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[Barbara]

During treatment at a hospital, my insurance would agree to pay for a period of about 3 days at a time, then would need to re-evaluate and decide whether to pay another installment, etc.  They had agreed to pay my last 3 days.  Now all of a sudden I get a letter saying they have decided not to pay for that and that I have to.  Knowing the health care system, I'm sure this is legal, but it just doesn't seem right.  What if someone had $60,000 heart surgery and then after the fact the insurance company decides  "eh, we don't want to pay for it after all"?

This happen to anyone else?  Thankfully, the amount I need to pay is not in the thousands but damn all if it was, how can they do that to people?

[Navi]

Nope, it's not right. Insurance sucks. You're damned if you do and damned if you don't.

I'm really looking forward to applying for insurance in a few years with my "pre-existing condition." 

I've never known anyone personally who had their insurance back out of a claim but I've heard plenty of horror stories about PCOS and insurance. My favourite being one woman who tried to find an insurance company that would take her with a pre-existing condition, and when she finally found one, they agreed to pay for anything BUT PCOS-related medications, surgeries, etc. Which is the primary reason why she needed insurance to begin with.

I feel very lucky the insurance company I'm on now hasn't looked at their computer screens and noticed how much they've probably been shelling out for my medication over the last 5 years. 

[Kitten7]

Can you appeal the decision?? If so do it ASAP. Also, for what it's worth, you can't have your credit rating ruined because of outstanding medical bills. Was it a private hospital? If not call the billing people; sometimes they'll waive the bill, especially in the case of insurance saying they'd pay in the first place. Good luck! Insurance of all kinds sucks!

[Todd]

I was in the same boat a few weeks ago I had an MRI scheduled for my spine and the lady at my doctor said that my insurance might take a few days to approve it and if I dont hear anything from her before the appointment go ahead and go I didnt hear anything so I drive clear across town and when I get there they tell me my insurance will not cover it. I got a letter from my insurance that they didnt cover it because they see no reason for an MRI to be issued the reason the MRI was scheduled was because I have holes in my spine I mean how much more proof do they need??

[xenya]

I agree with Navi - "Damned if you do and damned if you don't."

I have had my bill waived before, as Kitten suggested. That's only for the hospital, not the various Doctors (most of whom I don't recall ever seeing!), but it helps.

Todd - if you have to, check yourself into a hospital. Then they supposedly have to look at you. It's your health, and unfortunately I've found you have to fight for it.

[Dr Sketch]

If it's not in writing, they aren't bound to it.  It sucks, but it's true.

[Cyber]

I would most definitely appeal it.  If you have anything in writing that says they would pay for it, make them stick to that decision.  When you talk to them, get a name and extension number and always deal with the same person.

[Barbara]

Ok, this just gets weirder.  Apparently, we were sent an update sheet from the insurance company back when i was still under care, that said those dates were covered.  Then there are several sheets from the hospital and insurance company that now says they are not.  In addition, I've seen three different totals of what I would now owe.  The first two were $105, then $380, then the latest that came today is $1800!  The insurance company is claiming they didn't know my student status and wasn't sure if I was still eligible.  However, my account on their website currently lists me as eligible, and my mom sent in the verification that I am a full time student a few weeks ago, even though I should have been (and apparently was) already listed as such.  What a freakin mess.  My parents are in charge of paying for this, so I'll see what happens.

[Cyber]

Make sure they talk to the same person (get a name and an extension number) and that they make sure to get everything straightened out and a confirmation letter stating that their records have been corrected.

[William]

Hello,
 It is very common for insurance companies to deny claims.One of the big reasons is $ money $.The longer they take to pay out on a claim,the longer they can hold onto their money.During that time the insurance company can invest that money and earn interest.If they do that to thousands of claims during the year,they can generate alot of money.Insurance companies are no different than any other company.They are in business to make money.

[Kim]

I don't know what you where in the hospital for but I know in the mental health feild there is one person  usaually that cares of this issue. I would go to the billing office and show them all of the paper work and ask who worked on your case and if they do not help you go to the hospital relations.  the ones who will kiss your ass to keep you happy.  good luck.