QUESTION
What can I do if my insurance company is refusing to pay a hospital stay claiming it’s because it could be linked to a pre existing condition?
Asked on Nov 10th, 2012 on Personal Injury - New York
More details to this question:
The healthcare company had a 9-month pre existing condition clause but I did not have insurance prior to this hospitalization. They paid one of the claims and now are saying that it was an over sight and they are requesting the funds back from the hospital.
10 ANSWERS
Ronald A. Steinberg
You better pray that The Affordable Care Act (Obama Care) becomes operative. There will no longer be a "preexisting condition" clause in any policy. In the meantime, if you had a preexisting condition within 9 months of the beginning of this new policy, then you are screwed. The contract says what it says, and it is presumed that you read it and that you understood it. It is "all or none."
Answered on Nov 25th, 2012 at 5:39 PM
Answer: The answer will depend on the contract and application you submitted to secure the insurance. A lawyer will need to read the contract.
Answered on Nov 15th, 2012 at 8:37 AM
Employment Law Attorney serving Beverly Hills, CA
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Dordick Law Corporation
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Look at your policy. There should be a provision to contest their determination.
Answered on Nov 13th, 2012 at 5:31 PM
Personal Injury Attorney serving Pacific, MO
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Melvin G. Franke
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You must meet with an attorney who is experienced in health/contract law.
Answered on Nov 13th, 2012 at 5:31 PM
Personal Injury Attorney serving Charlotte, NC
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Paul Whitfield and Associates P.A.
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Sorry. not enough information here.
Answered on Nov 13th, 2012 at 5:30 PM
Plaintiff Animal Bites Attorney serving Missoula, MT
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Bulman Law Associates PLLC
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Write a complaint to your state insurance commissioner. Depending on your state law, the preexisting condition clause may not be valid. Keep all your insurance papers and sales brochures.
Answered on Nov 13th, 2012 at 5:30 PM
Criminal Defense Attorney serving Anderson, SC
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The David F. Stoddard Law Firm
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If you think they are wrong, if the insurance is through your employer, you should find an attorney who represents clients with employment benefit claims, also known as ERISA claims to review your health insurance policy and your medical records to determine if they are right. If it is your own private insurance policy, and ERISA lawyer, or a litigation/contracts attorney can help. If you agree that it is a pre-existing condition, and if the policy clearly excludes pre-existing conditions, then you will owe the bill as if you have no insurance. However, it may still be worth consulting an attorney because laws have been passed limiting the ability of insurers to exclude pre-existing conditions.
Answered on Nov 13th, 2012 at 5:30 PM
Litigation Attorney serving Olean, NY
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Black, Lyle & Habberfield, LLP
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Sue them. Good luck.
Answered on Nov 13th, 2012 at 5:30 PM
You should either contact your state's insurance department for assistance or consult with a plaintiff's insurance lawyer for specific legal advice.
Answered on Nov 13th, 2012 at 5:29 PM
Chapter 7 Bankruptcy Attorney serving Syracuse, NY
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Andrew T. Velonis, P.C.
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Get a complete copy of your insurance plan. There may be an internal appeal option. If not, there may be an arbitration clause.
Answered on Nov 13th, 2012 at 5:29 PM