Insurance claims tangle

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PostPosted: Thu Sep 29, 2011 7:19 am   Post subject: Insurance claims tangle  

The health insurance company continually denies the claims for my husband’s treatments. Even though they paid them last year, they will not pay them this year. We DO have a letter from the insurance company pre-certifying the procedures through later this year. We have been given a huge variety of different explanations, but the latest is that our insurance company outsourced the handling of these procedures to another party. And that party in turn outsourced it to yet another company

Can anyone explain on how to navigate through this tangle of insurance company outsourcings-upon-outsourcings? My only contact is with the main insurance company and they don’t know what is going on after that until the claim denial comes back, time after time.

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PostPosted: Thu Sep 29, 2011 12:11 pm   Post subject:   

Is the insurance through your employer or your husband's employer?

If so you can contact the office manager and ask him or her how to handle this. They should have someone to contact at the insurance company directly.

Have you tried to contact a state representative or senator about this? Sometimes they can offer some help.

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PostPosted: Thu Sep 29, 2011 8:27 pm   Post subject:   

Have you tried to contact a state representative or senator about this? Sometimes they can offer some help.

While this "help" is unlikely to come, the state does have a much better resource for you: the Dept of Insurance.

If you are in California and an HMO is involved, the proper agency is the Dept of Managed Health Care.

Find your state's Dept of Insurance website and file a complaint (CA calls it a "Request for Assistance"). This falls under the heading of UNFAIR CLAIMS PRACTICES and is dealt with severely by the states. In CA, UnitedHealthcare is still negotiating a potential TEN BILLION DOLLAR fine for its poor claims handling procedures involving more than one million claims (at $10,000 per violation = $10,000,000,000).


CA-licensed Life & Disability Analyst. CA Insurance Lic #0596197. Also investigating insurance company abuses, and providing litigation support/expert witness services. Send me your questions, and I'll send you my answers.
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PostPosted: Tue Nov 22, 2011 3:29 pm   Post subject:   

Thanks max, i think it is better understood by me also, you got it exactly the same.


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