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Jane Doe Deer
Jane Doe Deer, Attorney
Category: Legal
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Experience:  Atty. since 1986; Plain English answers to family law, employment, landlord-tenant, & other questions
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senior care plus of washoe county reno, nv failed to notify

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senior care plus of washoe county reno, nv failed to notify medicare in a timely manner of there cancelation of coverage as per the written request of the insured in this case my wife who was required to drop her senior care plus coverage upon becomming eligable for secondary coverage thru CHAMPVA. senior care plus ended thier coverage as of january 31 2009 and admittedly failed to notify medicare of this cancelation until August 2010 and as of November 2009 my wife required multi medical procedures five hospital stays three surgeries ect. all of the billing was submitted to medicare as should have been done and medicare paid there part and later resended all of there payments stating that senior care plus was the insurer. a claim that they refute. in the meantime all bills are comming to the to us un paid. I complained to senior care plus and they are telling me they being one customer person that they would help me try to clean up the mess so as I wouldn't have to file appeals on the hundreds of billings submitted to medicare. this senior care plus person asked for me to contact her by cell phone only due to the fact that office phone calls are recorded and that she could not provide her signature on any documents because in view of the fact that they arn't a provider to my wife. I get the feeling that senior care plus officials have assigned this person to make this issue disapear in the meantime hundreds of thousands of dollars in bills remain unpaid. I said to the senior care plus person that I think that I should compose a blanket letter of explanation and foward it to all billing agencies involved in the non payment by fhe insurers. she said I should hold off on that for now. I'm spending many sleepless nights and am a nervous wreck over this I'm service connected 100% disabled two time cancer survivor. and never dreamed this could happen when I did nothing wrong and only complied with every requirment of me to ensure that insurence matters were in competent hands. any advice would be welcome. Is any one liable to me?

Thank you for contacting Just Answer. I look forward to assisting you. I may have switched you out of "chat." If I did, it's because I have had technical problems chatting here. I hope that you don't mind!

 

 

While we write back and forth, please keep in mind that I do not know what you already know or don't know, or with what you need help, unless you tell me. Sometimes I'm unable to read your entire question until AFTER I write back to you.

 

Although it's usually five minutes, sometimes there can be a delay of an hour or more in between my answers because I may be researching the answer to your question, helping other customers, or taking a break. If we are writing late at night, I may have to go to sleep and resume helping you the following morning.

 

I need the following information before I can answer your question:

 

Let's go through this one step at a time, much as though we're having a conversation.

 

First off, who is the person that only wants you to contact her by cell phone? Is she the office manager?

Please be aware that JustAnswer is a "pay-for-answer" website. You have offered to pay $38 for my assistance.

 

I'll look forward to hearing from you,

 

Jane Doe Deer

 

Customer: replied 6 years ago.
No I don't believe so she has said on several occasions that she has spoken with other personell about this and that she has hopes of making things easier for me although very vague on about any resolution. actually she couldn't give me a personel bussiness card and wrote her name and cell no.# XXXXX someone elses card. I also upon her request turned over all documents in reguards to this matter to her she asked me if I minded if she were to take all of my papers home to work on them I being very desperate to recieve help in this matter agreed.

The behavior of the woman with whom you're dealing sounds highly suspicious to me. It is simply not the normal behavior of a normal employee.

 

Can you make an appointment to speak with the Executive Director?

 

Sometimes my customers don't understand why I do this, but I think you may also need to take all your paperwork and pay for a one-hour consultation with an attorney who specializes in insurance law. You can usually find such attorneys in larger firms.

 

The reason I suggest this in your situation is that it sounds as though (1) you have a big, costly mess; (2) you're working with a suspicious-sounding employee; and (3) a local attorney can look at all the paperwork, and will know more about the local entitites and agencies then I do.

 

An hour consultation is going to cost you probably $200 - $300 and should be tax-deductible. It's like going to the doctor, but you get a whole hour.

 

Don't actually HIRE an attorney without first checking references. And don't try to pick the attorney's brain on the phone. Schedule an appointment and visit the office, like you would for a doctor!

 

In Nevada, here are two good places to look for an insurance attorney (someone with a good grounding in contracts law would be especially helpful).

 

http://www.manta.com/c/mmffxrx/nevada-trial-lawyers-assn

 

and

 

http://www.nvbar.org/LRIS/LRIS.htm

 

Another option for you would be to file a complaint with the Nevada state office that regulates insurance. I can't find a webiste, but you can start with the consumer protection office: http://ag.state.nv.us/org/bcp/bcp.htm

 

I am left with the feeling that you and your wife did all the right things to ensure that you had insurance coverage, and that your supplemental provider screwed up, and is not fixing the problem they created.

 

I hope that you take action, and I hope that you file a complaint with the state. (The value of filing a complaint with the state is that (1) it's free; (2) the state may help you resolve the problem; and (3) if other people have similar problems, the state may file a lawsuit, all at no charge to you.

 

I am available to answer follow-up questions, or clarify any part of my response that wasn't clear. Just write back if there's something else you'd like to know.

 

I'd appreciate it if you would "accept" if I've answered your question. We can continue to write after you do so. It just makes me feel better, because some people never pay me.

 

My best,

 

Jane

 

 

 

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