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Author Topic: doctor visits and reimbursements  (Read 2728 times)

balleros

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doctor visits and reimbursements
« on: Feb 14, 2015, 06:24:50 PM »
My ex had paid zero bills from 2014 and by court order, he shouold pay 50 %.
The biggest issue I have right now is with out of network expenses that I paid. Any help on this? here is the situation:
My son receives weekly medical sessions. His dad and I have no parenting plan and no custody so techincally speaking, he may ask about services my son gets and I would respond but he never inquiries. I do keep him posted but he never responds so he has no saying now in questioning this.
Out of all the sessions I paid in 2014, I sent a claim to his insurance (which is primary for my son)  after checking with them what they allowed us to do. I knew I had 70 % reimbursement. So I gather the 5 bills from 2014 and I sent the claim. it weas processed right away and they issued a check for $ 500 that they sent electronically to him, the insuranced person. I understand that, no complaints. I told him that he was going to receive the money. When I knew it was done, I asked him to please check his mail and he said he had not received anything. I called the insurance to see if they could send it to the provider and they told me : (1) no, (2) the check was sent electronically and then yes, I was furious.
I sent an email again and I told him that I can't afford more session unless I start getting something back and I told him that rgardless of the money (which could have been lost and he might have to ask them to re issue a check) , I needed the explanation of benegits (which was online) so that I could forward a cliam to my insurace for the remaining balance. It took him 10 days to send that to me and he finally did it late on friday and with the long weekend, I wont be able to send it until Tuesday 18th. I might have to stop my on's treatment un til some money comes back.It is not life threatening so i wont get a court order.
The issue is that this will be on going for at least 6 months.I would hate to kkeep fighting about this.
I am also trying not to spend money on an attorney
how bad would it look if I write a letter to his attorney?
any other option?
FYI, I have never used name calling or anything crazy so he can't accused me of anything. I have not called him or bothered him in any way.
he received a certified letter from me explaning all this.
Also, if he doesnt reimburse me for anything, I guess my other option is sending him all bills for him to pay his 50 % but I would still get less money than going through primary and secondary insurance



this is out of network.I payed upfront. it is not a dr billing the insurance.it is a dr billing me, i pay at the end of each session. The 500 reimbursement is for 2014 and I just submitted a claim for $ 850 and I should get a 70 % of that. I  send all claims to his  insurance gives me 70 %. I also need from bio dad the explanation of benefits so that I can send the claim to my insurance. Basically if he would collaborate, I would end up paying a % 5


ocean

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Re: doctor visits and reimbursements
« Reply #1 on: Feb 14, 2015, 06:34:08 PM »
So after all of what happened this past time, did he give you the $500? If not, you have the EOB that they paid him but he has not forwarded the money to you?

Why won't the doctor's office bill the first insurance? Usually you sign a paper at doctor's office stating the check will go directly to them.

If he owes you money, send him another certified letter stating: (few sentences as possible)
ex:
You received a check from your insurance company for xx on xx date. I have already paid that bill and enclosing another copy of the paid bill. Also, after both insurances paid out, there was an additional copay of $$ and you are court ordered to pay half. Please forward the total of XX by xx date or I will contempt of court for non-payment. These appointments cost a lot of money upfront and your assistance in getting the checks cashed and forward to me will ensure xx be able to continue the appointments in a timely manner.
Thank you
You


balleros

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Re: doctor visits and reimbursements
« Reply #2 on: Feb 14, 2015, 06:46:08 PM »
provider can't bill insurance first for me to pay the balance as this is out of network.
We do the billing as you suggested with all providers and having primary and secondary means we usually have zero balance or a dollar here and there.So I don't even need to bill dad for his 50 %. I do have however about $ 350 out of network that he owes for 2014.
Now the biggest chunk and the one that will be ongoing are these sessions I have been claiming.
I can try a second certified letter
thanks

ocean

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Re: doctor visits and reimbursements
« Reply #3 on: Feb 14, 2015, 06:54:10 PM »
Send second letter with a due date to pay you. If he does not pay, go to family court and ask them for the contempt of court for non-payment. Most places it is free to file or small fee to file papers yourself, bring past court orders with you to file. Pretty straightforward and you can always hire a lawyer at anytime but if you have court order and checks are sent to you, he would have to explain why he is not forwarding you the money and his half of bills after insurance. This way you do not pay lawyer fees.

 

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