i had emergency appendenctomy in early october 2006, my insurance paid the claims in december 2006 and then i recieved a letter in late april 2007 that said.."during a routine investigation of your file, we see you had a pre-exsisting condition and thus we will be pulling back all your claims and denying benefits."
can they do this? they already paid the claims and then 5 months later they are denying them. I would have thought they would review the file before the pay the claim.
do the providers have to refund the insurance company the money? will the insurance company make me pay them back? i need some good advice! thanks in advance.
I have no clue what condition you may have had that would have caused an emergency appendenctomy !
Unfortunately health insurance companies are getting away with (should I use the word, "murder"?)... um... a LOT. If they owe you money, it is okay that they pay you 6 months later after losing your information you sent them three times. If you owe them money, it is another story altogether.
My advice... call them up and find out what "pre-existing" condition you supposedly had that caused you to have an emergency appendenctomy. Ask for one of their forms to appeal (if they have them) and have your physician fill it out. If that doesn't work, seek advice from an attorney but beforehand, read your insurance policy about pre-existing conditions. The language can be a little confusing though.
Copyright 1994-2016MedHelp International.All rights reserved. MedHelp is a division of Aptus Health.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Med Help International, Inc. is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.