Sep 23, 2001 - 11:52 am
Hi....Hope this finds everyone doing well. I know my problem is not as critical as some but none the less, I'm looking for advice. Our primary health insurer is denying my claims; they are trying to prove a pre-existing condition. They haven't paid anything, not the annual mammogram, lumpectomy, mastectomy or the colonoscopy so the bills are mounting up. I have filed an appeal but they have until Jan 11th to decide. I sent the annual letters from my doctors and the radiologists that all my mammograms were considered normal as part of my appeal. I even had our attorney call them and the surgeon!! With the denial letter, the ins company also sent a waiver for us to sign relieving them of all claims pertaining to any breast disease in either breast or complications thereof. The waiver had to be returned by Sept. 21st or they were going to cancel insurance not only on me but my husband and daughter as well. Even the attorney couldn't get us an extension on the deadline. Now that they have the waiver, what are the chances they'll pay anything? I doubt they will but haven't given up hope. If they deny this appeal, I am entitled to a 2nd. And in fact have to go thru that process before I could file a law suit. I have reported the company to our local Representative, The State Insurance Commissioner and I'm in the process of filing a complaint with our State Attorney General. Nothing budges these people. The Ins. Commissioner's office only has jurisdiction over whether the claim is paid according to the policy, not whether there where circumstances that put the coverage null and void.