health insurance representative is misleading?. what should i do?

I called my insurance company about claims that they were being denied. It was for my pregnancy. I asked a representative if i was covered for the claims that they were denying and he said yes and that the doctors office was putting in wrong claim numbers i continued seeing the doctor and after the fact the doctors office called them and the said i wasnt covered for the pregnancy. i have bills upon bills what am i to do?

Asked on June 11, 2009 under Insurance Law, New Jersey

Answers:

B. B., Member, New Jersey Bar / FreeAdvice Contributing Attorney

Answered 11 years ago | Contributor

Something sounds very, very wrong here.  As far as I know, health insurance companies in New Jersey aren't allowed to exclude pregnancy from their coverage, although I've never researched that exact issue.  And I can't be certain whether or not your claim is actually covered, without looking at the bills and your insurance.

New Jersey's courts are fairly protective of people who have insurance, in disputes with the insurance companies.  And if an insurance company does not deal with you in good faith, they can be made to pay your attorney's fees, if you have to sue them to get what you're entitled to.  Because of this, many times, an attorney's letter will persuade an insurance company to "reconsider" denying a claim.  Sadly, some insurance companies do deny valid claims at times, just to see if they can save some money.

The fact that the law allows attorneys' fees in this sort of case means that you may well be able to get a lawyer to take this on for you, without a lot of money up front.  One place to look for qualified counsel near you is our website, http://attorneypages.com


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