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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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Thank you.

I will let you know how it goes.

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