Complaint 12 of 16 in “Claim Denied / Delayed in Whole or Part”

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  • Insurance Carrier: Blue Cross Blue Shield
  • State: IL

Consumer Complaint:

I was taken to an emergency room on 12/30/08 (thought to be heart related at that time). Stayed in hospital overnight and had tests done the next day. Also had follow up tests done at another hospital on 01/26/09. Insurance refuses to pay anything citing pre-existing condition although until this day after all tests were complete nothing was ever discovered or diagnosed.

My policy started on 12/11/09 and Blue Cross received the total premium prior to that date. There is no way I can pay the bills which total around $20,000. I have a meager income as a distributor of bakery snacks and my wife does not work in order to raise our son. Please help.

Insurance Expert Answer:

Most Blue Cross carriers created special units to carefully examine large claims and try to duck paying. It is always a question of fact whether your application properly disclosed your condition. See a lawyer as there are lots of bad faith denials, but unfortunately some people omit to provide called for disclosure, or out and out lie and those denials are justified.

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