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How do I fight this insurance claim?

I signed up for health insurance back in october of last year. I was told by the agent and all of the emails that we exchanged that my insurance would be effective immediately. I went to the doctors 3 days after signing up and at the time they took my insurance and my co-payment. Now I'm being billed months later because my insurance was apparently denied. According to the claims agency, it was denied because my plan was not supposed to become effective for sickness until 5 days after the sign up date. I asked the claims department where that information could be found. They said that I would be able to find it on my online account with that particular insurance. I asked why it was not written out in the application and summary that I received when I first signed up. The woman said straight up that "Maybe there was not enough room to type it out".....then she tells me to call my insurance company directly to find out why. So I do. My insurance company tells me that my plan should have been effective immediately and that my online account is not supposed to provide me with any new information. The online account is only there to help me keep track of my records and payments. All of the important information was supposed to be received up front. So I call the claims department again and they can't really give me any real information or help. They tell me that I can appeal the claim but that it would essentially resort back to the policy. Help!!! They're sending me in circles.

4 Answers

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  • car253
    Lv 7
    2 months ago

    Call the Department of Insurance or Insurance Commissioner in your state.   You might want to post your state for more help.    That is your only source of help.

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  • 2 months ago

    First, and most important, you stop calling, immediately.

    There are two reasons for this:

    1) You can't prove later what was said on the phone.

    2) Calling tells them that if they keep doing what they are doing, then you will just keep making more phone calls.

    Next, send a written letter, by certified U.S. mail, return receipt requested, without calling. This may be enough, partly because it tells them that if they keep doing what they are doing, then you are going to do more than just call, and partly because they know it's often the last thing someone does before they sue.

    If that doesn't work, then you could also try complaining to the state insurance department.

    Or, if you just want to fight, and don't anything done, then keep calling.

    • car253
      Lv 7
      2 months agoReport

      This is a great answer.   Good advice.

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  • 2 months ago

    Sounds like you signed up to make a claim.  Health insurance doesn't typically go through that fast.  And, it makes sense that it wouldn't start right away and cover sickness right away; otherwise, people would wait until they needed a policy to buy it.

    Look in your policy.  I'm sure there's a memo regarding not covering sickness for the first X days.  

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  • 2 months ago

    Well, I would tell the person in the emails, that if the insurances company refuses to pay, that you will be suing him/her and everyone else. then call a lawyer. And yes, this is really bad advice

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