? about doctor bills?

Question

i have been to the doctor recently and got news today that my insurance company does not want to pay they say it was a pre-existing condition but i have not been to the doctor for this b4 i had insurance thru them
so how do i prove it was not a pre-existing condition, how do i get them to pay, and what do they consider pre-existing?
thanks

Answer 1

Pre-existing can be anything the insurance wants. I have a patient whose insurance is trying to call a COLD pre-existing.

What you can do is call your insurance company and ask what the time frame is for the pre-existing waiting period- most of them is six months, some have a year. Then ask your doctor's office for a copy of your actual chart notes for the last six months to a year - go a little over what the waiting period is - you may have to sign a release, but they have to give it to you - it falls under getting paid. Then, send a copy to your insurance company - keep a copy for yourself so they can't pull the "we didn't get it" routine - with a letter explaining that you have had insurance with this same company for x period of time, and have not been treated for this ailment previously, and you would like them to reconsider the charges and remit payment to the provider.

It is a tremendous pain in the you know what, but as long as you don't give up and back down, you will prevail - unless your plan has some rare funky rider.

Answer 2

FIRST - did you have insurance continuously with another company before you changed to this one? If so, you can provide the certificate of credible coverage from your prior insurance company to prove that you had other insurance and they CANNOT process any of your claims as pre-existing.

(If you can't find it - it usually comes with or around the time you would have gotten COBRA information. If you didn't keep it - you can call your former employer or insurance company and ask for a new copy)

If not, It may simply be a coding error or in some cases, for someone that is in their initial 12 months on the plan, common conditions are automatically considered pre-existing and the insurance company may code it this way and ALSO send you a letter asking you to provide them with the name and contact info of any doctor you've seen during the prior 6-12 months.

Once they recieve that information from you, then they will contact any doctors during that time and ask for a copy of your records to prove that you haven't been seen for the condition - at which time, they'll re-process the claim.

In either case, you should try going to your HR/Benefits person at work, because they can often get to people you can't and get the claim resolved from their side. But if not, call the insurance company and ask what steps you need to take to dispute or appeal this charge.

Answer 3

well this is a problem that most insurance companies take... You can have pre existing through on eximaner at the company and not the other... You need a hearing and a good lawyer..... Get to it ASAP Good luck Grant M in Pennsylvania

Answer 4

Call the insurance company.