Training Primer - Having All your Facts!

In our personal lives and in medical billing, we must always have our facts. Working on word of mouth or personal beliefs gets you nowhere. My brother called me to ask for my help. He wanted my help immediately and just going on his word. i said i needed documentation to support his side of the situation. I just took what he told me, with him understanding that I cannot provide a decent response based on his word alone. Bottom line, he lost his appeal. Why? One is that what he told me was not 100% true and accurate. This was an issue regarding personal residence and he implied that this was a rental issue. That one small thing changed everything. This can be the same with claims. Mr. Magoo could belong to ABC Insurance through an HMO. Yes, it is an HMO, BUT, is it a Medicare HMO, a Medicaid HMO, an ERISA HMO? Each one of these can make a huge difference with how we act and respond.

Now, having all your facts. Last month, I went to pay my bills. Most I do online because it is faster and cheaper. With one bill, ABC Company, I paid $43, which was my monthly payment. When I pay my bills online, I use a screen capture program so I can capture the image of my payment at the moment it was made. Why? I follow my training of Verify, verify, verify. I paid all my other bills and did the same with each. I also use a spreadsheet to manage my checking account. The next day, I went online to my bank and saw that ABC Company charged my account, $1,097 instead of $43. That put my account into a negative balance as many other of my bills also cleared. Now, instead of having $500 in my account, I have a negative $700 which included banking fees. I called ABC and spoke with someone who gave his name as Jasper (Not real name). Jasper said he would contact accounting and have my checking account credited with $1054 which is 1097 less the original 43. I documented the call with the time, date, number, name of contact and approximation of what was said. I was told my money would be returned to me in 3-5 business days. Every day, I check my bank account and it shows no credit. On the 6th business day, I again called ABC Company and demanded to speak with a manager. Now, Im speaking with Peggy (not real name). Peggy tells me the same story,3-5 business days. Again, I document the call. Now it is 5 more business days and no credit to my account. I called my bank and spoke with Rick, a district manager, he shows no credits coming from ABC company. I also document this call. Just after my original call with Jasper, I found the corporate address of ABC Company and their CEO. I sent a Certified Letter to the CEO. I called ABC Company and spoke with Vito. Vito informed me of the same stall story, my credit was sent to my bank on the 27th, which was the day I spoke with Peggy. I informed Vito of my meeting with Ric, my bank district manager. Now Vito's story changes. My credit is stil being processed in the accounting department and it should be processed in 3-5 business days and my bank could place a hold on the money for an additional 3-5 business days. Vito is informed I am filing a complaint on a charge of banking fraud. Now, I am sent to the accounting department, where I am speaking to Marlo. Marlo says the same story, the credit was returned to me on the 27th and it can take 3-5 business days for my bank to apply it to my account. Marlo is informed of my conversation with Rick. Now, her story changes and she will contact me by the end of the day with her findings. I explain I am no longer accepting her story and I am filing fraud charges against them. Marlo never called back. The next day, lo-and-behold, my account is credited with $1054. The bank shows the credit was sent to them the day before with instructions to hold the credit for 3-5 business days. Using the hard facts, showing phone calls, memorandums of each call, the certified mail and return receipt, bank statement, and screen prints, complaints were filed with the CEO and appropriate regulatory agencies not only where I live, but, also where ABC is located. ABC Ceo replied apologizing and sticking with his company's story despite the fact that the documentation says otherwise. Bottom line, ABC applied my losses to my debt with them. This was cheaper than an expensive lawsuit or federal investigation which could have resulted in fines against ABC.

My brother lost his appeal. I won my appeal. The difference was because I had all the facts. My brothers appeal was based on his word and no documentation. My appeal was thick with supporting documentation. It doesnt matter if you are a doctor, medical biller, or patient, anytime there are questions, when you respond, you must make sure you have all your facts. The burden of proof to prove you are right, is on you.

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