange, they didn’t seem so “unknowing” of these procedures last year. You would know if one was sent to you, but since you gave Keith the option the option to fax them last year, you lost your chance. :-), because now we don’t get them. (He wasn’t supposed to get them last year either, but they sent a few anyway, shhhh! Our secret, ok? <wink<) Nope, never read *POS policy and procedure manual. Don’t care to. (male REP) send Keith an email last November saying he would have their system set up to bill (Home Plan) as a courtesy. I know today (female Rep) in Customer Service at Reciprocity (that I spoke to) said she would talk to him about billing (Home Plan) as well. OOOOO had to get nasty huh? None of this is my concern. I was just helping Keith out. I know how to use the insuraunce correctly. I know how to use the correct providers. Maybe you should learn how to do the same so these little problems don’t happen anymore. 🙂 You know, I have seen a few eob’s from (Reciprocity), not very pretty. (don’t mean any offense to (Reciprocity of course). The original ones are just black and white, and last year, when Keith faxed a couple off to (*POS), I am sure they still were black and white. Now, (Home Plan) eob’s are quite colorful. They are on a sort of “teal” color papers, you gotta like the color teal to appreciate (Home Plan’s out of the norm, colorful eob’s. 🙂 Why are you yelling? Of course I have seen the eob’s from (Reciprocity). so have you. I know for a fact you have seen eob’s from (Reciprocity) because we have had them before, several years ago., and they were sent to you them. They really haven’t changed much either. Last year, you told Keith to fax them to (*POS) and that’s what he did. In fact, one time, (male Rep) said he didn’t need it because we had one, but Keith faxed it anyway, “just to be safe.” So we know for a fact that (*POS) has received them. Oh, and (Local) Hospital…now I know they have too because they are the ones that billed (Home Plan) for the bill from October 2003, and they couldn’t have done that without the eob from (Reciprocity). Are you feeling left out? you must be since you are yelling. 🙂 Nothing to get so mad about, really. It’s just paper, lol. Uh oh, you are yelling again, (or maybe your caps got stuck?) LMAO, controlling your insurance? Now how in the world can I do that? Is this like causing your divorce from (2nd husband)? (gosh, the power you give me!) No one is controlling where you have to do to the doctors, let alone your insurance lol. Clearly, you don’t use (Reciprocity) contracted providers because if you did, none of this would be happening, and if I was “controlling” where you have to go, you most definitely would be using Keith’s insurance like they way you are supposed to. If he can’t control where you take (her daughter), how can I? lol… As far as removing (her daughter) from Keith’s insurance, I can’t do that. He has to. I didn’t remove (her son) either. I don’t have that power (or control) either. (Her son) got himself removed, Keith just signed the paper. Gosh, you STILL hung up on that? time to move on, I am sure (her son) has. Gosh, I never realized how much power your give me, amazing.”

BTW, when Keith removed his son from his insurance, his son was 19 years old. Keith’s ex threatened lawsuit for him keeping their son on is insurance past his 18th birthday, LMAO….

#Can’tMakeThisStuffUp

December Claim….Still….

,The ex emailed me at 6:55am this morning. She wrote, “This is your insurance and neither myself or the providers need to call anyone to get the claims paid. that is your job. You get it straightened out.”

LMAO… wow, this difficulty is all because she doesn’t use the providers she’s supposed to, nor does she bill properly, BUT…no worries, I can get it straightened out because I used to work private insurance claims at a previous job I had.

I also found it funny how she calls our insurance on whims, and suddenly, because SHE made the issue, she can’t. LMAO….typical.

She sent another email at 6:56 am saying it “was a contradiction of a message.”

She went on to respond that her provider of service told her that “the (denial) EOB was mailed to us, and that no EOB’s were sent to her provider as noted by the email. Normally the EOB is sent to the insurance holder not to the clinic. How would I or (the provider) know what the EOB says if neither of us has received one. You must have received one to know what it says. You seem to remember what? (Provider of service) policy and procedure manual. Maybe you should stick your nose into this more and contact (provider of service) and tell them what to do just like everyone else. Again, I have never seen a (Reciprocity) EOB to see what they say should be billed or not but apparently you have seen them. AGAIN I HAVE NEVER SEEN A (RECIPROCITY) EOB AND APPARENTLY NEITHER HAS (PROVIDER OF SERVICE) OR (LOCAL) HOSPITAL BUT YOU HAVE. IT BECOMES DIFFICULT WHEN YOU ARE CONTROLLING MY INSURANCE AND WHERE WE HAVE TO GO TO THE DOCTORS. WHY CANT YOU JUST REMOVE (DAUGHTER) FROM YOUR INSURANCE THE SAME WAY YOU DID FOR (SON). THINGS ARE SO MUCH EASIER WITHOUT YOUR INTERFERENCE.”

Good LORD, LOL….

At 9:28am I emailed both the ex and the Rep she spoke to earlier. I told both of them that I spoke to woman in Customer service who said she would contact the Rep and fax him a copy of the EOB for dos 12/1/2003, so his department can bill our home plan.

I again told them that for “routine visits and none medical emergencies, it is basically a step program for the lack of a better term. The provider bills our Reciprocity (visiting members) department. They sent out weekly bulk payments which is probably why (provider of service) doesn’t send copies of EOB’s to their patients and understandable how sometimes eob’s are missed. The provider them bills our home plan as instructed to do so on the Reciprocity eob’s for (her daughter). Home Plan sends the eob to Keith and it gets forwarded on to the ex and she bills her insurance. We will never get an eob from Reciprocity and will only get eob’s from Home plan IF they are billed. ALL URGENT (URGENT CARE VISITS) and EMERGENT (ER room visits) MEDICAL CLAIMS are billed DIRECTLY TO HOME PLAN.” I cc’d this email to Keith.

I also sent another email to the ex at 8:03pm, in response to the email she sent to me yesterday, about getting the issue straightened out. I wrote, “Just got this email. How come you didn’t send it to Keith too? No worries. I added him. Actually, it’s Keith’s insurance. You seem to have no problem calling them (our insurance), as you called them last week regarding prescriptions and mail order, surely you could have inquired about this claim from Dec. 03 at the same time. If you guys want this bill paid, then I would think it would be in the best interest to have your provider call them, like (Rep she spoke to) did. The insurance has no problem having providers call for the status of claims. You could probably call yourself, if you wanted to. Wonder why there was no follow up until now. It’s no one’s fault, certainly not Keith’s or (Reciprocity) if (her provider of service) doesn’t document the ENTIRE batch of EOB’s they get. It is straightened out. It’s a very simple and easy process. 🙂 Patricia “

Email from the Ex

SO the ex emailed me at 7:26pm regarding my email to Keith and her. She told me that what she received from our insurance company was “nothing in comparison to the email that was sent to me from you.”

She forwarded the email she received from a rep at our insurance company, and it was wrong information. He said the claim was denied and a denial was sent out January 8th, 2004.

At 10:29pm, I emailed her back and told her that it seemed the rep may have gotten wrong information by not talking to the right department. I told her he should have spoken to the Visiting Members dept (Reciprocity) since they are the ones that handle the claims. I went on to tell her that I spoke to the right dept. and was told that Keith will not get a denial that it will only go to the provider of service. I told her that unless the provider bills our home plan as instructed to do so, with the eob they got, then either the provider can submit the claim to her insurance themselves with the denial eob they received or the provider can send her copies of the denial eob themselves so she can bill her insurance.

December 2003 Medical Claim

I spent some time gathering information on this claim that the ex was taking issue with yesterday. I called our Insurance. I was told that this “missing” eob from this date of service of 12/03 was processed back on January 8th 2004.

JUST an FYI, Insurance companies legally have a 30-45 day time frame to “pay, pend (for more information) or deny a claim.” This claim was processed in 37 days.

Our insurance received the claim on Dec. 23rd, 2003, 22 days after date of service. They received 2 claims. One for 125.00 and the other for 71.50 for a total of 196.50

Where the ex runs into problems is here: If she doesn’t use our insurance providers, Keith will never get an EOB, unless her provider bills our insurance home plan. Keith and I have explained to her that all non emergent claims go through the Reciprocity dept. and all urgent and emergent claims go straight to our home plan. It really is not that difficult.

I emailed Keith and the ex this information at 12:55pm.

Primary Insurance Coverage

Using medical/dental insurance should NEVER be as difficult as the ex made it. She blamed Keith for all the hassles she’s had using his insurance, but it wasn’t his fault. It was “the user’s” (her) fault.

She emailed Keith today at 4:07pm about a claim back from 12/1/03 for their daughter. EX claims that “as of this date, there has been no payment from his insurance and/or no denial of benefits received regarding (daughters) office visit…” She goes on to say that “An outstanding balance of 196.50 still remains now 78 days past the date of service. I have the forms t submit to my insurance however am still waiting for the denial of benefits from your insurance. 78 days is entirely too long to wait to pay a bill. Please mail me the denial of benefits and (provider of service) does not bill my insurance in this case. I have the forms to self bill received from (provider of service.)”