My sutdent health insurance denied claims, because my new husband's insurace. They are saying my student health insuracne is not covering when I am listed under my husband's health insurance.....My doctors and hospitals were under "my" insurance, not under my new husbands. My husband re-claimed thru his insurance, but was also denied.... Which place do I need to go first? Should I hire a lawyer? Or file a complaint at Department of Insurance (California)? I am worrying the state agency is so~ slow, and miss right timing to fight against. Anyone has experience with filing a complaint thru state agency, and get it resolved? How long does it take to start their investigation?
2007-08-02 05:16:11 · 4 answers · asked by hong j 1 in Business & Finance ➔ Insurance
- Also my other concern is... doctor's office and hospitals already turned their billing to collection agencies, and those collection agency claimed my banck account. Do you have any recommendation to resolve this while I am working with state agency or attorney?
2007-08-02 05:49:27 · update #1
My husband's insurance was HMO. My student insurance was PPO. The doctors and hospitals were under my student insurance's PPO, not under my husband's HMO. This is the reason my husband's insurance denied the claims.
2007-08-02 14:47:22 · update #2
The first question you need to answer is whose birthday falls first in the year? Yours or your husband's? (It does not matter who is older, just which month you both were born in ) Whichever one of you has the first birthday in the year, that is the primary plan. Once you figure out which plan is primary, make sure they know that they are primary and the other plan knows it is secondary.
The second thing you need to do is to notify the providers that you are appealing the denials, and that you will keep them informed as to the progress. As long as you keep them informed as to what's going on in the appeal, as long as the providers are humans, it should keep you from being sent to collection.
Next: Call the primary plan and ask about an appeal. Ask them for the exact process - meaning what documentation you need, where it gets sent, and to whom it gets sent. Ask for a phone number you can call to follow up.
Send the appeal. Keep copies of EVERYTHING you send and mail the paperwork with a return receipt requested. This way, you know when it has been received and who signed for it. It will eliminate the "We never got your paperwork." problem. Once you know your submission was received, wait ten business days and start calling to check the progress. Call them every other day if you have to. DO NOT get frustated or give up. Insurance companies COUNT on that.
Once you have exhausted this option, then you file a complaint with the state. Otherwise, most states will not take action, they just sit on it.
In NY, it takes about 6 weeks for an investigation, but CA might be longer.
2007-08-02 05:58:52 · answer #1 · answered by zippythejessi 7 · 0⤊ 1⤋
Hello. you would first need to find out who's insurance has you listed as primary. I would think it would be your student insurance. I am a certified medical billing specialist and insurance companies will deny deny deny. Watch out for the timely filing rule. Keep everything you receive from them, stay on the phone until you get answers. As a last resort report them to the Insurance Commissioner of your state. Hope I have helped
2007-08-02 05:23:14 · answer #2 · answered by Anonymous · 0⤊ 0⤋
OK. Your husband's insurance should be first. Student insurance never coordinates. The birthday rule doesn't apply to your situation. Its supposed to be used for children who are double covered.... Anyway, You need to start w/ your husband's insurance co. Why did they deny??? Out of network? Write an appeal to them. It they deny it, & your hubby's insurance is through his job, speak with someone in HR. If they don't correct it, call the dept of insurance in CA. If they can't help you, then call a lawyer. This is the cheapest and most widely used process. good luck.
2007-08-02 13:27:26 · answer #3 · answered by Custo 4 · 0⤊ 0⤋
No I do not. I own a small company. I pay the full amount of health insurance and pay the full coverage for my employees. If you want to hire quality people you need to compensate them appropriately. I do not want health issues interfering with running the business, and it is the right thing to do. In the technology arena we do have a bit of a disadvantage over the guys that hire off shore or H1B folks with no benefits. If we had universal coverage, most business owners would benefit from a level playing field.
2016-05-21 00:59:15 · answer #4 · answered by ? 3 · 0⤊ 0⤋