Kane In Your Corner

Kane In Your Corner: Woman could lose home after $80K insurance claim snafu

Posted:
If you think your doctor and health insurance provider don’t do a good job of communicating, just be glad you’re not Patricia Amerino, of Howell. If you think your doctor and health insurance provider don’t do a good job of communicating, just be glad you’re not Patricia Amerino, of Howell.
HOWELL -

If you think your doctor and health insurance provider don’t do a good job of communicating, just be glad you’re not Patricia Amerino, of Howell. Four years after she was preapproved for a surgery that should have cost her only a $54 copay, Amerino stands to lose her home over more than $80,000 in unpaid medical bills. 

But things may be looking up for Amerino, now that she has Kane in her Corner.

Amerino says in March 2013, she learned she needed emergency sinus surgery for a fungal infection.  Dr. Anthony DeGennaro, of Red Bank, got the surgery preapproved, but her bills were never paid by insurance, and eventually the doctor’s office filed a lawsuit against Amerino, obtaining an $81,000 judgment, backed by a levy against her home.

"It’s just so stressful,” says Amerino, who says she made dozens of phone calls trying to get the claim paid. “It’s literally the last thing I think of and the first thing I think of when I wake up.”

The problem seems to stem from a breakdown in communication. Although she lives in New Jersey, Amerino’s husband works in New York and is insured through Empire Blue Cross, which preapproved the surgery. But after the surgery, documents show Empire repeatedly asked the doctor’s office to submit claims information, claiming it had not received any.

Dr. DeGennaro insisted he had billed insurance. During his lawsuit against Amerino, he even presented faxes that he said were sent to Empire Blue Cross. However, the area code on the faxes shows they were actually sent to a 973 area code.

“They were sending it to (Horizon) Blue Cross Blue Shield of New Jersey, who of course, didn’t know who these people were, because they weren’t their insureds,” says attorney Allen Kaplan, who only began representing Amerino after she lost her lawsuit. Amerino says he thought she could represent herself during the lawsuit because it was obvious she had insurance and she was confident the court would realize she was the victim of a mistake. 

Dr. DeGennaro’s attorney, Kathleen Wall, insists her client billed Empire Blue Cross twice, before sending the faxes to the New Jersey number. However, when Kane In Your Corner asked for proof to support that claim, the attorney did not provide any.

An Empire Blue Cross spokesperson tells Kane In Your Corner the company has yet to receive a claim, but invites Amerino to call her personally, promising to work with her to resolve the issue.

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