Question
My wife had coverage with HMO #1 from 11/1/99 to
10/30/00. Her surgery was authorized 10/26/00
and performed 11/05/00 (five days out of contract) and the payment was denied.
Three days before HMO #1 expired, 10/27/00 she
started with the HMO #2 the payment also was
denied because was a pre-existing condition.
Does the HEALTH INSURANCE PORTABILITY ACCOUNTA
BILITY ACT (HIPAA) or WOMEN'S HEALTH CANCER ACT
work on our favor? we feel desperated like a
dead end situation.
We truly appreciate your answer and time
Answer
I'm not sure if it is this way in your state but generally HMO #1 would be obligated to pay since they were authorizing and paying for treatment and to include the course of treatment. Any new complications or new treatments should go to HMO #2. You can contact the state insurance office or an attorney for more specific information.
Answer
Hello don62, thank you I'll try here, NJ
hmo.nj