Insurance Drama...OH BROTHER....



SO, because my husband had a hard time getting EOB's from his ex wife, he had asked me, because I had time, to call the insurance company and find out the status of claims. I knew how to do this, because I worked Private insurance claims when I worked for an ambulance company, back in the late 80's and early 90's.

In late April 1997, Juanita had called my husband asking to speak to me regarding the reasons we needed copies of the EOB's from her insurance company.

First let me say, apparently, she had forgotten that in 1995, she and Keith  had entered into an agreement that "Any medical, dental, orthodontia, counseling or vision care costs, reasonably incurred on behalf of a minor child, and not covered or paid for by insurance, shall be paid equally by Petitioner (J) and Respondent (K)."

Secondly, due to the fact that this is a CALIFORNIA court order, there is such a thing called, NOTICE OF RIGHTS AND RESPONSIBILITIES Health-Care Costs and Reimbursement Procedures.  KEY WORD, PROCEDURES. I'll get into that later.

When it got to the point where Juanita was not sending the eob's like she should, I would call her (husband's) insurance to get a status of the claim. I would give them information they needed to access the claim. I didn't want to know WHY the kids went  to said providers, or WHAT they went for, I just wanted to know the status of the claim, and what could we do, to expedite the processing of the claim.

In Feb 1997, Juanita wrote, yet again, "I am enclosing the most recent copies of the Eob's  from July 9, 1996 through December 31, 1996. Although I don't understand why you need to see the EOB's from John's insurance company. I keep you updated on the expenses and I am not looking to steal your money..." THIS was funny to us, because we KNEW, when she said Keith owes what his insurance doesn't pay prior to billing HER insurance, that could be construed as "stealing."


SO, back to Juanita's phone call in late April. I did not talk to her on the phone. Instead, on 5-3-97, I wrote her a letter, telling her that simply put, when we receive her copy of the eob from her insurance, we attach it to OUR eob from OUR insurance, so we can keep our records updated as well. This way, when she sends her letters updating past due balances, we can compare the figures intelligently, not blindly, since we will have something to compare it against. I knew she understood this, plus, Keith had also explained his reasons for needing copies of the eob's from her insurance in his court declaration of Nov 1995, as well as in his letters to her dated June 12, 1996, June 16, 1996 and July 1, 1996. Juanita always felt it was none of Keith's business what her insurance paid. She felt that he was to pay one half of what his insurance did not pay, prior to her sending the claim off to HER insurance company for further processing. WRONG. ALL claims were to go through our insurance first, then her's, and THEN they split the difference.

Juanita called our home on May 14th, 1997 to yell at me and accuse me of "invading her privacy" regarding the insurnace, She called again in the 19th, 3 days before I gave birth, and reamed me for calling her husbands insurance to find out the status of claims. She said HE would be canceling coverage on the kids, she accused me of using her husbands social security number without his consent and fraudulently, I was invading their privacy and she was going to sue. WHATEVER....this wasn't the first time she accused me of bullshit and it wasn't going to be the last.

She did not send eobs when she got them. She sent them on HER time, and she admitted it, but it would take anywhere from 1 month to nearly a year, to receive them, and ALL the while, she would complain and accuse Keith of not paying his share. On more than one occassion, he told her he would NOT pay anything on any bill she says he owes, until he has copies of the EOB's from HER insurance.

I continued to call her insurance to find out status of claims. I would also fax, or just give information to her insurance from OUR insurance, if her insurance pended a claim for reason's having to do with our insurance.. I worked well with her insurance. :-) THEY appreciated my efforts to get THEM reimbursed money they overpaid on claims, because "others" ( the provider of service or Juanita) were taking too long.

So my response to this letter from her husband John, goes a little something like this...

"Dear John U,

I have no record on any EOB of calling your insurance in the month of November 1997. Could you please provide proof of your accusation. Since you say the calls I place are recorded, documented somehow, getting proof to support your accusation should be no problem. While I have called them in the past, to find out the status of claims regarding my husbands children, your stepkids, I have no record of calling them in November.

I do not need your permission to call your insurance, especially since I am not calling regarding you or your wife. The only thing I need to "access" your insurance company is their PHONE NUMBER, and that I could get from the phone book or 411. I certainly do not need your medical plan number or your social security number to access your insurance company. Another false accusation on your part. Please provide proof of my using your medical plan number and social security to access your insurance company, as you said. I do concede that you did not give me permission to use your social security number for this purpose, and I have NOT used your social security number for this purpose. I simply picked up the telephone handset and dialed their number. THAT is the only way I know how to access ANY company, including your insurance company.

YES, you did give me permission to pass on your social security number to providers of service we use, when your step children are with us, should the need arise.

GO ahead and revoke, we aren't doing anything illegal. Since your wife takes her sweet time forwarding the eob copies, she's legally required to do so, we will continue to keep track on our side, however necessary.

You have clearly misunderstood what you read or what Juanita told you about the child support agreement. NO WHERE in the agreement that Keith has with Juanita, does it say that "we are to pay half of what his insurance company doesn't pay." NO WHERE. If you or Juanita have read that, PLEASE provide a copy of the order/agreement that shows that verbage. Don't bother, you won't find it, because it doesn't exist.  What it DOES say is ""Any medical, dental, orthodontia, counseling or vision care costs, reasonably incurred on behalf of a minor child, and not covered or paid for by insurance, shall be paid equally by Petitioner and Respondent." You're are right when you say Keith's insurance is Primary. Juanita has sent Keith copies of their insurance cards and has given the kids the cards as well. So, should the need arise to to take one or both of the kids to the doctors, we give our insurance information and the kids give them your card for them to make a copy of for billing purposes. Juanita having claims processed through your insurance is NOT a choice. It is required. While she may not be court ordered to carry insurance, she IS obligated to use any and all insurance available to her. If she wasn't married, and worked at a job that did not offer insurance, then she would have no insuranc, but since she IS married and you ARE carrying the kids on your plan, then she IS obligated to use it. If she has an issue with that, she needs to talk to her attorney, get clarification or file papers in court and have the judge explain it to her. Not only this, but your wife let the court know in 1998 that Keith was carrying Primary coverage and you were carrying secondary.

It's not Keith's issue that your insurance premium "is increasing another by $45.00 a month." Our's goes up as well, every year. Keith has always carried insurance on his kids. Whether Juanita has to carry the kids on insurance is a matter for HER to clear up through her own attorney or with a Judge, since she is the one that seems to not know. Then you could find out as well. Don't threaten. Maybe if your WIFE was more on the ball with getting out the eob's to Keith in a more timely manner, instead of months and months later, no call to the insurance co. would be necessary, but she doesn't, so... We can and do and will continue to call your insurance co. to find out the status of claims pertaining to KEITH'S kids, your step kids, ONLY.

P~


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