October 01, 2004

George Costanza Watch

They're screwing me!

Actually, I was hoping some of you Llama Fans out there might have some useful insights on a situation in which I suddenly find myself:

In April, 2003, I collapsed from what turned out to be simple exhaustion at work. The DeeCee ambulance was duly summoned and whisked me off to George Washington Hospital.

I didn't give it much more thought. However, just this week, I got a bill from the ambulance service. A day later, I got a note from the insurance company saying they weren't going to pay it because it was filed out of time. The bill is damn near $500. Even though I am a card-carrying henchman of Halliburton/Carlyle Group/Scrooge McDuck/Trilateral Commission, Inc., this ain't exactly chump change to me.

Long story short, I have no intention of paying this. It's not my fault the damned ambulance service can't keep its books straight. I'm going to go into all the legal falderal of it myself, but I was wondering if anyone out there has had a similar experience and might have some useful tips, pointers, etc.

Muchos gracias!

Posted by Robert at October 1, 2004 09:22 AM | TrackBack

Yeah. Tell 'em to kiss your ass.

Dan Patterson

Posted by: Dan Patterson at October 1, 2004 09:42 AM


Several years ago now I was working 6 days/week. Three days in Farmer City, IL followed by a 4 hour road trip, then 3 more days in Nashville, IL, followed by another 4 hours on the interstate. I did this for 3 solid months. Long story short, that much travel, not sleeping in my bed, weird travel food, stress, etc. led me to collapse at the gym while waiting my turn on the treadmill. I hit the deck. Talk about embarassing. They transported me to the ER and the doc told me I was dehydrated and needed a few days off. Then the ambulance bill came to me several months after the insurance company had denied the bill. The insurance would pay for the ER...but not the ambulance. Why? It was not their preferred ambulance company. Nevermind the fact that I didn't make the call, nor did anyone consult me as I was not conscious at the moment. Nothing I did or said would change anything.

Good Luck! Nothing I did or said achieved anything.

Posted by: Phoenix at October 1, 2004 01:03 PM

Like I said, tell them to kiss your ass.


Posted by: Dan Patterson at October 1, 2004 01:42 PM

Bad news, pal. You are on the hook. You are primarily liable for services provided, not your insurance carrier. If it chooses not to pay, the ambulance service is looking at you to cough up. For $500, suck it up and bite the bullet. The alternative is a black mark on the old credit report that will cost you more than $500 down the road.

Posted by: LMC at October 1, 2004 03:32 PM

"You are primarily liable for services provided, not your insurance carrier. If it chooses not to pay, the ambulance service is looking at you to cough up."

then what the hell is insurance good for?
good God, the monthly premiums are going to what?
i mean, if you're not bedridden throughout the year or whatever and spend thousands of dollars a year on insurance (either directly or indirectly through your employer decreasing wages to cover company insurance policies) then what the sam hill is the benefit of paying that money if the stupid insurance provider doesn't feel like covering a damn ambulance bill?
good f'ing grief.
i hate insurance companies.

Posted by: merc at October 1, 2004 05:56 PM

George is getting upset!

Posted by: Lord Floppington at October 1, 2004 07:47 PM


You do not say so in your post, but I presume that the "note" which you received from your insurance company was actually an Explanation of Benefits (EOB). According to what you say, the "note" indicates that the claim for services was not filed in a timely manner. Are you the one who filed the claim? I would be very surprised if you did so. Typically, the provider of service (i.e. the ambulance company) files the claims.

On your Explanation of Benefits, there is typically a statement regarding how you can appeal in writing if you disagree with the disposition of a claim. Follow the procedure it should detail about how to appeal, and don't delay. Often you are given only a short period of time in which to appeal in writing. Send the written appeal return receipt requested so that you will have a record of receipt and who signed for it and when.

Contact the ambulance service as well. They have probably similarly received a notice from your insurance company and they also are typically given the opportunity to appeal. They would need to demonstrate that they had indeed filed the claim prior to the deadline.

This isn't "legal advice" and I don't claim to be an attorney. I am basing my advice on my years working for insurance companies and Aetna Medicare part B. Prior to that I also worked for hospitals and physicians' offices, so I've worked with both submitting claims to insurers AND adjudicating claims for insurance companies.

I cannot believe that you need an attorney at this point, although I obviously haven't seen your documentation from the ambulance service or from the insurance company. My best guess, based on the information you provided is that this is simply a clerical problem between the ambulance service which should have billed and the insurer which should pay if it is included in your coverage.

Best wishes and good luck. I hope you are able to get this ironed out. If you are willing to take the time and effort to contact the provider of service (the ambulance company) and your insurer, you should be able to resolve this equitably, in spite of the hassle and the inconvenience of having to deal with paper pushers and wade through red tape.

Frank Villon

P.S. Let us all know how it turns out, please.

Posted by: Frank Villon at October 1, 2004 10:48 PM

This is a very long comment, but it is the text of a letter that I wrote in very similar circumstances - and it worked. Please feel free to adapt it for your situation. Good luck.

Re: Insured No.: 123-45-6789
Group No.: 987654
Patient: Pebbles Flintstone
Date of Service: 2/6/2000

Dear Sir or Madam:

I am writing to ask you to reconsider the denial of this claim. This claim is for the services of Barney Rubble, the emergency room doctor at St. Luke’s hospital for my daughter Pebbles, who is disabled and is covered by Medicaid as well as Humana.

Pebbles had previously visited St. Luke’s emergency room in 1998 when we lived at 1234 Jefferson Street, Kansas City, MO. When we went last February, we gave our insurance card, Medicaid card and our new address, 5555 Rosewood, Praline, KS.

St. Luke’s billed us without event. In November of 2000, I was contacted by a collection agency for Emergency Physicians LLC (the practice that Barney Rubble works for), saying that this bill had not been paid. I had received notification from Missouri Medicaid that they had denied this claim – as they should, because in February 2000 Pebbles was covered by Kansas Medicaid.

After some discussion with the collection agency, I discovered that the hospital had changed our street address, but not changed the city or state, so all their bills and correspondence had gone to 5555 Rosewood, Kansas City, MO, which is a nonexistent street address. This is also why they tried to bill Missouri Medicaid.

I asked the company to bill Kansas Medicaid and I assumed that this bill was taken care of.

In April we began receiving recorded telephone calls that we thought were from a telemarketing firm. We ignored them, until one day in May when my husband called to tell them to stop. We discovered that it was this same collection agency. Kansas Medicaid had denied the claim stating that the primary insurance had not paid yet. The collection agency asked me for a copy of the Explanation of Benefits showing that the claim was not paid. I looked through my files for the last five years and could not find that Explanation of Benefits. I did not call your office because all the EOB's clearly state that “DUPLICATES ARE NOT AVAILABLE.”

I went on your website and discovered that I could research claims online. After waiting a few days for the PIN number to arrive in the mail, I looked up this claim and at that point discovered that Emergency Physicians LLC had never submitted the claim at all. I called them and asked them to submit the claim, and gave them the needed information again.

Today, I received an Explanation of Benefits saying that the claim had been denied because it was not submitted within the time described in the plan. I called today, and it turns out that there is a 15-month limit, which expired May 6th. The company filed the claim May 16th, 10 days late.

I ask you to please consider these circumstances. This was only 10 days out of your time limit, and I would really appreciate it if you would make an exception and pay this claim, as the service should have been covered under our plan otherwise.

Thank you,

Wilma Flintstone

Posted by: Teri at October 2, 2004 09:37 PM

And by the way, if a letter appeal doesn't work, contact your state insurance department. It is quite possible that your state has a "fiduciary responsibility" type law, such that if the medical provider accepts insurance contracts that they have an obligation to file them timely and correctly on your behalf. Otherwise there would be no incentive for the company to do a good job on insurance collections, and a definite incentive to do a bad one - because usually insurance contracts pay at a discount of the amount charged, whereas they could collect the full amount from you. I have gotten good assistance and advice from my state insurance department in the past.


Posted by: Teri at October 3, 2004 02:52 AM

Medical charge-offs don't have much of a consequence credit-wise. Mortgage lenders, for example, don't consider them pertinent in the least.

Posted by: Uncle Mikey at October 3, 2004 04:13 PM

Do let us know how this turns out.

Posted by: Teri at October 9, 2004 01:28 PM
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