by Scari » Wed May 09, 2012 04:01 pm
I had back surgery from an auto accident 12 years ago. The surgery was only at one disc level. I got a very small settlement-3000.00, after attorney and some medical bills.
Now, I have 3 bad discs (one at the same level as 12 years ago,) I just go a phone call from my health insurance company, asking all kinds of questions, including if I had a car accident. I really didn't deny an auto accident, (I just answered the question with a question.) I feel they are trying to get out of paying for my surgery, before I even have it. Plus, it's been 12 years and it's 3 levels, not just one. Plus, they found a genetic disorder in my spine. I don't feel this has anything to do with my auto accident 12 years ago.
Does anyone know the statute of limitations on something like this? Can my health insurance company deny claims, if they find out I had a car accident 12 years ago? I already admitted that to my surgeon, so I'm guessing it's in my current medical records.
I'm in the state of FL. I know that my old medical records are gone, as I tried to get them from my old doctor. They only keep them 10 years.
Thanks
(I'm not sure which place to post this-so sorry if you are reading this twice,)
Now, I have 3 bad discs (one at the same level as 12 years ago,) I just go a phone call from my health insurance company, asking all kinds of questions, including if I had a car accident. I really didn't deny an auto accident, (I just answered the question with a question.) I feel they are trying to get out of paying for my surgery, before I even have it. Plus, it's been 12 years and it's 3 levels, not just one. Plus, they found a genetic disorder in my spine. I don't feel this has anything to do with my auto accident 12 years ago.
Does anyone know the statute of limitations on something like this? Can my health insurance company deny claims, if they find out I had a car accident 12 years ago? I already admitted that to my surgeon, so I'm guessing it's in my current medical records.
I'm in the state of FL. I know that my old medical records are gone, as I tried to get them from my old doctor. They only keep them 10 years.
Thanks
(I'm not sure which place to post this-so sorry if you are reading this twice,)
Posted: Thu May 10, 2012 07:24 am Post Subject:
Your insurance query has been answered
Posted: Thu May 10, 2012 12:43 pm Post Subject: answer
For some reason I cannot submit my response to this in the other forum.(This was the response I got, then at the bottom is my answer.)
Well, you've just admitted here that you made a misrepresentation to the insurance company (and later you admit you've told your current physician the correct information, too).
It's not up to you to decide what they can or cannot do with the information based on its age, but you have a responsibility to provide them with ALL the information they require. State insurance laws govern the use of that information. It applies to both you and the insurance company.
The fact that the accident occurred 12 years ago is probably in your favor when it comes to the insurance company trying to deny a claim due to a preexisting condition. But they have even greater flexibility to CANCEL your insurance based on MATERIAL MISREPRESENTATION. The fact that you had prior surgery in the same area, even if 12 years ago, may or may not be MATERIAL information, it's up to the insurance company to decide, and for you to dispute. But it has to be disclosed.
This has nothing to do with "statute of limitations". An insurance company is free to research and obtain information about all prior medical treatments from the time you were born. Generally, it may only count them as a preexisting condition if you have received advice, diagnosis, or treatment for the condition in the past 24 months.
Quote:
I know that my old medical records are gone, as I tried to get them from my old doctor.
You are sadly mistaken on this. Just because your physician trashed your records (which he probably should not have done without making some kind of electronic or other archival record), doesn't mean the hospital's records of your surgery don't exist.
You made a BIG mistake not giving the insurance company all of the correct information. It's probably not too late to correct that mistake. Call them and tell them what the situation is before it is too late.
_________________
CA-licensed P&C Broker-Agent and Life Agent. CA Insurance Lic #0596197. Now investigating insurance company abuses, and providing litigation support and expert witness services. Send me your questions, and I'll send you my answers.
My response
Thanks for the reply.
My policy doesn't have a, 'no pre-existing conditions' clause. I'm wondering why they called and asked all those questions to begin with. I have a TON of other medical problems going on and have never received a call like that for those.
I already got screwed over by the auto insurance AND health insurance companies the first time around. Ironically, I'm STILL paying on medical bills from 12 years ago.
I see you are a person who investigates insurance fraud. There are a bunch of agencies watching the insured-who's watching the insurance companies? No one-they are free to take your premiums all day long, then bail out, when you need them the most. Insurance companies don't get rich by paying claims
I'm a very honest person-perhaps too honest. I feel like I'm being set up here by the insurance company, BUT, I did go ahead and call them back and told them all about my past. I really didn't get a response, so I guess i will just have to see what happens.
Posted: Sat May 12, 2012 12:54 am Post Subject:
If you think you are being abused by the insurance company, contact me, and we'll see what is going on and whether there is a problem or not. There are a few of us out here who are keeping our eyes on what the insurance companies and/or their agents are doing.
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