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Health Insurance (Expert Forum)
Health Insurance Claim Question
This forum is for questions and support regarding health insurance issues such as Medicare, Medicaid, Long-term health insurance, COBRA, insurance portability.
Health Insurance Claim Question
by holdem31, Apr 29, 2007 12:00AM
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.
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.