by mkelly677 » Thu Jul 14, 2011 06:28 pm
I have a medical insurance co. who agrees that they are obligated to pay for doctor visits 5 times per year but when the doctor bills them, they have not paid for over 18 months. Therefor my doctor's office makes us pay each time so the insurance is bogus. When questioned, the insurance company claims that their processing center is way behind and to be patient. I have called at least 4 times in the last 18 months and each time I get the same answer. So in essence, I am just throwing my monthly premium money away because they don't cover anything.
Posted: Thu Jul 14, 2011 06:40 pm Post Subject:
they have not paid for over 18 months.
You have a couple of separate issues here.
First, this needs to be reported to your state's Dept of Insurance IMMEDIATELY. Most states' insurance laws require that claims be paid within 45 days or less (California = 40 days from proof of claim).
Second, if you have incurred expenses that were supposed to have been paid by your insurance, but have not, then you have a breach of contract issue, and would be entitled to rescind the policy from the time of the first breach, and receive back an amount equal to all the premiums paid after that time (less any claims actually paid).
Depending on the amount of money involved, it is either a matter for Small Claims Court or a higher level court.
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