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I haven't sent this letter yet and would appreciate any and all advice.

Thanks,
e


September 9, 2003

My name
My address
My city, Texas Zip

Claims Customer Service
Ameritas Life Insurance Corp.
P.O. Box 82520
Lincoln, NE 68501-2520


Claim #: The claim number they assigned
Plan Member: My husband
Patient: My daughter
Plan #: Our plan number
Plan Sponsor: My husband's employer
Date of Service: 08/18/2003

To whom it may concern:

Yesterday I received your letter (copy enclosed) stating you received a claim for my daughter's orthodontic treatment on August 18, 2003. On August 5, 2003 I made a payment of $150 to her orthodontist for models, x-rays and photos of her face. Then we returned on August 18, 2003 and I made a payment of $2,760 to her orthodontist for the spacers, lower appliance and upper braces. So, as of today I have paid the orthodontist, out of my pocket, $2,910 for the services she has received to date. I realize, as you pointed out in your letter that the maximum benefit that I am entitled to through this policy is $1,200. Oddly enough your letter stated that I would be paid this benefit in quarterly payments beginning November 18, 2003 with your final reimbursement being August 18, 2004.

I would have to assume that you are not familiar with Texas Insurance Code, Article 21.55, titled “Prompt Payment of Claims.” This statute entitles the consumer to interest penalty money of 18% per annum for payable claims not paid within 45 days. Additionally, if the insurance company refuses to pay the penalty owing, the statute stipulates that any attorneys' fees incurred in demanding and obtaining the penalty will be charged to the insurance company. If you would like to review the actual statute yourself to see that dental insurance is included you can find it online at http://www.capitol.state.tx.us/statutes/in/in0002100.html#in157.21.55.

I look forward to your prompt payment of $1,200, and will wait until October 18, 2003 before seeking help from the Texas Attorney General, Gregg Abbott.

Sincerely,
e
Enclosure(s) cc: Texas Attorney General, Gregg Abbott

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