Complaint 5 of 16 in “Claim Denied / Delayed in Whole or Part”
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- Insurance Carrier: Summacare (appo)
- State: OH
Entered hospital 3/25 with heart attack. Accumulated bills in excess of $140,000. My company’s insurance provider refuses to pay any bills until I can prove that I was not treated for this or a related condition up to six month prior to my effective date of coverage (Feb 2, 2008) I have had no medical treatment or insurance for five years prior to this insurance. They said that if my cardiologist would affirm that he did not treat me up to six months prior to Feb 2, most likely the pre-existing condition issue would be resolved. Then they wanted the same thing from the hospital, then all the doctors who saw me in the hospital must do the same thing. They claimed to have contacted the hospital and some of the doctors, and got no reply. I contacted two of the doctors and the hospital, and they denied they were ever contacted. I have been trying to work with SummaCare for the last five months and am no closer to getting any of these bills paid. One billing office suggested that they may be playing a waiting game so that my debtors will come after me leaving them alone.
Insurance Expert Answer:
This is awful. It looks to me as if the insurance company's delay may be acting in bad faith.
Is yours a privately purchased policy or if you got coverage from your or your spouse's employer, and if from an employer (even if you pay some of the cost) what is the name of the employer? (Why do we ask? The applicable laws can differ dramatically depending on the whether or not it is employer provided -- in which case the federal ERISA law applies, and if not, state law applies -- and whether ERISA applies often depends on the status of the employer.)
You can arrange for a free initial consultation from a qualified attorney who handles these cases, usually on a contingency basis.