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Software snag slowing payment

By NANCY PARADIS, Times Action Columnist
© St. Petersburg Times
published June 7, 2002


I need your help regarding a balance due notice for $371.79 from Sunstar Emergency Medical Services for transport of my husband. I have sent Sunstar copies of my Medicare Summary Notice showing that Medicare paid its part ($246.05) of the claim. Sunstar continues to ignore this. It must have applied the money elsewhere. How can Sunstar deny this? The payment amount wasn't the $433.30 that was billed and I probably owe something, but not $371.79. Mrs. Donald Collins

Response: Barbara Shiels, administrative support specialist for Pinellas County Emergency Medical Services, doing business as Sunstar EMS, said that sometime in mid-May, Sunstar's billing office became aware that there were Medicare payments for claims processed in February that it had not received.

Apparently several patients had called, saying they had received Medicare Summary Notices showing their claims had been paid, but Sunstar had no record of the payments. Also, Sunstar had received payments from supplemental insurance companies, even though no Medicare payment had been received.

Shiels said the billing office called Medicare and learned that these claims were all processed Feb. 25. Sunstar had not received the Medicare Remittance Notice for claims processed on that date. She said Sunstar believes this was attributable to the recent changes in Medicare's computer system and software, which resulted in a large volume of claims processing problems.

On May 21, Shiels said Sunstar sent Medicare a written request for the remittance notice for Feb. 25. Unfortunately, she said Sunstar has no way of knowing how many Medicare beneficiaries this has affected. As patients call, their accounts are being put on hold until a response is received from Medicare.

According to the Medicare Summary Notice you were sent, Shiels said Medicare processed your claim Feb. 25 and paid $246.05 to Sunstar. It also forwarded your claim to Aetna Health Plans, and Sunstar has received $61.51 from it. Once Sunstar receives the Medicare Remittance Notice for Feb. 25, the payment will be posted and you will owe nothing further. Until that time, your account is on hold and you should receive no further notices from Sunstar about this invoice.

Reaction

On May 26, your column included a letter from David A. Plouf. Mr. Plouf was concerned because he was asked to give his Social Security number to a cellular telephone company. The same thing happened to me in April, but I was not as quick-thinking as Mr. Plouf.

Within two days of this telephone application for cell phone service, I received calls from banks to verify credit applications. If the banks had not called me, I would not have known someone was using my Social Security number and my identification to obtain credit.

I spent two days on the telephone with credit bureaus and various government agencies and an attorney who specializes in identity theft. I was told to make a local police report, but Pinellas County police told me they were very busy and that identity theft is such a common problem it is basically unsolvable. I explained my suspicion of the cellular phone company, but my theory was rejected.

I then contacted the business that was offering the cellular phone service and found out that there was an employee there who was being investigated by the Miami police because other customers had reported the same coincidences.

I do not know the outcome of that investigation, but I was glad I was able to trace the probable suspect. (I guess I am not as busy as the police department.) Please warn your readers! Kathleen Wagner

Response: Done. There's nothing like hearing the voice of experience.

Although you appear to have nipped this problem in the bud, you may nonetheless want to call the Federal Trade Commission's identity theft hotline toll-free at 1-877-438-4338. In addition to getting advice on what steps to take, your information is put into a secure consumer fraud database and may, if appropriate, be shared with other law enforcement agencies or private entities. The commission has also developed a form, the ID theft affidavit, which you can use to alert companies where a new account has been opened in your name. Information and the affidavit are also available at the Web site www.consumer.gov/idtheft.

Action solves problems and gets answers for you. If you have a question, or your own attempts to resolve a consumer complaint have failed, write Times Action, P.O. Box 1121, St. Petersburg, FL 33731, or call your Action number, (727) 893-8171, or, outside of Pinellas, toll-free 1-800-333-7505, ext. 8171, to leave a recorded request.

Requests will be accepted only by mail or voice mail; calls cannot be returned. We will not be responsible for personal documents, so please send only photocopies. If your complaint concerns merchandise ordered by mail, we need copies of both sides of your canceled check.

We may require additional information or prefer to reply by mail; therefore, readers must provide a full mailing address, including ZIP code. Names of letter writers will not be omitted except in unusual circumstances. Letters may be edited for length and clarity.

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