Sample letters demanding payment of doctor's fees
and breastpump rental
8/17/2001
XXXXX XX Healthcare
PO Box XXXX
XXXX XXXX, XX XXXXX
To whom it may concern:
Enclosed is a letter from XXXXXXXXX XXXXXX, Clinical Coordinator of the Maternal Child Health Care Center at XXX Medical Center where I gave birth to my daughter, XXXX, on 8/1/2001. As per conversations during my pregnancy with your representatives, it was established that because my daughter has a bilateral cleft lip and palate, the breast pump rental, accessories, and any special feeding implements will be covered in full by XXXXX XX healthcare. As of yet, I have not had to purchase any bottles, since the hospital supplied me with 2. The receipt enclosed shows a total cost of $160 to date, for the initial 2-month rental fee and the cost of the accessory kit. Hopefully, I will be able to sustain my pumping ability for a while, and will send you paperwork necessary for those claims, as well as additional bottles or other necessities for her feeding, that may be needed in the future. Thank you very much for your time, and please do not hesitate to contact me i f you have any questions.
Sincerely,
XXXX XXXXXXX - XXXXXXXXX
To: Virginia
Fax: XXX-XXX-XXXX
From: XXXX XXXXXXX - XXXXXXXXX
Tel: XXX-XXX-XXXX or XXX-XXX-XXXX
Date: 10/19/2001
Virginia, thank you so much for your help today. Following is the paperwork AGAIN for the orthodontic appliance for my daughter XXXX XXXXXXXXX. Dr. XXXXXX's office just confirmed with us that the information was sent and received by XXXXX (we called them at 4:35pm today after speaking with you), and that they had confirmed this information had been filed with XXXXX yesterday, Thursday 10/18/2001.
I've also attached the paperwork for my breast pump rental for 4 months, which XXXXX representatives assured me time & again (before and after the birth of my daughter) would be FULLY covered.
As the mother of a child with a birth defect, the fact that I have had to
deal with the stress that XXXXX is putting me through during this very
emotional time in my life is very frustrating, and I think it's sad. There
is enough for me to deal with that I do not need to be brought to tears over things like claims filed 6 or 7 times by myself and the hospital, or by promises of refunds for an essential piece of hospital grade equipment for the health of my daughter, only to be told after paying out of my own pocket for 4 months worth of rental that receipts can not be read, when your representatives, including yourself, have all assured me that they are clear.
Thanks for letting me vent. Please have a supervisor call me as soon as possible on both of these matters. I am angry and frustrated, and can't understand why a health insurance company, who is supposed to help people during emotionally and financially difficult times, would create so much more stress instead of relieving it. This anger is not directed to you or any representatives that I have spoken with, but rather XXXXX's way of dealing with their job. I do have a listing of the other representatives that I had spoken with recently about these issues, if needed. I also know of another XXXXX member who went through this same "process" for the same diagnosis and in the end was covered, if that information might help. Thank you, and I look forward to speaking with a supervisor soon and straightening out this situation so that I can focus on healing my child.
To: Virginia
Fax: XXX-XXX-XXXX
From: XXXX XXXXXXX - XXXXXXXXX
Tel: XXX-XXX-XXXx or XXX-XXX-XXXX
Date: 11/05/01
# Pages:3, including this page
Hi Virginia, thank you again for your help on 10/19/2001. The issue with Dr. XXXXXX's office seems to have been resolved.
Today I received a check for $160, to cover the first 2 months of my breast pump rental. I had spoken with a woman named XXXXX on 10/30, who was very helpful in my pursuit of rightful reimbursement. Unfortunately, I lost her fax number to send more copies of my receipt for October and November rental fees. They are following this cover sheet. The total is $100.00.
I was also informed by XXXXX that I am covered for a breast pump purchase, with a note from my daughters Pediatrician. I will be doing that, since my supply is excellent and I want to provide mother's milk for her through at least her first year. Please inform me if I need any more information. I have the number for XXXXX at (XXX)XXX-XXXX. I hope this bill won't be as much of a struggle as the rest has been so far.
Thank you again for your time, and if you have a way of finding XXXXX please thank her for me as well. You both have been to date the most helpful and kind during such a difficult time for me and my family. Please know that your kindness does not go unnoticed.
12/17/01
XXXXX XX Healthcare
PO Box XXXX
XXXX XXXX, XX XXXXX
To whom it may concern:
Enclosed are copies of the following:
Photocopy of receipt for breast pump rental for December 3, 2001 - February 3, 2002. The total is $100. A letter from XXXXXXXXX XXXXX RN C MSN IBCLC Lactation consultant, confirming the extension of my breast pump rental through February 3, 2002,
and the cost of $100, which was charged to my credit card. A receipt from Breastfeeding Basics.com for the purchase of 3 Haberman
feeder nipples @ $8.95 each, plus $4.50 s&h.
Since my child cannot physically breastfeed and can only obtain her milk through the special haberman nipples, I have been told that these items will be reimbursed to be at 100%. Please contact me if there are any questions or problems. I have been having a hard time with my claims, which are all valid and legitimate, and have only found out upon my own investigation that there have been problems, and that I was not going to be informed unless I inquired. I would appreciate any information that you could supply me to help expedite these claims. I am due a fair amount of money at this point and cannot afford to go further into debt at this time. Thank you for your
time.
Sincerely,
XXXX XXXXXXX - XXXXXXXXX
2/1/02
XXXXX XX Healthcare
PO Box XXXX
XXXX XXXX, XX XXXXX
To whom it may concern:
Enclosed are copies of the following:
A photocopy of my credit card receipt for a breast pump rental until April 14, 2002. The total is $100.
A letter from XXXXXXXXX XXXXXX RN C MSN IBCLC Lactation consultant, confirming the extension of my breast pump rental through April 14, 2002, and the cost of $100, which was charged to my credit card.
I am due a full reimbursement for this, because of my daughter's inability to breastfeed (due to her cleft lip and palate). Please contact me if there are any questions or problems. Thank you for your time.
Sincerely,
XXXX XXXXXXX - XXXXXXXXX
4/25/02
XXXXX XX Healthcare
PO Box XXXX
XXXX XXXX, XX XXXXX
To whom it may concern:
Enclosed are copies of the following:
A history of receipts from the year 2001 for our daughter XXXX XXXXXXXXX's cleft lip and palate related treatments and surgery. According to our insurance plan with your company, we have not only met the deductible, but have spent $3,190.00, which is $1,190.00 over our annual out of pocket maximum of $2,000.00. Therefore, we are due a refund of $1,190.00 from XXXXX. The receipts will reflect the following: We paid Dr. XXXXXX a total of $1,440.00 and he was reimbursed the balance from XXXXX. Dr. XXXXXXX received from us (this is calculated with reimbursments from XXXXX, therefore our out of pocket expenses in total) 4/19/2001 - $100, 8/8/2001 - $150, 11/28/2001 - $1,500.00. This all totals to the amount of $3,190.00.
A photocopy of my credit card receipt for a breast pump rental until April 14, 2002. The total is $100. I was refunded $90, but upon my call to your customer service representatives, I do not have a co-payment with Durable Medical Equipment, as per the DME Rider on my account.
We were not told, until today, that we needed to send you copies of the receipts to obtain our $1,190.00, even after numerous inquiries to your customer representatives. This has been a frustrating process, to say the least, and we would appreciate it if you would contact us as soon as possible, by any and all means of communication, if there is something not legible or missing.
There is still an outstanding balance with Dr. XXXXXXX's office of $404.00. We have been told time and again that we will not be responsible for any amount over $2,000.00 (annual out of pocket maximum) in any given calendar year, by numerous XXXXX representatives, and a co-worker who's child had the same diagnosis, doctors and treatments as my child. As we understand it,
XXXXX is to remit payment directly to Dr. XXXXX XXXXXXX in the amount of $404.00. Please let us know immediately, by phone, fax or email as to the status of this situation. Thank you in advance for your prompt attention in this matter, and we are expecting our check soon.
Sincerely,
XXXX XXXXXXX - XXXXXXXXX
4/25/02
XXXXX XX Healthcare
Attn: Claudine
Fax: XXX-XXX-XXXX
Dear Claudine,
Thank you for your help this afternoon. As per your request, I have enclosed copies of statements I could find for my daughter XXXX's procedures. My husband did in fact find a copy of his credit card statement indicating the $1,500.00 deposit for Dr. XXXXX XXXXXXX.
Again, enclosed is a history of receipts from the year 2001 for our daughter XXXX XXXXXXXXX's cleft lip and palate related treatments and surgery. According to our insurance plan with your company, we have not only met the deductible, but have spent $3,190.00, which is $1,190.00 over our annual out of pocket maximum of $2,000.00. Therefore, we are due a refund of $1,190.00 from XXXXX. The receipts will reflect the following: We paid Dr. XXXXXX a total of $1,440.00 and he was reimbursed the balance from XXXXX. Dr. XXXXXXX received from us (this is calculated with reimbursments from XXXXX, therefore our out of pocket expenses in total) 4/19/2001 - $100, 8/8/2001 - $150, 11/28/2001 - $1,500.00. This all totals to the amount of $3,190.00.
We have sent these items in several times, and have had similar problems along the way. Is there anything we can change on our end to make this process easier for everyone involved? Our daughter is scheduled for another surgery in a few weeks, which has been precertified and approved. However, I now know that this is not enough. Please advise us on an easier way to straighten all of these insurance issues out, so that we may concentrate on our daughters healing process.
Please let us know immediately, by phone, fax or email as to the status of this situation. Thank you in advance for your prompt attention in this matter, and we are expecting our check soon. Again, the total amount is $1,190.00, plus an additional $10 for a breast pump rental up to April 14, 2002. The total was $100, which I paid. I was refunded $90, but upon my call to your customer service representatives, I do not have a co-payment with Durable Medical Equipment, as per the DME Rider on my account. Therefore, our grand total is $1,200.00 for our overpayment for the year 2001, plus an additional $10 for the breast pump billing mistake. Thank you.
Sincerely,
XXXX XXXXXXX - XXXXXXXXX
Attached documents:
-Letter I sent to XXXX dated 4/25/2002 that is not found in your system.
-Copy of Credit Card statement showing $1,500.00 paid to Dr. XXXXX XXXXXXX.
-4 statements/receipts from Dr. XXXXXXXX XXXXXX for Molding Device prior to surgery - our responsibility, which we paid via several checks that are listed, was a total of $1,440.00
-4 statements/receipts from Dr. XXXXX XXXXXXX for Consultations, Deposit for surgery, follow up, cleft lip repair, ginigovoperiosteoplasty, reflecting our payments and insurance reimbursments to Dr. XXXXXXX. Our total payments to Dr. XXXXXXX are shown as $1,750.00.
This is a total of $3,190 that we have spent out of our pockets. You will see that all numbers check out, and we are indeed due a refund in the amount I had stated earlier.
We subscribe to the HONcode principles of The Health On Net Foundation
This cleftAdvocate page was last updated March 25, 2014
Sample Family #1
cleftAdvocate
a program of ameriface
