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Author Topic: stuck btw QMCSO, NCP and court: help!!!!!  (Read 2421 times)

balleros

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stuck btw QMCSO, NCP and court: help!!!!!
« on: Jul 21, 2015, 07:20:34 PM »
I went to court today and the main goal was to get these issues of QMCSO fixed but it didn't happen.This is the story.
My son gets insurance from NCP and from me. His father 's was the primary and mine secondary. We had $ 2000 on out of network expenses that I paid. I filed a claim with his insurance and they were all approved and paid and the money was sent to a POBOX in Florida that deals with QMCSOs. It is stuck there and it has never been released to me, the parent that paid them.United Health care (dad s insurance) says that subscriber (NCP) needs to contact them and his HR and hs garnishment department to get all straighten out and to complete the file that according to them, is incomplete. Between feb and May 2015 I have sent NCP several emails and letters requesting his collaboration. he never helped so court clerk prepared all paperwork to have him be responsible for 50 % of ther $2000.
I had hoped that the motion will make NCP fix the issues .
it wasn't the case. Today at court he aggred to pay his 50 % instead of having UHC sent the money .
It is hard to understand as I know he lives pay check to pay check.
For me, it also sucks as I get more money out of the 2000 I paid if dad sends me the EOB and the reimbursements and then my insurance can reimburse part of the balance. So instead of 50 %, I would get 95 %.But dad chose not to collaborate for who knows what reasons.
My fear is that if we go through a simialr situation in the future (kid is 4 so chances are we will see a lot of more doctors), I will have to do all this work again: contact dad, see no collaboration, see a court facilitator, prepare paperwork, file a motion, go to court (which means taking a day off) and blah  blah blah.
Court clerk said today that they would not engage in that issue and that is something dad has to do or choose to pay his 50 % like he did.
So If I want to have all paperwork done properly, what are my options? Do I have to get at attorney to request that NCP completes our files at United Health care? do i have any other option?
thanks


ocean

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Re: stuck btw QMCSO, NCP and court: help!!!!!
« Reply #1 on: Jul 21, 2015, 08:27:51 PM »
My first guess is he already got the check for the full amount as he is the subscriber. Paying you half, he came out ahead.

You could ask that the health part of your court order be amended so make dad use the medical insurance so both parents can save on medical out of pocket expenses. How is your insurance? You can ask that you be court ordered to cover son as primary that way you can send to secondary.

In the future, go to in net work providers and ask the doctor office if they will bill two insurances. If not, go to next dr.

MixedBag

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Re: stuck btw QMCSO, NCP and court: help!!!!!
« Reply #2 on: Jul 22, 2015, 06:03:35 AM »
I agree that you might need to get the court order fixed.

As for the suggestion of other doctors -- Ocean, if I remember correctly, Mom can't due to child's unique medical challenges and where she lives or something like that.

I wonder IF Mom got the order to change to where SHE is primary - if the selection of doctor's would change to make whom she is using in-network etc...

I'd have to go back and find her other posts to remember the history. 


balleros

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Re: stuck btw QMCSO, NCP and court: help!!!!!
« Reply #3 on: Jul 22, 2015, 07:16:52 AM »
According to United Health care, the refunds went as a virtual check to a QMCSO PoBox in Florida. They have always told our provider and myself that they didnt go to the subscriber.They also gave me a ref number but it is an eletronic check so they can't check if they were cashed or not.
I received the first EOBs from the QMCSO Po Box that forwarded them to the Los Angeles County offie but not the last ones. They only sent that, not the money to CA.
That is why I asked United Health care for the reasonss why (I read online that reimbursements needed to go to the paent who paid them) and they said our file in incomplete and the subscriber needs to complete it.
NCP has always said that he never received the money.
I asked multiple times including yesterday at court hearing while the clerk was out of her desk picking up opies. he keeps saying "it is complicated and it is not an easy process".
Basically he is playing with money I used for my child for medial services. I paid $2000. I could have received $1800 to 1900 back if he had collaborated.Now I will be receiving 1000 that NCP will pay.
As for changing primary, yes, I took care of that in April when I saw how this was going. So for future out of network, his insurance balance will be the minimum and not the maximum I could be getting back (or losing in this case).
For the medical care we needed, we ONLY had out of network options. One option asked us to pay the $ 2000 at once and the other after each treatment. I chose to pay as we used services.NCP asked at court if we could have an agreement to ONLY see in network doctors. Clerk said that it would be impossible to add that as you can't predict when and where a childwill get sick. I added that he spends zero time with son so he can't make parenting decisions and he has no custody so before making parenting decisions he will need to file for custody and submit a parenting plan.
back to QMCSO: would I need an attorney to straighten this out? a letter requesting him to do it?

ocean

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Re: stuck btw QMCSO, NCP and court: help!!!!!
« Reply #4 on: Jul 22, 2015, 01:05:47 PM »
You can file yourself in family court asking to modify the court order as father is not allowing his insurance to cover the child making out of pocket expenses very expensive to mother. Mother requests the courts to order that the father will call his insurance company and straighten out the issues with secondary payments. Mother also requests that her insurance be primary for child to allow her to communicate with the primary insurance as father did not allow his insurance company to reimburse mother for last medical bill instead costing them each $1000 when it would have been almost fully covered.

I am thinking that you did not ask for the right thing in court this past time. You could have asked dad for the $1800 and when the courts asked why, you could have said that is what was supposed to be covered but he is not allowing the court ordered insurance to reimburse.

Maybe pay a lawyer for a one hour consult. See what they say and then you can file yourself to save money. Do you expect another bill like this soon?


 

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