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 “

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