ElleMD

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Everything posted by ElleMD

  1. This is not fraud. Not even close. Yes, the insurance carrier can require the claims contain certain information before they will pay them. An itemized bill is not an onerous burden. Nor are records from the actual medical provider as to which teeth were worked on. I know of no IC anywhere in the world (of the 50+ other countries I have dealt with- including Russia) who would accept a chart made by the spouse of the patient. One of the challenges of receiving care outside of the country where insured, is coverage of claims. Every plan has exclusions. Every plan reimburses different services at different rates. For example, the plan might exclude experimental practices or only cover local anesthesia, not general. It might pay only 50% of the cost of bridges made from certain materials, but pay 70% of bridges made from others. It may not pay at all if the treatment was outside what is indicated by American medical standards. For example, the plan may cover 70% of the UCR (usual, customary, and reasonable) costs of a bridge, which might include only local anesthetic, outpatient, no x-rays, and exlcude the cost of post-op medication. If the bill includes fees for general anesthesia, hospitalization, x-rays, and her pain meds, those fees would be excluded. Without an itemized bill, the IC has no idea what services are being covered. Trust me, it is absolutely possible to obtain documentation from a Ukrainian dentist which would allow a plan to cover benefits due. Now, whether your wife's dentist is willing to do that, none of us can say. She can't either until she asks. As far as the time limit goes, the regulations indicate how long it should take to render a decision for a properly submitted claim, but there is no penalty specified if they miss the deadline. You must exhaust internal administrative remedies for the denied claim before you can sue. Even then, more often than not, these sorts of minor procedural missteps fall under the "substantial compliance" doctrine. Translation, the courts provide no remedy to you and no penalty to the carrier. At best, you would be entitled to the benefits the plan states you are entitled to (once that has even been established), and possibly attorney fees, but that is not a given. You are going to need an itemized bill for that as well.
  2. If there was no written agreement it becomes he said, she said. Depending upon the dollar amount involved, it would likely have to be settled by small claims court. Your mother could file a claim and argue that work agreed upon was not performed and seek a refund for the incomplete items. Likewise, he could counter or sue himself claiming he did all the work they had agreed upon and she has not paid all she had agreed. It is a toss up as to who the judge will find more credible. Going forward your mother should stick to licensed contractors who use actual contracts. A POA wouldn't change this as she is still the one who made the agreement.
  3. There isn't a legal issue here. If there are specific days you want to make an exception to the usual custody arrangement, you will have to negotiate it like anything else.
  4. This thread is from 7 years ago.
  5. If you aren't available when they have needed you to work, that could well account for you being scheduled fewer hours in general. The employer sets the schedule and is not required to only schedule employees for their preferred shifts. Hiring others to work different shifts is not indicative of anything. It isn't clear why you believe your disability is the real reason. It takes much more to have a viable claim than just having a disability. You know your workplace better than we do. Whether you would be best served to schedule a meeting with this supervisor to discuss your schedule, or speak to the store manager, we can't say. I'd avoid making accusations as to motive and focus on the actual problem.
  6. No you can not sue the school system even if she did use her work email/computer. You certainly have no claim at all against the DOE. It is unlikely in the extreme that this will have any negative effect on her employment. I say that as one who was responsible for compliance for a school system and has been in education for a good chunk of my career. These kinds of petty complaints against employees from exes were not uncommon. They went nowhere. Unless there is a lot more to the story, it isn't going to even register with her employer 99.9% of the time. I can assure you that her district has much more pressing concerns than someone using their work email to sign up for a credit monitoring service. You have reported it to the police. It will be up to the state to determine if they will prosecute. You can only sue civilly if you actually have damages. While rotten to pretend she is you, there are no damages based on her signing up. Whether or not someone may claim children on their taxes is an IRS decision. If she is not following the terms of your court order, you will have to file in court to have it enforced.
  7. What isn't governed by law is what information the plan may require to process a claim. That is determined by your plan itself. Are you seeking reimbursement or is the Dentist? There are time limits, but not much if any recourse if they are not followed. Your best bet is to appeal the denial through the plan's established procedures (should be outlined in the letter) and supply what is being required.
  8. " my abusive child that intended to cause me bodily harm through hitting(20+ times), kicking, and trying to headbutt and bite me" " lying is part of humanity and there is nothing wrong in doing so" Sounds an awful lot like a mental health condition as this is NOT normal behavior for a 12 year old. If you assert that it is not, and medication is not needed, you are going to have an awfully high hill to climb.It sure is going to take a lot more than you stating there is no condition and medication isn't necessary. Whether you can block medication, how long your temporary order is in place, and how much time you get are all things likely addressed in the order we have not read. Whatever the most current order says is what is in place. Your old order is irrelevant. Does this current temporary order indicate that you must consent to any medical treatment? If so, and you do not agree, you get to fight it out in court. Talk to your attorney as to what is needed to convince a judge that your child is perfectly healthy and the medication not justified. Again, you don't have an alienation of affection claim based on not having more time with the child if you are getting the time you were granted under the temporary order. You are both obligated to follow the order as written. We haven't seen the order, and don't know if that is what is happening or not. As you have an attorney, that is the best person to advise you on modifying the order or enforcing the order.
  9. I don't know who "they" are, but comments made in a meeting regarding genuine differences of opinion are not slander. No doubt "they" do not agree that your claims have merit and the belief that you are not bright is purely opinion. That one claim some time in the past might have had merit does not change this. It is also not clear what damages you suffered as a result. If you missed the deadline to file a claim you can't just repackage said claim under a different name.
  10. Well, you asked about something we could only know the answer to if we had read the order. As for what you call judgement, it is what it is. You want to persuade a court to bar your ex providing medical treatment to a child who shows every indication of needing that treatment, and which a medical provider has deemed necessary. There is a very high bar to overriding a parent's right to treat a child's medical condition, and it is even higher when there is an actual medical professional supporting the existence of the condition and prescribing the treatment. Add in behavioral evidence that the condition exists and requires that treatment and your own admission the behavior is a problem and I am not sure on what basis you think any judge should overturn the prior order.
  11. Being as you hadn't given us any details about why you are suing and why you are adding to an existing claim, it is difficult to guide you. If you do not have an attorney, you need one.
  12. This is not governed by law. The carrier is permitted to dictate what information and format is required for claim reimbursement. Submissions by the patient or the patient's spouse are irrelevant. I've been the administrator for self-insured plans, including ones with a large international employee base. One of the challenges in seeking treatment in a country other than the one where the plan is administered is that international providers typically only conform to what the standard is for the country where they operate. Your best bet is to have your wife contact the provider directly and ask if he/she will provide what is needed to have the claim approved. Many will if provided the specifics and asked by the patient. Your plan administrator should have a procedure for appealing any denials. Itemized bills are the norm in the US, but not so in other parts of the world. Yes, the ICD codes can be and typically are required. While you can request a summary plan description at any time, it isn't going to necessarily cover the internal policies and procedures to accept a claim.
  13. Being as none of us have read your order, we couldn't possibly know its terms. You do not have to be criminally charged in order for a family law court to find you unsuitable and restrict your visitation and or alter custody. It is clear that you can not parent this child appropriately and that is enough to warrant the change. Yes, the other parent can absolutely administer medicine. Why would you think they could not? If the kid is lying and becoming violent to ordinary announcements about bedtime, you are going to have an extremely difficult time persuading any court that there isn't some mental condition and medication is unwarranted. It is absolutely not alienation of affection for the other parent to follow the court order and not grant the parent accused of abuse extra time or unsupervised time.
  14. Dentists (and doctors) have the right to refuse to take on new patients, and or restrict which patients they will accept based on insurance. Doctors in a life or death type emergency may be required to render care, but swollen gums does not even come close to this standard. The dentist who would not see you that day is in no way responsible for your HBP. While your insurance carrier may treat emergency appointments as in network for their coverage purposes but that in no way compels a provider to accept you as a patient. You also are not the one who determines whether it meets the definition of an emergency per the carrier.
  15. It is not clear why you think the school or chaperone are responsible for your son hitting his head on a roller coaster. It isn't clear that he ever told the chaperone (or anyone else) that he passed out several times. "Nah, I don't feel like riding", doesn't do it. Unless the chaperone was sitting next to him on the ride, how would she know?
  16. Of course you are at a disadvantage without a lawyer. That should be obvious. This is something you are going to need to bite the bullet and hire a lawyer for as it is not the kind of thing that can be addressed by message board. If he isn't complying with the decree you have, take him back to court.
  17. A form? No. There is no general form to request basic information about one's adult children. You haven't shared when this modification happened, why, or what was modified, nor what your order says regarding any of these things. It can be written into an order that your ex must provide you with certain information, such as the children's school enrollment, but we have no way of knowing if yours says that or not.
  18. When did you modify the agreement? How was it modified? As your son is an adult, you are not entitled to see his grades, whether or not you are paying support or tuition. Certainly you can impose parental consequences if he does not comply with your wishes, just as you could if he fails to do anything else you ask, but as a matter of law, once he turns 18, your entitlement to access ceases. Your daughter can't change her legal name but if she wants to change what she is called in school, and the school agrees, that is allowed. It is no different than if she suddenly decided she wanted to use a different nickname or go by her middle name.
  19. No, a PPO does not obligate the other party to pay for damages to your residence. You can try suing them civilly for any damages you incur on their behalf. The PPO is useless if you refuse to use it. Contact a domestic violence support center or hotline. See what resources are available in your area. Most have shelters and other supports available should you need them.
  20. Medicals for claims continue even if you no longer work there, so long as the treatment is for the compensable injury. Lost time benefits are typically not owed if you become unemployed for other reasons as TTD is intended to replace income you lost because you were unable to work. If your employer was accommodating you and you were fired, you don't have any wages to replace. File for unemployment and begin looking for jobs within your restrictions. There are literally thousands of jobs that do not require lifting over 10 lbs. and which allow you to stand/walk/sit during your shift.
  21. Have you called the police with this psychopath goes on a rampage and becomes violent? You need to. Have the idiot served, have a safe place to stay, and as soon as he violates it, call the police. You can speak with your landlord about breaking the lease. They might be understanding. You are the one who signed the lease so you are responsible for the terms of the lease and any damage to the unit. Change the locks, get a security system (even just a cheap one that sounds an alarm with a door/window is smashed), have someone stay with you. Perhaps your neighbors would be willing to let you stay with them for a night or two, or at least keep an eye on your place and call police if he appears to break in.
  22. As a US citizen, you can obtain citizenship for your child and spouse in a much easier process than if you were not. If you hold a US passport, you are eligible to travel to the US at any time. Here is a link to information about obtaining a green card and eventual citizenship based on your status. https://www.uscis.gov/green-card/green-card-through-family/green-card-immediate-relative-us-citizen
  23. Ultimately, in virtually every organization, the chain eventually stops with one person (CEO, President, owner, etc.). HR doesn't float out in the ether as a totally independent entity.
  24. Under federal law, even disabled students who attend private schools have certain rights. In fact, many children are enrolled in private schools specifically as a result of IEPs. IDEA also grants both parents the right to be part of the IEP if divorced, unless there is a specific court order stipulating otherwise. If the custody order doesn't forbid Dad from participating, he is allowed to be there under federal law. As described, if the parents disagree, Mom's decision prevails but it does not preclude Dad's participation. The exact language may change that, but I am answering based on what was shared.
  25. Looking at the GA statutes and information, support for the oldest would end once he graduates HS as he is already 18. College does not extend this unless the parents agree to do so.