In 2001, FabGrandpa was diagnosed with squamous cell carcinoma of the tongue. Cancer. The Big C.After we got over the shock of the diagnosis, we set about doing all the things involved in getting ready for treatment of it.Part of that was going to an oral surgeon to have all of his teeth removed in preparation for radiation to his mouth and throat.
The extractions were done in two sessions, first all of the top teeth, then a month or so later all of the bottom teeth were removed and the jawbones scraped.After the upper teeth were pulled, the lady in the oral surgeon’s office filed a claim with our insurance company (I still had health insurance then), and they paid the claim.Then the fun began.
After the lower teeth were pulled, the same lady filed a claim with an insurance company with whom we NEVER had coverage. As in, the WRONG insurance company. So, when I received the denial of benefits from them, I called up Ms. Nastypants at the oral surgeon’s billing office, and asked her to file again with the correct insurance company.She said, “We only FILE ONCE.”And I said “Well, you will need to file again in this case because you filed with the wrong insurance company.” She humpfed and puffed and finally agreed to file the claim again.
Soon, I received a denial of benefits from my health insurance, which stated that they did not provide us with DENTAL benefits.So, I called Ms. Nastypants again, and told her, again, that she would need to file the claim again, correctly. She was VERY NASTY to me, and was very adamant that she WOULD NOT file the claim again, as they ONLY FILE ONE TIME.So, I asked her if she could send me a form so I could file the claim myself. She said I would have to get a claim from my insurance company. What a BITCH!
Next, I called the insurance company, and requested the form so I could file the claim myself. The nice man at the insurance company told me they did not accept claims from the patient, that it had to be filed by the provider. Shit. He did tell me though, that he could see that they had paid the first claim, and told me the exact wording to tell Ms. Nastypants to use when she re-filed the claim so it would be paid, too. I thanked him for the information, and called Ms. Nastypants at the oral surgeon’s office AGAIN.And she told me again, that she WOULD NOT file the claim again.
For the next 12 months after that, I received a bill from this doctor’s office for $2406.36. Every month for 12 months, I wrote a note on the bill “I will be glad to pay this bill after you have filed a claim with my insurance company so I will know how much of it I am responsible for.” And mailed it back to the doctor’s office. At the end of those 12 months, I no longer received a bill from them.
In September of 2003, FabGrandpa and I were working in south Texas, 1600 miles from our hometown in Georgia. I received a frantic phone call from my stepdaughter saying that a deputy sheriff had knocked on her door and served her with papers for her Dad. The oral surgeon was suing us for the unpaid bill.My stepdaughter sent us the paperwork by next day mail.
The suit said:
Now comes the Plaintiff in the above styled action and states its complaint as follows:
- The defendant, a resident of this county, is subject to the jurisdiction of this court and can be served at XXXXXXXX.
- The Defendant is indebted to the Plaintiff n the amount of $2406.36 as principal and $419.50 as interest.
- The principal and interest are past due and Defendant refuses to pay.
Wherefore, Plaintiff demands Judgment against the Defendant in the principal sum of $2406.36, interest of $429.50, and court costs of $93.00.
You are hereby summoned and required to file with the Clerk of said Court and serve upon the Plaintiff’s attorney, whose name and address is:
An Answer to this complaint which is herewith served upon you within 30 days after service of this Summons upon you…
And Answer I did.I wrote the following:
“To All Those Whom It May Concern:
In January of 2001, my husband, Jim was diagnosed with squamous cell carcinoma of the tongue. His radiation therapist advised him to have all of his teeth extracted before radiation treatments began. On January 23, 2001, Dr. XXXXX pulled of Jim’s lower teeth. The doctor’s office filed a claim with my medical insurance company, XXXXX Company, group # NNNNNNNNNN, claim # NNNNNNNNNN. XXXXX Company paid that claim. A copy of that explanation of benefits is attached.
On March 13, 2001, Jim went back to Dr. XXXXX to have the upper teeth extracted. The same doctor did this. The insurance claim was filed by the doctor’s office. However, they submitted it to the wrong insurance company, one with whom I have never had coverage of any kind. This time I received an explanation of benefits showing no payment was made, with a notation that said, “This patient has no coverage with us.” Copy attached.
I called the doctor’s office and asked the person in the billing office to resubmit the claim. She was rude, and told me that they only file once, and she would not file again. After much discussion, she agreed to file the claim again with the correct insurance company.After the claim was resubmitted, I received an explanation of benefits showing no payment was made, with a notation “Our records indicated the member’s health plan does not include benefits for dental care. I have attached a copy of this denial of benefits as well.
When I received the denial of benefits, I called the billing office again, and spoke to the same person again. She insisted again, that they ONLY FILE ONCE, and that she would NOT file the claim again. I asked her to send me a form so I could submit the claim myself. She told me I would have to get the form from my insurance carrier.
I hung up, and called my insurance carrier. The customer service person I spoke with told me that they did not accept claims from the patient, that all claims have to be submitted by the provider of services.I explained to him that I had talked to the accounts receivable person at my doctor’s office and that she had refused to resubmit the claim. I also explained to him that XXXXX Insurance Company had paid for the first set of extractions because it was medically necessary to have the teeth removed in preparation for radiation treatments. He advised me to call the doctor’s office back and ask them to resubmit the claim and add a statement saying that the work was done in preparation for cancer treatment. I called Dr. XXXX’s office back and talked to the girl in the office again. She still refused to resubmit the claim for me.
I understand that the bill is for services rendered, and that at some point I should pay for par of it because I did not have 100% coverage for the service provided. However, I feel that Dr. XXXXX and his office staff should be held partly responsible for the delay of their payment because their insurance person flatly refused to assist me in getting this claim filed correctly and paid.
I also feel that XXXXX Insurance Company should be held party responsible for their inaction and less than satisfactory customer service. If the first set of extractions was covered, then the second set of extractions should have been covered. If the representative I talked to at XXXXX Insurance Company could see that the first claim was paid, and agreed that the second one should have been paid, why did he not reopen the denied claim and pay it?
I copied this letter and all the attachments, and mailed them by certified mail, return receipt requested. I sent one to the doctor, one to the lawyer handling the case, one to the judge in the case, one to the insurance company, and one to the insurance commissioner of the state of Georgia. In ALL of the letters I sent, I included my correct address in Texas. And we heard NOTHING from anyone.You would think that they would have sent us something telling us we had lost the case and owed the money.
So, it was a complete surprise to us when we received a letter from our employer’s debt management branch, advising us that they had received a garnishment order on FabGrandpa’s wages, dated July 2008. The gist of the letter was to tell us that they would be taking $267 every payday out his check, and there was nothing we could do to stop it. It was, after all, called Involuntary Debt Repayment. Shit.And the document said they were into us for $4646.34 now! Shit again!After I got over being pissed off, again, by Ms. Nastypants, I got out my calculator and refigured our budget so we could stay on track for our savings goal. And tried to not be angry at the world for the injustice of it all.
So, they took out the deduction for $267 for two pay periods. Then last pay period, there was no deduction. And I was confused, and worried, that they would take two out this time. But when we got FabGrandpa’s check today, it was for a lot more than normal. When I looked at the pay stub, it showed that they had REIMBURSED us for $267. I was really really confused now. What if they decided to take it all back next time?
Today I spent an hour or so on the phone, calling the payroll office, here, there, everywhere, until I got the right person on the line. It turns out that we DIDN’T lose the case, after all. They judge in the case DID order us to pay all that money, because my letters didn’t get there in time. But, the insurance commissioner in Georgia somehow got my insurance provider to pay that claim. And the doctor had his lawyer send a release of liability for the debt to our employer.
I was so happy I cried. What a big relief. And I hope Ms. Nastypants got fired.