Medican Questions again

[lovingstepmom12]

Back in October we wrote about Mom giving us bills that were back from December of 2002, May and June of 2003, it was over 400.00 in bills.  Well we wrote her back and told her we want to pay the provider and that Money does not need to be exchanged between Mom and Dad.  We also again requested for the benefit package.  We have something from the website of the company and it does not match what she says is their benefits, but she wont' give them to us.  The benefits we have say after the dedcutible is done then the fund covers 80% either to the party or to the physcian depending on how they ask for it. So she can pay the bill then send it to the fund and get 80% back, but she says NO that is not how it is, but won't give us the booklet, in court in November she told the courts she ordered one, but still has not received it.  It is now January and we still do not have it since October.  So again yesterday she handed us another 207 in medical bills from May and August, she didn't pay them until Nov, Dec and one just this Monday.  Now she is obligated for the first 250.00, should we pay the Nov and Dec and then tell her the other is towards the 250 for this year since she didn't pay the May bill until January of this year.?  We don't know what to do, at this time we did send her a letter telling her that no payments what so ever will be given until we get a benefits book, we also again asked that we pay the provider,  What can we do?  When we call the provider they won't give us any info because of the privacy act law that is new.

Any Suggestions?  

[Wishing]

I'm in the benefits field so I can offer some qualified advise. I would advise that you receive the benefits booklet and an EOB before you do anything. An EOB (explanation of benefits) is a form that the insurance carrier sends the member regarding all benefits that have been received. It specifically details what is the member's responsibility and what was paid to the physician/hospital. Without an EOB, you are totally blind as to what was paid and what was owed.

For doctor visits, most physicians want to be paid on the spot and let the member deal with the insurance company - but not always. If the procedures were pricey, namely $500 or more, the physician will normally just ask for the members responsibility. The physician's office calls the insurance company and is told the details.

The information is out there so I would hold off until proof is submitted. Once paid, it is hard to get anything back.

Also, most divorce agreements specify a time limit for submitting expenses to the former spouse. In my case, it is 90 days. I'd also question if any claims had been submitted for 2002. Most insurance companies have a 1 year limitation for claim submissions.

Good Luck

[Peanutsdad]

Without proof of benefits or who's been paid or whats been paid, I simply would refuse to pay until she comes clean. If shes trying to pull something underhanded,, let her take ya back to court.