Author: Patricia

,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 “

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.

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.

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.)”

(email to stepdaughter this morning)

“Thanks for talking to Thomas on the phone on wednesday afternoon. He really enjoyed it. He told Keith (your dad) all about it. Thanks again.”

It’s apparent to me that when a PARENT doesn’t want anything to do with their child, or their spouse takes issue with child’s parent, they will provide incorrect information to the insurance carrier.

Such is the case now. I had to email Anthony’s benefits dept person today, at 12pm, and let her know the correct information they were provided.

Sarah’s name is spelled SARAH, not SARHA, like their records show. Her birthday is 8/1/93, not 1/28/94. What the hell?

The petty bullshit is annoying as hell. Grow UP for God’s sake, RIGHT!?

Seems I’ve pissed someone off…. can you guess who? LOL

I got a letter today from Coleen. She was NOT happy. Apparently, she read the letter I wrote Anthony.

Her letter is dated 1-7-04, it’s postmarked 1-8-04 and I received it today, Jan. 9th. Good LORD this woman….

Her letter reads as follows: “Patty, I am writting this letter so that we can get a few things straight.

Number 1: Your facts are a little screwed up for instance Tony’s insurance if its so duel dont use it. And if he’s not paying for it who in the hell is. We pay over $700.00 a month for medical insurance so you better screw that head of yours on a bit tighter. 2: We have our own daughter to support, if the $600.00 a month you get off my husband is not enough you get off your fat ass and get a job. You have a lot of nerve bitch. Take us to court and I hope that judge tells you the same thing the last one did. Number 3: Here’s a picture of a cute kid.” And she enclosed a picture of a little blonde haired toddler. No clue who she is, but here is my response to Anthony regarding this letter.

Dated today, Jan 9th, “Dear Anthony “Tony” (rest of legal name),

I am writing this letter so that YOU can get a few things straight.

YOU and I, Anthony, had a child together, NOT Colleen and I, so my “legal business” is with YOU, not Colleen. YOU are court ordered to carry medical insurance on Sarah (legal name). IF I were to quit using one of the two insurances that Sarah is presently covered under, I would quit using my husbands plan.

YOU do NOT pay $700 a month in medical insurance. A letter from your employer dated in 1998 with confirmation as early as today, BOTH state that your employer pays 100% of the premium. There is no cost to you for health insurance that you carry on Sarah or yourself. Remember, when you tried to make this same claim in 2002. NO ONE believed you. Remember the DA’s officer we met with at the Court house called your employer to verify your information, and at that time as well, your employer said there is no cost to you. The Judge didn’t believe you either.

YOU do NOT pay $600.00 a month in child support for Sarah. I have attached a document, a copy of the most recent court order, stating that you are ordered to pay $466.00 a month. Where that extra $134.00 you have someone ELSE believing you are paying in support, is, I have no idea, nor do I care because I KNOW I you don’t pay $600.00 in support.

Congratulations on the baby, IF she is even yours. All Children are cute and all little girls are Princesses. The new child support order I got was filed 9-30-02, “15 months ago”, what a coincidence huh? I know that you tried to claim a hardship for a child that wasn’t yours to support. This should be interesting…

If you do not pay the balance of $284.15 off, on or before Feb. 8th, 2004 like I stated in my letter of Jan 2 2004 to you, then I will take the necessary steps to rectify this problematic situation, legally. Patricia (full name)”

Sent Anthony a letter dated January 2, 2004. I mailed it on Jan 6th and he got it, today, Jan. 7th. In it, I wrote:

” Dear Anthony,

Attached is a copy of the expenses I have paid since 1995. As of December 31, 2003, you are still owing the amount of $284.15, which is the remaining balance due after your $110.01 payment in 1998.

There is absolutely NO reason why this balance cannot be and has not been paid off for 8 years. The child support you pay goes towards Sarah’s monthly living expenses, ie: food, clothing, and shelter. To carry her on your medical insurance (at no cost to you) and to pay one half of her medical expenses as court ordered is on TOP of the child support you are ordered to pay. You KNOW this to be true, by your agreement, in 1998, to pay these outstanding medical expenses at $20-$25.00 a month until there were paid in full. You failed to keep your end of the agreement, when you told that is what you pay child support for and refused to pay any more towards this balance.

As you can see, due to the fact that Sarah has dual insurance, the out of pocket medical expenses are cut drastically, especially where dental is concerned. My husband does not have to carry Sarah on his insurance, and since I am not working, nor am I court ordered to carry insurance on her, these expenses can be much more annually. My husband carries Sarah on his insurance as extra protection for HER, something I am very appreciative of. HE and I have paid all these expenses, $788.32, ($394.16 of it is your half) minus the $110.01 you have contributed.

I have already sent you all the copies of the eob’s and receipts of expenses you owe. I will not send them again.

I am giving you until Feb. 8th, 2004, approx 36 days, to become current on these medical expenses. If you have failed to bring current these outstanding medical expenses from 1995 to present, I will bring this issue before a judge and request a wage garnishment for medical expenses, as well as to be reimbursed for court costs and filling fees.

Any questions? You can write me at the address above, or leave a voice mail at (my phone number) OR, if you have access to email, you can email me at (my email address).

Happy New Year. (My legal name)”

Wrote Anthony that he now owes $394.16, that my husband and I have paid $788.32. I let him know I was giving him until 2/8, approx 36 days to get current and if he fails to, I will bring this issue before a Judge and request a wage garnishment for medical expenses as well as court costs and filing fees.

I told him if he had any questions, he can write me at my home address, leave a voice mail, or email me.

I wrote this on 1/2, took it to the PO on 1/6 and he got it today.

Keith wrote his ex and his daughter at 3:58pm. He addressed the email to his ex, stating, “(her name), I have no idea what lies you have been telling (daughter), but I don’t know ANYTHING about this. If I owe you money, then maybe you should start sending me copies of bills and copies of EOB’s so that I know what and that I owe instead of whining to (daughter) about how I won’t pay for something, when I don’t know anything about it. Court Orders say I have to pay half of uncovered medical, and I can’t pay for things that I know nothing about. “