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Claim paid after contractual review

I had a heart attack requiring quadruple bypass surgery while I was on a business trip to Louisville, Ky. The heart attack occurred Aug. 20, 1996, and I was operated upon on Aug. 23.

I had no history of a heart problem. A routine medical examination in October 1995 and blood tests in March 1996 showed no sign of trouble.

The company I managed had changed insurance carriers from American Medical Security to Pacific Mutual, PM Group, in April 1996. The reason for the change was their presence in states other than Florida, where ITI Technical Services Inc. also had employees.

Since my surgery, ITI has had to cease operations. So far, Pacific Mutual has not paid a nickel to any of the service providers (doctors, hospitals, etc.) involved in my care. They have been on a fishing trip to find if this was a pre-existing condition.

Every time I have provided them with the requested information. Every time they have come back with yet another trivial requirement. Each time they referred it to the review board, which takes six to eight weeks.

In the meantime I am being hounded by the collection agencies to which the providers have turned over my accounts. I had continuous medical coverage from February 1995 to November 1996. This was the first time since 1967 that I was admitted to a hospital.

I am seeking your help because, if nothing is resolved, I may have to file for bankruptcy. Maqbool Qurashi

Response: All claims that PM Group, Pacific Mutual has received to date have been paid, said Joseline Lorenzo, manager of media relations. The delays, she said, were due to their contractual obligation to determine whether your medical condition existed before the date coverage became effective.

Your enrollment application did not disclose the existence of any pre-existing conditions, and this affected the length of time required to conduct the review. Once the review was completed and the determination made that your heart attack and resulting surgery were not pre-existing conditions, your claims were promptly paid, she said. They acted in good faith and in accordance with their contractual obligations and regret any hardship you may have experienced as a result.

Here's a reminder to consumers who think the late payment of bills might affect their credit rating. You can request a copy of your credit report from any or all of the three major credit bureaus, Experian (formerly TRW Inc.), (800) 682-7654; Equifax, (800) 685-1111, and TransUnion, (813) 273-7833. The charge is $8.

For a copy of our tip sheet, "Credit Bureaus and Reports," send a long, self-addressed, stamped envelope to the address below. In addition to general information on credit bureaus, it outlines the steps to take if your report contains information that you consider false or inaccurate.

Estimates reconciled

I had New York Carpet World in Clearwater come to my home in January to measure for tile installation. On Jan. 19, I went to the store and informed the salesman that I wanted to take advantage of the zero credit, zero finance the store had advertised. I put down a $20 deposit, and my credit was approved the following week.

For reasons I cannot explain, I decided to get another estimate from the St. Petersburg store. For the exact same rooms, their estimate was $600 lower. Naturally, I canceled my Clearwater order and requested my $20 back. I was told I would receive it within a week. That was some time ago and I still have not received it despite repeated phone calls.

What scares me is that I might have ended up paying $600 more than necessary. Does this type of thing happen often, or did I have "sucker" written on my forehead when I walked in the door? Patricia Wild

Response: Robert Wise, administrator of New York Carpet World in Southfield, Mich., said there never was a $600 difference between the Clearwater order and the St. Petersburg order.

The Clearwater store estimated 86 boxes of tile for the job, including three extra boxes to allow for possible breakage and future dye-lot matches for any needed repairs. That job was quoted at $6,883.99. Unused boxes could have been returned to the store for credit toward labor and materials.

The St. Petersburg store estimated 83 boxes of tile. They did not include extra boxes for breakage or future repairs. The price quoted was $6,712.35, which was $171.64 less than the Clearwater quote, not $600.

According to Wise, no tiles were left over from the job the St. Petersburg store performed. In fact, you had to purchase an extra box. Compensating for Clearwater's slight overestimate and St. Petersburg's small underestimate of materials, the two price quotes were virtually identical.

The $20 deposit was transferred from the Clearwater to the St. Petersburg store and credited toward your purchase of the additional box of tiles.

We noticed that the sales contract from the Clearwater store that you sent us was for $4,144.05. It was not clear whether this reflected both the materials and the labor, however.

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, 893-8171, or, outside of Pinellas, (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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