time limit on claim filing

Posted: Wed May 07, 2008 09:25 am Post Subject:

Hi,

Xwife gave my husband $7000 in bills that she never filled out proper paperwork.

Posted: Wed May 07, 2008 11:39 am Post Subject:

Hey, listen, under a group insurance policy, your group would enter into a legal contract with the insurance co. while you possess the certificate. Over there, it becomes absolutely important for you to understand the clauses of your policy & thus identify your rights. Go thru them once more to make sure that you're not missing out on anything.

It is not your wife's fault at all..it is either the billing staff's fault at your doctor's end or else it might just be the fault of your hospital. Also, it might happen under specific circumstances that your claim gets conveyed to another carrier, which might consume some of the time.

But, make sure that in case they deny, you'd need to pursue your case single-handedly!
Don't forget to get the claim-denial in writing. Also, be prepared to follow-up a no. of times before your claim is settled (for any query call => (877) 527-9431).
Regards,
Pulsar69

Posted: Wed May 07, 2008 11:54 am Post Subject:

Dear Beth,

I see no reason why you'd need to carry no with this pain-in-the-ass!
Not point restricting yourself from visiting the consumer health insurance division of your state doi & seek help at filing your claim. The first step towards that would be to serve an appeal letter to your carrier stating the reasons why you'd believe that your claim has to be settled.

Make sure that you furnish every minute details as to why your treatment is necessary & why you feel it should be taken care of by your carrier (in doing so don't forget to include your medical lab-test results in support of your claim).

Make sure that you don't forget to have a copy of all these things with you. Now, all you'd need to do is to wait for the carrier to respond to your appeal, beyond which you'd reach out to the div. of insurance.

I may suggest 2 alternatives for you to reach out to them in case you see that they have not come up with good solutions in your favor.

You may convey your complaints at 320 W. Washington Street, Springfield, IL 62767
On the other hand you may as well fax it to (217) 558-2083

Goodlick! relix_p

Posted: Wed May 07, 2008 01:02 pm Post Subject: time limit on claim filing

Thanks for all your responses! I am going to try to talk insurance company myself, but, the last time I tried they refused to talk to me due to the fact it was not our insurance, but, my husbands xwife's insurance. The hospitals did bill this to insurance company, but, they (insurance) had a form she was to have filled out stating whether "due to an accident"? But she choose to ignore the requests on 3 different times on each bill (5 total). We weren't even aware there were bills out there. The kids live a couple hours from us.
To make matters worse, I carried secondary insurance on all the kids. Between the 2, there should have been no money owed by my husband or his xwife.
I did manage to obtain a copy of the latest denials and it does state right on it that the denial is due to "claim information not received in time limit".

Posted: Tue Jun 03, 2008 11:08 pm Post Subject:

Couldn't you legally hold her responsible? I would think that if you could show you had the insurance coverage and that she faulted on filling out these forms someone would have to find her at fault. If not she could do this all the time and who knows how much in bills you could be responsible for. I would think an atty would be cheaper than $7000. Maybe you could even take her to small claims. Surely something can be done. Please keep us posted.