Insurance Co May Contest Hospital Stay

[kencan]

A client was hospitalized for 7 weeks during Aug-Sept of 2012. The client had an emergency gall bladder operation and recovery period. All of the itemized paperwork for the stay has been sent to the company. I followed up on the claim today. A customer service person told me that since the client had the policy less than 2-years that the claim will be contested. I thought the contestability period was for life insurance claims only. Perhaps this is nothing to be concerned with since the client had a medical emergency that required a hospital stay.
The client has lost her patience with the way the insurance co has handled her claim thus far. She's threatening to report this to the State Attorney General's office. I'm doing everything I can to help see this claim is resolved. How should I proceed? Thank you.

 

[somarco]

Tell your client to cool their jets. The review is not out of the ordinary for a policy less than 2 yrs old. Might take 90 days or so to finalize, but if the applicant did not lie there is no problem.

The AG won't do anything. This is a DOI case, but even they won't do anything at this point.

The only thing that bugs me at this point is, why the investigation now? 8 months or so after discharge and the carrier is just now notifying the insured they are investigating?

Something smells.

 

[AllenChicago]

All of the itemized paperwork for the stay has been sent to the company. I followed up on the claim today. A customer service person told me that since the client had the policy less than 2-years that the claim will be contested.

This claims problem/issue raised several questions in my mind...

1. Is this a "brand name" health insurance company? Most of them have a 1 year Pre-Existing exclusion...at least in my state.
2. Is this a true Major Medical plan?
3. Why did you, or the customer have to send in the itemized billings? May be an indemnity plan?
4. Is the company perhaps in some financial trouble at this time?

 

[Yagents]

If only two years old, and a major medical plan, then it is a non grandfathered plan and is subject to the new Obamacare super powers appeals board, who protects the consumer after the first appeals board rejects the first appeal. Just go through the appeals process.

If that doesn't work, send the prez a letter, I'm sure he'd love to talk about it in his next speech, somewhere in podunk town, with grandma in wheelchair, a nurse, and children standing behind him. The insurance company will wish they'd paid double. Make em' pay obama!

 

[kencan]

This claims problem/issue raised several questions in my mind...

1. Is this a "brand name" health insurance company? Most of them have a 1 year Pre-Existing exclusion...at least in my state.
2. Is this a true Major Medical plan?
3. Why did you, or the customer have to send in the itemized billings? May be an indemnity plan?
4. Is the company perhaps in some financial trouble at this time?

This is an hospital indemnity claim with a Milwaukie B+ rated company. The co. wasn't clear with me initially about what itemized hospital codes thay wanted. Thanks for your feedback. Should I consider moving my other clients from this co?

 

[bill3173]

Should I consider moving my other clients from this co?

Yes, you should. I've never had this problem with the HI policies that I write. If you go with the better ones, you'll make less commission, but you won't have to worry about stuff like this as much.

The good news is you've got a valid reason to make a new commission and put your clients in a better situation. It sounds like you really care about your clients, which is good news. There are a lot of assholes out there that wouldn't answer the phone to help anyone.