Billing > Billing

Ex-Husband / Privacy / Timely Billing

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DMK:
Maybe I'm not clear on this, but if the insurance company DID receive and process a claim, then the hospital HAD the information and DID submit a claim. 

If she provided the info timely (but 8/09 to 4/10 is a long time to not have provided information), and the hospital just failed to file the claim timely (and the definition of timely will be different for each insurance company, but for many it's 90 days) then she should be able to have the insurance company back her. 

If she has proof of when she provided the information that will stand up in small claims court.  The facility will have to prove that she did NOT provide the information when she says she did.

My biggest question is why did it take her 8 months to get her own insurance benefits information?  I can usually get people's insurance information with their date of birth and social.  Why was this case so difficult?

Funkymark:
She was going through a very public domestic dispute (Her husband was a Cop and was charged with many felony charges against him), it was in the papers, on TV.  All the insurance was under Him and His employer (City Police Dept). They were going through a very public Legal Separation and know one would provide her the Insurance ID number, saying it was a "Privacy" issue.

There were domestic violence issues, restraining orders, and fear for her life. And the Ex-Husband refused to provide the Insurance ID to her.  The only reason she got it on 4-2010, was their son broke his arm and the hospital needed the number, and the Ex provided it to her then.

When she go the Insurance ID that day, she called Hospital ABC with the ID number, but since it was out of their time to bill, Hospital ABC had already turned her over to a Collections Company.

She did provide the Insurance ID number (4-2010) to the Hospital, After the Timely Billing period, should they still have submitted the claim?

The insurance company only processed the claim after I got involved (9-2011).  The hospital Billing Supervisor said she would not submit the claim because she did not want to write off the charges.  The Billing Supervisor said that WE could submit a UB form to the insurance company, and the insurance company should pay the claim.  She would not mail the UB form to us, we drove for 6 hours to pick it up.

She is a single mom with 4 kids, working one full-time job, and just took up a part-time job to pay this medical judgment.  And her Ex-husband is paying Zero in child support.

I'm doing my best to help with this one past issue.
Thank you

DMK:
So sorry for this lady's troubles!  The insurance company should back her up though, she was a covered member at the time of the claim.  With these extenuating circumstances the insurance company should "man up" and pay the claim, even though it fell out of timely filing.  I would appeal to the highest possible level on behalf of the patient. A few well placed phone calls (you'll be on hold for awhile!) to the appeals department, and then your state's insurance commissioner wouldn't hurt.

JMO the hospital biller is being a stinker, but they do have their guidelines they have to follow, and their hands may be tied. 

The patient will have to advocate for herself (or with your help) to the insurance company.  Even the most heartless companies should be understanding in this circumstance.  I would not, however, wait very long to really jump on it.

Michele:
I agree with DMK.  She should appeal the timely filing stating all of the facts that you have given us.  She did everything in her power to try to provide the information to the hospital and to assist in getting the claim filed appropriately.  The hospital may have had the means to get the id# as well.  If they had the patients name, dob, ss# and other personal identifying info, the insurance carrier should have been able to locate the patient and provide the id#.  I don't know why it had to go this far.

PMRNC:
First I say this is a highly legal issue that needs the attention of an attorney first and foremost

A few strikes I see here is that there was no police report on the stolen ID, etc..  the fact that a "Judgement" was issued by hospital tells me this has already seen it's legal eyes and the fact that there is a garnishment in place also says this is being followed properly.. THAT is why I strongly recommend a lawyer to appeal the judgement and stop garnishment.. why wasn't this done at time judgement was pending (before issue, and well before garnishment) There had to be proper notification of the judgement and then of the garnishment before hand..that was the time to strike, but I know you are coming into this late. 

Another thing.. while we might all think the ID number was not a private issue..that's not true.. Some states prohibit the use of SSN for this very reason, it does NOT go by the state of the employer it goes by the state of the underwriting issuer of the policy. It's not cut/dry since this is a city employee. You can't assume it's THAT city/state where the policy was underwritten. 

Bottom line is there has to be legal representation because there is a judgement and garnishment in place and a lawyer is the best person to go around this and well..practically speaking if a judgement and garnishment is already in place..there's no longer any basis of appeal until the judgement is settled and then you can try and recover AFTER to recoup. 

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