Hi all! I haven't been here in quite awhile, life you know... so forgive me if I am rusty and out of the loop. I am re-learning a lot and as I go I am learning what has changed. So if I ask a dumb question, please overlook it and humor me. I was posting at Art of Credit too, but with everything going on, I am going to go back to only posting here. Besides I think everyone who I was working with there are here too. Here are the two prominent things going on. 1. I am being taken to small claims court by a CA who purchased a debt occurred 7/04. After looking into the debt, the claim for my newborn was submitted to the insurance co. by the drs office before he was added to our policy. The drs office asked us for cash until they got paid by the insurance company but then did not resubmit the claim and was never paid. We did not pay them with exeption of the co-pay. The insurance company assured me that all was well, the baby was added, etc. etc. Until I get a call from the CA who is uncooperative and bullying. Last friday we were served papers. Since this time I called the insurance company who found the problem and sent out the checks to the drs. office. The CA is going forward with the suit. And after checking my CRs the CA is listed on all three. I have been working with flyingifr and am denying the claim and filing a counterclaim, filing a motion for joinders and a motion for a Bill of particulars. I am typing these up and filing on Monday so we'll see where this goes. Is there something I should be doing regarding their entry on my CR? 2. Alrighty... I get a call on Wednesday from a CA about a debt that I think I do owe. However, in light of the insurance problems with the doctor, I would like to make sure that everything with this debt, the hospital, was submitted correctly too. They are not on my CR yet. My plan is to start with a simple validation letter CMRRR. Am I correct in that? Other than those two, our scores are really low right now due in part to our high credit usage. I am working on that. Plus many of our current credit cards are coming to the two year mark this summer. Does that still help? Thanks and it's good to be back! Shelley
Have you received Explanation of Benefit statements on these accounts from your insurance company? These are generally sent when they have processed the claim and are preparing to pay the doctor or hospital.
On which problem? I've received many, many of them. Because I had an emergency c-section, I've gotten bills not only from my doctor, my pediatrician and my hospital but also from doctors I don't even remember meeting including two who just happened to be in and stopped in to check on the baby per my pediatricians request. I am still trying to sort out who is who and what part they played. I am finding out that because the baby was not added to our insurance until I got out of the hospital, a lot of claims were denied and not resubmitted.
Send a written request to the hospital for all parties who should be billing for services. They should know this, since that is where the various doctors, labs, and hospital departments get their billing information. Then follow up by contacting each, to provide your insurance info, whether they have yet contacted you. Are the hospital, and the various doctors, "in-plan", under contract with your insurance carrier?
It is normal for the insurance to allow a new baby to be added to your policy, with full coverage for pre-existing conditions, within 30 days of birth or adoption, retroactive to when it was born or adopted (assuming this is the usual company-provided insurance policy). (I think this is required under federal law, possibly COBRA, ERISA, or some later addition.)
What do they expect? 1) Add your baby to your insurance prior to undergoing an emergency C-section? Not possible, it's not born yet. 2) The moment you wake up from surgury, call your insurance company so the baby is added before the bills go out? The baby was added in a timely fashion, the coverage is in place, so resubmit to get paid. In medical billing, the bills commonly undergo corrections, resubmission, etc, since the original billing information is often not obtained under the best of circumstances. Find out if the hospital has an ombudsman, or someone to assist patients with billing problems. You have coverage, all parties should be happy to get paid. (Plenty of times they don't.) The hospital has an interest in its patients being happy with their services, including billing, even if one of the providers working thru them is obtuse.
