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What next? Insurance Co. dropped me.

JanBred
Posts: 42
Joined: Jul 2012

Besides having EC, dealing with an insurance co. is bull crap!!
I was on a short term medical insurance policy until I found work. Five days after effective date, I started having swallowing issues...went to Dr. put on meds then went for scope 20 days later. Then DX 4-26. Insurance Co. denied claims initially stating I was under investigation for pre-existing condition. They investigated all my prior medical records back 5 years and found nothing.. After four months, they started to pay claims. Now, they have requested their monies back from my providers. Now looks like all of these bills are mine to pay--like 300k worth. Insurance company stated that my symptoms started before effective date which is untrue..otherwise why would I get a six month policy? I am just beside myself, trying to figure out what to do. Jan

paul61's picture
paul61
Posts: 1110
Joined: Apr 2010

Jan,

Contact the office of your state insurance commissioner and file a complaint against your insurance company. Each state has an Office of the Insurance Commissioner and and they will intervene on your behalf.

Click Here to go to a list of State Insurance Commissioners 800 Numbers

It sounds like you have excellent grounds for an appeal.

Best Regards,

Paul Adams
McCormick, South Carolina

DX 10/22/2009 T2N1M0 Stage IIB
12/03/2009 Ivor Lewis
2/8 through 6/14/2010 Adjuvant Chemo Cisplatin, Epirubicin, 5 FU
Two year survivor

Life may not be the party we hoped for, but while we are here we might as well dance!

JanBred
Posts: 42
Joined: Jul 2012

I will be appealing, and/or suing them. This is a perfect example of a bad faith insurer. I haven't received a letter from them, but my nearby hospital did. I guess the costs of treatment were more than they wanted to deal with. Just another hurdle in life to get through.

paul61's picture
paul61
Posts: 1110
Joined: Apr 2010

Jan,

Some additional good suggestions from some of our other "EC Family".

1. Contact your congressional representative and inform them of your situation.
2. Contact the governors office and ask them to prioritize the intervention of the state insurance commissioners office.
3. Contact your local TV news station and ask them if they are interested in a "human interest" story.

Insurance companies tend to change their stance when they come under public scrutiny, they depend on people feeling helpless and giving up.

Best Regards,

Paul Adams,
McCormick, South Carolina

NLMCEM
Posts: 52
Joined: Aug 2010

If the doctors/ hospital said they would accept the insurance you had then the insurance should pay what their allowed amount is. Do you have a secondary ins policy also? 80% coverage still leaves a large 20% not covered. I know had we not had our secondary ins we would be in horrible debt. Also we ran into the ins not covering the chemo company first try so our medical team found the company they would cover, same drugs just who was making them.

Definitely get with your State asap as suggested above.

Best to you

JanBred
Posts: 42
Joined: Jul 2012

This was a pretty expensive short term policy which my oop was around $8000. They are saying my symptoms were present before I was in effective coverage. They are calling it now pre-existing. They haven't sent me any letter, but am starting to get the bills from providers. I made complaint to state, and they wanted more info., so hopefully I can get something done. Bad faith, retroactive recission, and post underwriting.

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