~This Is My World~

One of the things I noticed early on was the way the ex billed for any services rendered to the kids.

She had an agreement with the providers that she would either pay in full at the time of service, or agree to make payments while a claim is being processed through the insurance. ALL the while, the ex felt that Keith should pay HIS half BEFORE the claims have been properly processed through both insurance companies. HE was like no way. SHE was like, “it’s not fair, you never pay for anything, I pay for it all, you should too while it processes, and blah blah blah..” She even said she would reimburse him should she ever be over reimbursed, which was a joke. ANYWAY.

There was a claim from Sept. that hadn’t been paid yet, and it’s now November. I called our insurance to see if they had even gotten the claim yet and they said it wasn’t showing in their system. So, I filled out a claim form and sent it to them today.

Keith knows it will take 30-45 days to pend, pay or deny a claim.

Upward Modification in Child Support today, beginning 10/1/04 to $630.00 per Judge. Anthony wanted an order for me to show receipts where the $630 goes, SMH. Judge didn’t order it.

She’s too funny. The ex thinks she’s slick. in her email this morning, she wrote, “Want to know your daughter L or your son N- pick up the phone to call. Don’t email. don’t put other people on the phone, don’t have others send things, real simple. Pick up the phone every day for a month and call. You will solve it all with that easy step. I was told by R L at (local hospital) to hit the delete button when you e-mail. You caused such a problem and continue to cause problems for us…I agree with the kids now, don’t e-mail about stuff you nothing about- about kids who you can’t seem to talk to. In fact just leave us all of us alone if you can’t use a telephone.”

SO, to address the first part- “other people” would be my son who called his brother and was hung up on. “Don’t have others send things” would be me. I have sent letters to the kids only to have them returned.

Keith was not happy about what she wrote about the hospital rep. He emailed the billing supervisor later that afternoon to file a complaint against his billing rep. R L. He told the Supervisor he felt it was very inappropriate, unnecessary and very unprofessional for that rep to interfere in something that is clearly none of her business and she is not a party to, other than to collect money for a bill.

He wrote, “Does she even know WHY I emailed my ex wife? I would venture a guess that she doesn’t, but she seems to be of the mind set that she has the RIGHT to tell my ex wife what to do and how to handle the situation between her and I. I emailed my ex wife, because of a concern I have about our daughter. I was NOT expecting to read the email I have attached from my ex wife, and it explained why she refused to answer me.

I appreciate my ex wife sending me this email, and giving me the name of the person she spoke to. I will be forwarding it on to my attorney and letting him know what is going on.

Please speak to R L about her interference. It is not wanted, warranted or justifued. IN fact, it has probably added more fuel to the already out of control fire.

Thanks for your time,

Keith D”

The Money order and check we sent J on 4/27/04 was “delivered to” (POB) and signed for by J on 4/29/04 at 12:15pm.

today at approx 1:20pm, via USPS Signature confirmation, Sent J a check from our insurance co, that was made out to E (L), and sent a money order for the amount of $9.82 which is half of the $19.63 her insurance said is due on another claim.

I called our insurance this morning regarding this claim from 12/1/03. The claim was just paid on 3/25/2004 in the amount of 186.50 and that payment was being sent to the provider of service. FINALLY!

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.

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

,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.