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Tina
Tina, Lawyer
Category: Legal
Satisfied Customers: 8775
Experience:  JD, BBA Over 25 years legal and business experience.
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In 2014 I had two insurance policy. I had Anthem Blue Cross

Customer Question

In 2014 I had two insurance policy. I had Anthem Blue Cross and Blue Shield, which I painlessly provided to Facey. In January of 2015, I received a bill from Facey medical center stating that they billed my insurance company but they refused to pay. I went ahead and paid the copay I owed and asked them to contact Anthem Blue Cross for the claim.Two times in 2015, I was really ill and the representatives at the offices reigned abusive words on me and declined me to see the Doctor. We got in touch with the corporate office and explained that I was not responsible and then they finally let me visit the doctor.During my daughters pregnancy, I had taken time off work to try to setlle the facey issue with Blue Shield and Anthem and then we found out that Facey never submitted the required document Anthem asked for to facilitate and process the claim so they could be paid.
I went ahead and called Facey and the representative I spoke to cursed out, was very rude and did not want to listen to my explanation. She then hung the phone up.
The next representative I spoke to listened to me and I told her that I have spoke to all of my insurance company and that Anthem Blue Cross said they are responsible for the paym,ent but because Facey had refused to send them documentation, they could not pay out on the claims. I asked if she would like to fax the claims to Anthem and she said NO, that Anthem had to request for the claim. I got their fax number and after speaking to her, I called Anthem and I told the lady what Facey said. She assured me, that she would send out the Fax.
Two weeks later, I receive a voicemail saying that she had faxed out document asking them to send her the claim and all other required document and Facey had not gotten back to her.Fast Forward to 2017. Facey sent me to collection and the collection agency asked me to pay. I told them that I will not pay because it is not my responsibility and that I am disputing the transaction. I immediately reached out back to Anthem and Blue Shield. Anthem told me that they had requested documentation from Facey but received no response and they were trying to get information so they could process the claim.Then Last month, I had an almost 2 hour conference call with Facey and Anthem and Anthem kept of trying to fet information for Facey, but the representative seemed unwilling and they kept of giving us the run around. It was then determined that Facey never sent the required documentation to Anthem to process the claim and as a result, could not come after to collect. Anthem took full responsibility and pleaded with the Facey representative to provide the required information so that they could expedite the claim. Every question the Anthem representative asked she literally said NO.
He left his number and his information and then went ahead to Appeal the issue with Anthem so they could pay while they wait on receiving the document they need from Facey.
The collection agency Facey sent went ahead and spoilt my credit.
Submitted: 2 months ago.
Category: Legal
Expert:  INFOLAWYER replied 2 months ago.
Greetings! I am a legal expert on the site and am working on your question.On review of your facts, you have a good case.I can suggest some options. would you like that information? please let me know and i will put it together and respond shortly. You can wait or come back later when we email you that a reply is ready. Thanks for your patience. This is not the answer. just an opening question so I can better focus the answer and make it more helpful.
Customer: replied 2 months ago.
I will
Expert:  INFOLAWYER replied 2 months ago.
You want to prepare your case by creating a time line starting from the earliest event. For each event, write down key details and witnesses and if there is a document that relates to it, save it and refer to it. This timeline can be very valuable in narrating your case and presenting it later in a concrete and specific way.martindale.com and findlaw.com are both excellent lookup directories. Both highly rated. Both used by lawyers. Easy to search and find local options.If you sue in court you may end up with a judgment. The judgment generally allows you to levy on bank accounts, lien real estate and work with the sheriff office civil enforcement division. Many lawsuits result in settlement - which expect the judge to encourage.You stand to recover not only your actual losses (compensatory damages) but also interest, costs and legal fees. on occasion special damages (punitive damages) are also available.Often this will settle.Please let me know if that is acceptable and feel free to reply back and follow up