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At my wits end....medical/dental expenses reimbursed

joka1111's picture

My husb ex has submitted bills to us from a dentist for a few thousand dollars. The problem? They are invoices and do not list what the providers negotiated rate is, what the patient's responsibility is or what the write-off is. There are NO explanation of benefits attached. We sent her a letter letting her know that we need the EOB so we can get it paid. My insurance company cannot pay without the EOB from the primary. I am the "third-party" and she refuses to deal with anything to do with me...so I am at a loss. Two of her three invoices show that "estimated" insurance is 100% of billed charges.

The order is in Washington state. The BM hasn't factored in the 5% extraordinary credit each month and is also submitting invoices for balance forwards that do not list any information from the insurance company, let alone WHY there is a balance forward.

I am trying to just get her the money, but my hands are tied. So, now they have a family member that is a lawyer that will be "suing us" to have us pay. We aren't denying it is owed, we are just wanting to get full and complete info so we can get reimbursed from our insurance/flexible spending account.

HELP.....will a judge really allow her to just give us an invoice? Or will he have her release the EOBs to us (and why do we have to go to great lengths to NOT give an EOB--what is she hiding??) What is to stop her from giving us an invoice with an extraordinary amount on it and nothing else? (and yes, I can totally see her doing this...haha!) She told my SS16 last night that she is going to pay off this and that and buy this and that when she screws us over. OY!

thanks in advance!

joka1111's picture

Kris, thanks for the reply. the doctors office won't deal with my husb bcse she has custody. due to hipaa, they can't discuss without the BM giving them permission to discuss with us. But...I will try that route. I work for an insurance company, so it is just so very frustrating to have to deal with this and someone who is just stonewalling us at every turn. Not fun!

We contacted the case worker for our child support case and she directed us to their paperwork that shows they require the eob, payment receipt in order to collect on it. i hopeful that since they are both governed by the state, then the requirements are going to be the same. of course, weirder things have happend.

joka1111's picture

foxie, i *think* that the billing is at the same number as the dentists office. they don't appear to be a big corporation, but i will ask them for the billing dept first.

and foxie--i agree, it is unacceptable, unfortunately, we have God1 and God2 as the ones who want to call the shots and think that you should bow down to them....they used to intimidate my husb...me, eh, not so much. i find them both quite funny. and these verbal sparrings are hilarious! i still find it amazing that we are required to carry insurance, yet we can't have the documents to properly bill the insurance we are required to carry (ours is secondary to her plan). I have already submitted the bill and will contact the correct department (did i mention i work for the insurance company that will be paying for this???) and ask them to decline asap with eob code indicated need primary insurance eob. this will all be submitted with our response to their "lawsuit". good thing i have been nice in my correspondence to her....i have some not so nice ones that i would have rather sent.

joka1111's picture

kris, we are in a different state.....about 12 hours away...she is in washington. i wish.

and yes, i have the court order and the parenting plan and NEITHER forbid him from having access to medical records. Per rcw 26.10.150 access to child's education and medical records : Each parent shall have full and equal access to the education and medical records of the child absent a court order to the contrary.

however, i am afraid that will be just the actual "medical" part of it, not including the billing part of it.

and am i the only one that thinks this is the stupidest pissing match of all time? honestly, you want us to pay you money, send us the eob that tells us what we owe...it's not rocket science. heck, based on her "comments", she can bill us for 10k and we have to pay her as long as there's an invoice or statement attached. there's laws to protect the custodial and non-custodial parent...this is one of them.

joka1111's picture

foxie, yep...we have told her that we will pay when we can see the eob. per the guidelines, we are responsible for non-covered expenses--her info doesn't say that. i guess it just sux bcse bm father is an atty, so there are no out of pocket costs to her...but i would rather nip this so she knows what is required by her and by us.

joka1111's picture

it doesn't say that they can't withhold....there is not mention of it, so i think by the info i posted prior, as long as it doesn't prohibit him, then he can have access to them. she's such a pill...the ones that go down hard...i have to smash my large pills and put them in some yogurt...hmmmm...ya, that's what needs to be done. hate bully's hate them.

joka1111's picture

no, i haven't done that yet. when i called the providers office, they indicated that they need her permission to talk to him regarding the account. i am sure, based on all of her responses it will be a hell no.

windee's picture

I was just about to tell you the same thing. I work with a lady that has skids and their BM is a total lunatic! Sh makes up charges and all kinds of weird stuff. My friend calls the doctor office and the insurance (once her husband ok'd her to talk to them all the time)to verify the info and has found out NUMEROUS times that what the BM told them was BS. Then she mails the pymt to BM and texts her the pymt is on the way with a copy of the info. faxed to her from the office etc.... I LOVE IT when the BM gets it thrown back at her!!! I am a BM and was NEVER like this to my exbfs girlfriend when he was in my sons life (not long). Good luck!!

joka1111's picture

windee...your work lady's bm sounds like mine skids bm. she's a freak. i am going to have him call the dentists office and ask for it and if they need to get her permission, then so be it. but if she denies, that is one more thing that we will take to court when she "sues us". and i have researched a little already..she's trying to screw us just a few hundred dollars (hence the need for the eob ;)!!)

and hear hear...im not that horrible to my ex or his wife, but then again, i was graced with common sense ;)...no reason to be a pain, unless of course, you are hiding something :D.

joka1111's picture

there are NO reciepts that shows SHE paid. I recommended dcs, she said that she doesn't have to go through them, it is her choice to involve them or not. of course this is after we mailed her a letter asking her for the eob and also letting her know that she can contact the child support office to have them collect, provided the form with the info highlighted that shows she needs to provide a receipt of pmt and the explanation of benefits.

i couldn't find anything negating the 5%, but i had read that it was monthly. i talked with the case worker at dcs and she indicated that the first 5% is factored into the child support amount already. so if you find somehting let me know, i just quickly ran through the statutes.

thanks again everyone for your help. i am pretty positive that we are in the right, however, i hate that we are having to go through this.

smonster2's picture

This looks so familiar. After DH's ex got the CS raised, she decided to start billing us for unpaid medical. She thought she was just going to send us balance forwards, bills with no patient name, voluntary services(chiropractor),meds (birth control pills) and designer glasses and we would just pay them. WRONG! Since I work for an insurance company (as you do) I broke down everything for her, what type and what information she needed to send on the bill to be "considered" for reimbursement and also told her that if she chose to make a unilateral decision for medical treatment (this was our lawyer's term for what she was doing)then she would be responsible for the cost. This went back and forth a few times with her stating that "smonster2 should know this from working for an insurance company" to which we responded, that is why we are telling you how to submit the request...what an idiot! She finally gave up and we did not pay a cent towards these charges. Good luck, I know what a pain this is, but if you let them get away with it once, it will be never ending.

joka1111's picture

smonster, i hear ya! preaching to the choir. im actually an auditor, so i really know what i am looking for since i look at it daily. and i hv been in insurance for well over 16 years, worked in cs while going through college and worked my way up. im not about to let her tell me how things are done....and for the record, i was able to access the fee schedule (hey, it was published online, what can i say) and then went to her work website where they have their benefits spelled out. and ya, she's really trying to pull a fast one on us. there is one piece that i can't figure out though (it is a supp plan) and if she has this plan, it picks up where the other leaves off. im not sure if i can request verification of her insurance or not though......

and yes, i refuse to let her get away with this...my poor hubby is so clueless when it comes to insurance. he usually pays what she says. so now we are correcting past behavior.