What should I do if my insurance company has made a clerical error but is not fixing it?

UPDATED: Oct 1, 2022

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What should I do if my insurance company has made a clerical error but is not fixing it?

I got health insurance through my work back in November. Every month since then I have had issues getting my prescription medications. Since January, my pharmacy reports that my coverage ended in January and can’t bill my insurance. Every time this has happened, I called the insurance company and was told thatthere is a clerical error that

Asked on February 13, 2019 under Insurance Law, Indiana


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 3 years ago | Contributor

You can sue your insurer for any costs you incur by buying the medicines elsewhere or in some other way, if the insurer should have covered them for you. You would sue based on breach of contract, or them violating their contractual (the policy is a contract) obligations. You would sue for the difference between what you paid elsewhere/otherwise for the medicine vs. what you would have paid had it been properly covered (e.g. an copay). Unfortunately, if they will not voluntarily reimburse you for any cost you incur, suing them is the only effective way to seek compensation.

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