Bman

Stenger and Stenger Help

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Last year Stenger and Stenger filed a court case in my local courthouse for 2 bills dating Dec 2014 and Dec 2015 to Emergency Prof Services.

They never billed my correct insurance company and I did not pay them. I countless times gave them the correct info. I still have no record on my insurance for them filing a claim to get paid.

We went to Civil contested hearing last october (stenger motioned for a phone hearing but the judge denies it so they hired a local lawyer to represent them). The judge said they needed to do more work to find out why the insurance was not billed.

Now I received a " Plaintiff's First Set of Interrogatories, Request for Admission, Request for Production of Documents, and Notice of Service" packet.

What should I do, I can list all of the questions if needed.

Would appreciate any help with this.

Thanks!

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5 hours ago, Bman said:

Last year Stenger and Stenger filed a court case in my local courthouse for 2 bills dating Dec 2014 and Dec 2015 to Emergency Prof Services.

They never billed my correct insurance company and I did not pay them. I countless times gave them the correct info. I still have no record on my insurance for them filing a claim to get paid.

UGH.  Too many times consumers assume that a provider is required to bill their insurance.  They are not.  Most do as a COURTESY but they are not required to do so to get paid.

The instant you discovered they had not filed a claim you should have opened one.  Now it is WAY WAY too late to file one and get the care covered yet you are still liable for the bill.  When you go to the ER you sign a financial guarantee which specifically states that if your insurance does not pay you are still legally responsible for the bill.  That is where you are now.  Regardless of the reason your carrier did not pay so you are responsible for the entire amount.  The upside is that because neither of you ever opened a claim you might be able to settle for less than what they are seeking because illegal rebating will not be in play.

5 hours ago, Bman said:

Now I received a " Plaintiff's First Set of Interrogatories, Request for Admission, Request for Production of Documents, and Notice of Service" packet.

If you do not respond and answer them they are deemed admitted and will win by summary judgment.  You need to post redacted copies here.

 

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Redacted file attached.

I appreciate any help. I did not know it was a COURTESY for them to bill the insurance. I have tried in the past to send stuff in to my insurance company but was told they needed more information like billing codes which I do not have.

Thanks again!

redacted.pdf

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Those are pretty straightforward.  When I get home from work soon will give you more detailed answers and a set of those that you can send them.

 

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On 7/10/2019 at 9:47 AM, Bman said:

The judge said they needed to do more work to find out why the insurance was not billed.

This is good because it means he questions why they did not use due diligence to get payment from the carrier.

What I am suggesting will build on that.  First you want to file a counter claim against them for contributory negligence. I would state that their failure to act upon the information the Defendant was insured in a timely manner directly contributed to a lack of timely payment.  Unjust enrichment:  by refusing to file a claim and to supply necessary CPT and ICD9/10 codes to the defendant or their insurance carrier so they could file a claim themselves the provider seeks to be compensated more than would have been contractually allowed had they complied with the terms of the policy.  Laches defense.  By not filing a timely claim or providing the patient/guarantor/Defendant with the necessary information to open their own claim they unfairly prejudiced the Defendant in being denied valid coverage.

Format this the same as theirs and include the added statements about if you deny explain it etc.

Admissions:

1. Admit that you received information regarding the Defendant's insurance coverage from the medical facility [name].

2. Admit that at no time did you or your company [name] submit a claim to the carrier for any services that were rendered.

3.  Admit that after sending bill(s) to the defendant, that defendant disclosed insurance coverage and you failed/refused to file a claim for the services for which you are seeking payment.

4.  Admit that you have taken no action to investigate insurance coverage as instructed/ordered by Judge [name] during the hearing on [date].

Request for production of documents:

1.  Produce a copy of the financial guarantee that the Defendant or guarantor signed agreeing to payment.

2.  Produce a copy of the face sheet from [facility] from which [provider] extracted identifying information to bill Defendant for services.

3.  Produce a copy of any and all correspondence, including denial(s) of coverage regarding the care and services rendered to [Defendant] that are sought in the complaint.

Interrogatories:

1.  Provide all CPT, ICD9 and ICD10 codes for all care/services you maintain were rendered to [Defendant] as described in the complaint.

 

Here is my goal ultimately.  They did provide care and the chances the court won't award them anything are slim but not none.  By filing a well worded counterclaim demonstrating their failure to act caused you financial harm puts you in a position to negotiate the amount they get in settlement talks if not painting the Judge into a corner to only order the reduced amount based on contractual coverage.  Once they provide the CPT/ICD codes I would get a statement from the carrier that based on those codes and the coverage in place at the time of service the amount due the provider is estimated to be $X and your out of pocket would have been $Y.  I would then make a settlement offer at half that amount and work up to the total of $X and Y as a final number.  They get no court costs, attorney fees, or interest.

Another possibility but do not bank on it is they fold when you file the counter claim and they have to explain to the court why they did nothing and want more money than they were ever legally entitled to.  It is possible they never filed a claim to get around the legal prohibition on balance billing.

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Thank you for your help Clydesmom.

Do you have any suggestions for my answers to their questions?

Should I answer the questions and send my return question, etc that you listed in the same document / filing?

I really do appreciate you taking time out of your schedule to help out on here!!!

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1 minute ago, Bman said:

Do you have any suggestions for my answers to their questions?

Unfortunately you do have to be honest and this is not the same as a credit card case where there are a LOT of ambiguities.

You did receive treatment to you simply answer "Admitted."

Did you receive statements?  

"Request for admission number 4:  Admit that you owe $1240"  Answer:  DENIED.  Interrogatory #5:  Plaintiff refused or failed to file a timely claim for their services with the Defendant's insurance carrier which would have resulted in timely payment.  Refusal to supply necessary CPT and ICD codes to the Defendant prevented Defendant from filing their own claim and deprived them of their contractual and legal right to valid health insurance coverage.  Plaintiff is not entitled to more than the contractually agreed upon amount. Plaintiff has not complied with judicial order to investigate their role in insurance coverage.

Request for admission No. 6:  DENIED.

Interrogatory #7:  Plaintiff denied Defendant their contractual right to a reduced amount based on valid health insurance coverage in attempt to collect more than the allowed amount under said contract.  Plaintiff is not entitled to more than their contracted amount under the terms of the policy and failed to timely act up on it.  Therefore, interest and costs are not due based on Plaintiff's failure to act.

No. 7:  DENIED.

Defendant has amended their answer to include the affirmative defenses of Doctrine of laches, Contributory Negligence, and unjust enrichment.  Counterclaims have been filed based on these defenses.

8 and the last one:  Discovery is ongoing at this time and Defendant has just submitted their Admissions, Interrogatories, and requests for production to Plaintiff.  When such information becomes available it will be disclosed to Plaintiff and their counsel.

You need to amend your answer and file the counter claim FIRST.  Then send the answers to the admissions to them.  You can do both the same day.  File with the court then mail copies CMRR to them.  Your admissions requests from them is SEPARATE from our answers to theirs.  Format it the same as theirs down to last comma other than what you are asking for.

 

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@Clydesmom,

It has been 37 days since I submitted to the court my Defendants First Set of Interrogatories, Request For Admissions, and Request For Production of Documents. I sent the plaintiff my answers the same day (thanks again for your help!). The plaintiff also received their copies of my answers as well as my requests via certified mail, 2 separate packages (I have copy of receipts) on the same day.

The plaintiff has yet to answer either me or the court. Can I file any documents to get this case thrown out? In my requests, I gave them twenty-eight days upon receipt (which is the same time frame they gave me).

I appreciate your help!

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3 hours ago, Bman said:

The plaintiff has yet to answer either me or the court.

That is good for you.  That means their answers are deemed admitted i.e. they admit they failed to file an insurance claim, respond to the judge etc.  That benefits you a LOT.

Did you file a counter claim?

3 hours ago, Bman said:

Can I file any documents to get this case thrown out? In my requests, I gave them twenty-eight days upon receipt (which is the same time frame they gave me).

What day did they receive the documents and what day was it stamped at the clerks office?

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16 hours ago, Clydesmom said:
 

That is good for you.  That means their answers are deemed admitted i.e. they admit they failed to file an insurance claim, respond to the judge etc.  That benefits you a LOT.

Did you file a counter claim?

What day did they receive the documents and what day was it stamped at the clerks office?

I did not file a counter claim at the time as my wife did not feel comfortable doing so at that time. I know you suggested to file a counter claim but I did add the following to my answers to their requests for admissions:

Quote

Request for Admission #7: Admit that you are not a minor, incompetent, or have any other affirmative defenses to avoid payment of this debt.

Response to Admission #7: DENIED.

Interrogatory #7: If you deny the above, state the reason for your denial.

Response to Interrogatory #7: Defendant does not waive their right to file a counterclaim or other defenses until the Defendant receives the responses to the Defendant’s First Set of Interrogatories, Request for Admission, and Request for Production of Documents which have been sent.

Should I now file a counter claim? I hope I did not mess anything up not doing so. :oops:

17 hours ago, Clydesmom said:

What day did they receive the documents and what day was it stamped at the clerks office?

I sent the plaintiff the documents via CMRR on July 24th, 2019. The receipt showed that they signed for the documents on July 29th, 2019.

I personally filed my paperwork (Notice of Compliance and Defendants 1st set of Interrogatories, etc...) on July 26th, 2019 and they are stamped that day. They were recorded that same day according to the online case access.

Thanks again for your help on this, you really are a life saver.

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5 hours ago, Bman said:

I did not file a counter claim at the time as my wife did not feel comfortable doing so at that time. I know you suggested to file a counter claim but I did add the following to my answers to their requests for admissions:

GOOD call.

5 hours ago, Bman said:

Should I now file a counter claim? I hope I did not mess anything up not doing so. 

You didn't mess anything up at all.  If there was a counter claim it changes how or if you can file for dismissal.  In some states if there is a counter claim both parties have to consent for dismissal.  Filing a counter claim now would be about forcing them to pay you for this mess but I personally would not want to rock that boat at this stage.

5 hours ago, Bman said:

I sent the plaintiff the documents via CMRR on July 24th, 2019. The receipt showed that they signed for the documents on July 29th, 2019.

I personally filed my paperwork (Notice of Compliance and Defendants 1st set of Interrogatories, etc...) on July 26th, 2019 and they are stamped that day. They were recorded that same day according to the online case access.

I personally would wait until the 60 day mark after they received it but to be safe my recommendation is that you file at the 45 day mark from the receipt of the admissions.  This is so you can argue to the court (if necessary) that more than sufficient time to comply with the rules of civil procedure was given and their failure to respond to your rogs and the order from the Judge to investigate the insurance indicates a failure to pursue the case.  I would file a motion for summary judgment in my favor.

The reason for this rather than a dismissal is you do not want the judge to give them a break and grant the dismissal without prejudice thus giving them potentially another bite at the apple.  They could simply get their ducks in a row and gather paperwork and try again.  The summary judgment in your favor means the court ruled you do not owe the money.  If they tried again or sold the debt to someone else who did you have a gold plated defense [res judicata] that the courts already decided this matter and you do not owe the money.  It also means that you can use the judgment in your favor to remove any trade line from your reports because the court ruled you do not owe the money.

Start working on a well worded motion for summary judgment.  The basis would be that by not responding to the admissions the answers are automatic and they have admitted they were attempting to circumvent the laws preventing balance billing and intentionally interfered with your contractual right to insurance coverage.  The better and more thorough your motion is means that if the court does not get an opposition to it they Judge may simply sign it and grant it without holding a hearing.  You can post a redacted copy here for feedback if needed.

Is there a trial date set?

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If by some chance they come out of the woodwork and want to discuss "settling" that is when you take a hard line stance:  mutual walkaway or you file a counter claim for their negligence and malfeasance.  You want your day in court so they can explain their overt efforts to get away with balance billing.  I doubt this happens but have it on the back burner.

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5 minutes ago, Clydesmom said:

Is there a trial date set?

There is no trial date set. 

 

10 minutes ago, Clydesmom said:

Start working on a well worded motion for summary judgment....You can post a redacted copy here for feedback if needed.

I will start working on it and will post a redacted copy for you to review.

You are so helpful!!!!

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On 9/4/2019 at 2:13 PM, Clydesmom said:

You want your day in court

Good morning Clydesmom!

I was out of town last week and decided to check the online case access before I started to draft my Motion for Summary Judgement.

It appears that on 9\16\2019 (yesterday) there was a court date set for 11/1/2019.

The plaintiff still has not answered our questions etc. I have not received anything in the mail and online case access still shows that they have not filed answers yet.

I just wanted to check with you to see if I should draft up the Motion for Summary Judgement and submit it to the court.

Your help is always appreciated!

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1 hour ago, Bman said:

I just wanted to check with you to see if I should draft up the Motion for Summary Judgement and submit it to the court.

Yes.  Make sure you do not use a cut and paste only model.  Tailor it very specifically to your case.  Make sure to include that the basis is the Plaintiff failed to respond to discovery and therefore their answers are deemed admitted.  See if there is some case law to support it in the OH courts as well.  Then get it filed.

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HI Clydesmom!

I was out of town the last few weeks and have been working on our motion for summary judgement. When searching for some supporting case law, I came across an article that highlighted a change in Ohio starting July 1st, 2019 it states:

Quote

Other notable changes include the requirement that any pre-trial motion must now be filed at least 28 days before trial

Our trial is set for November 1st. 28 days prior to that was yesterday. Does this mean I can't file the motion for summary judgement or am I reading that wrong?

Thanks again for all of your help.

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It might but file it first thing Monday anyway.  My guess is they won't oppose it or show for trial.

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Hi ClydesMom,

On 10/5/2019 at 6:55 PM, Clydesmom said:
 

It might but file it first thing Monday anyway.  My guess is they won't oppose it or show for trial.

Court did not allow a pre-trial motion 28 days prior to trial.

Court date coming up quickly,  do you have any suggestions for the 2 scenarios that I can think of:

  1. They don't show for the court date (most likely since they did not answer our 1st set of Interrogatories, etc...). What do ask the judge for in a way to remove this from her credit report and not allow them to go after her again for this debt?
  2. If they (or a surrogate local lawyer like before) show up. I already know if they want to negotiate any settlement before court that I am going to flat out say no and go to trial. Is there any motion I should make before the judge to get this dismissed? Or something else?

Again, I want to say how much I appreciate you taking time from your bust schedule to assist on this forum. You and the others that help are truly a blessing to all of us that need assistance!
Thanks!

 

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Stuck in Utah working. Will have a detailed answer when I get home. Hang in there.

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10 hours ago, Bman said:

They don't show for the court date (most likely since they did not answer our 1st set of Interrogatories, etc...). What do ask the judge for in a way to remove this from her credit report and not allow them to go after her again for this debt?

Dismissal with prejudice.  That is a decision in her favor showing the court ruled she didn't owe it and the credit bureaus will/should heed that.  With prejudice precludes them or anyone else from using the courts to pursue it or at least gives you a bona fide defense of res judicata.

10 hours ago, Bman said:

If they (or a surrogate local lawyer like before) show up. I already know if they want to negotiate any settlement before court that I am going to flat out say no and go to trial. Is there any motion I should make before the judge to get this dismissed? Or something else?

You need to be prepared to use all the arguments we have gone over up until now.  Their failure to file a claim or provide necessary information so that you could file a claim on your own.  Their failure to answer the discovery you sent deems the answers admitted which means you are not liable for the amount they are claiming. Because they have refused to provide the necessary information to determine if you do have a balance owed or it might have been covered 100% then the amount of the debt cannot be determined and the case should be dismissed.

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