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Ex-Husband / Privacy / Timely Billing

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Funkymark:
I am trying to help out my new girlfriend.

Ex-Husband broke into her car (7-4-2009) and took the Heath insurance card Drivers License, and SSN card.

A month later she needed medical care in a town 4 hours away at Hospital ABC.

At time of service (8-2-2009), she was covered under her husbands (now Ex-Husband) heath plan.

She informed the Hospital ABC that provided the medical services that she was cover by her husbands plan but did not know the plan number.

After being discharged, she went to husband employer, (the City) to get the ID number, but since they were going through a legal separation, the City would would NOT provide the ID number.

She tried to get the number from her local hospital, since they had it scanned, and were paying claims, but they refused to provide the ID number also, for privacy issues since the Ex-Husband was the primary policy owner.

All the insurance EOB's were being sent to the Ex-husband since he changed the address for the plan communications.

By the time she was able to provide the ID Number to Hospital ABC, the time to for Hospital ABC to file the claim had passed and Hospital ABC did not submit the claim, and Hospital ABC sent her to collections and a judgment was issued that she must pay the entire amount.  Her wages are being garnished.

A month after the judgment was issued I got involved.  I got the UB form from Hospital ABC billing supervisor and submitted it to the Insurance provider which processed the claim (9-15-2011). 

The insurance provider EOB says the patient responsibility is $0.00.  Claim was not submitted timely based on the contract between the Hospital ABC and the insurance provider.

In the Insurance Company EOB message it says " This service was submitted for payment after the claim filing time limit. The member is NOT responsible for this amount." (which was the entire amount of the claim)

She did provide Hospital ABC the ID number as soon as she possibly could.

She was sued for the entire amount of the bill and lost and has a judgment to pay the entire amount.

She is an honorable person, and wants to pay her fair share, but not the entire bill.

Thank you in advance for you assistance.

SLITTLES:
This is such an unfortunate case that I have seen happen often just not to this extent.  From the hospital's point of view, they could not file the claim within the timely filing limits because they were not given the proper information to file the claim so it's her responsibility to pay.  Did she explain her situation to them because it's not that hard to get an ID number once you have other identifying information? I'm not sure what can be done at this point since it has been adjudicated in court but has she tried to negotiate only to pay a portion of the bill considering the circumstances???

rdmoore2003:
she could try to appeal with the insurance company and explain to them the circumstances.   Does she have proof that the ex stole her belongings and if so was there a police report filed?   I have also had a similar issue (not to this extent) with a patient, but it was theft by a coworker and due to police report her insurance was appealed and she won the case about 2 years later. 

Funkymark:
She did provide the ID Number verbally on (4-2010).  The Hospital ABC did not submit the claim to the insurance provider.  The first claim to insurance was (9-15-2011) when I got the UB form from the Hospital Billing.  The hospital billing supervisor said she would not submit the claim from her end as she "did not want to have to write this bill off."

No police report was filed on the car break in. No cash, No wallet, CD's, or Stereo's we taken.  Only Drivers License, Insurance ID Card, and SSN.  Only things to make her life difficult. The Ex-Husband (an on duty cop at the time) did plead guilty to Misdemeanor Vandalism (her car) and Unlawful disclosure of Dept. of Motor Vechile records (hers also).

We spoke to the insurance company and we told she owes NOTHING to the hospital, and the EOB says her responsibility is zero.

The insurance company also said that since they have a contract with Hospital ABC, that if they try to get her to pay, they are "Double Dipping" and volating the contract they have with the Hospital ABC.

The insurance company said the Hospital should have used "reasonable and customary" procedures to get her Insurance ID number since she was not able to.

This is very frustrating.

Again, thank you all for any thoughts and advice.

rdmoore2003:
It seems that if she gave a verbal insurance id# that facility should have billed the claim.  If the insurance company is on her side, then she really needs to fight this all the way, especially if she can prove that she did give them an id# etc.   in my state, some instances like her wages being garnished, they must repay with interest..... good luck

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