by Scari » Wed May 09, 2012 03:56 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 Ingentix-asking all kinds of questions, for my health insurance company. I denied an auto accident, because 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 Ingentix-asking all kinds of questions, for my health insurance company. I denied an auto accident, because 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: Wed May 09, 2012 06:56 pm Post Subject:
I denied an auto accident, because I feel they are trying to get out of paying for my surgery
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.
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.
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