Question
i'm a new member of this forum.
I need urgent help for suggetsions to deal with helath insurance company!
I'm a international living in SC, The insurance comany is England company.
teir claim office is in INDINNAPOLIS.
I bought health insurance from Specialty Risk International for my son.
when I read about their requirement of eligibility, I was not sure about it, so I sent emails to the agent asking if my son was eligible to enroll.
they replied with positive answer after they contacted the underwriter. So I bought the insurance for my son for a year from this company, that was last JULY. deductible is 250 dollars.
This year in MARCH, my son went to see a doctor for a cold, the expense is not too much, about 300 DOLLARS. After I satisfied the deductible, they paid without dispute.
The next time, my son got irritated at the front skin of the penis. we went to an urologist. The doctor suggested a surgery to sovle the problem once for all.
according to the "pre-notification "requirement of the policy, we called the insurer about this, and ask them if we can do it, the representative said" go ahead do it", so we took the surgery on April 19.
but when we claim, they first denied under the excuse of" preexisting condition", I called them that my son never needed to seek a doctor for the problem before and asked the doctor's office to submit more information to them to explain this situation.
then the insurer responded by doubting my son's eligibility to be insured with the health insurance policy. asking for me to submit a copy of his passport to them.
My concern is that is it lawful for them to deny my clain by doubting my son's eligibility after he got his certificate for 10 months? ( I'm guessing they are trying to do so).
If my son was not eligible, why not they denied my application in the first place. It is not my fault if my son is not eligible, I did not lie when I submit my application to them.
Shouln't they check my son's eligibility at the beginning of our application last JULY?
or shouldn't they doubted my son's eligibility at the first claim in March? why they paid for the first claim?
I'm guessing they just want to deny big claim ( this is a $6000 claim)!
If I want to my interest be treated fairly, what should I do?
we are poor international students, we can not afford to hire a lawyer to fight against them.
any suggestions are highly appreciated from this forum.
thanks in advance!
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Answer
If you have the certificate of elibility showing that he was definitely awarded coverage under your active policy, then there should be no claim denials. I am surprised that the doctors office and/or hospital is not fighting this as well. I would definitely try to get the hospital and physician to fight with insurance company as well. Also, never hesitate to get your local consumer reporter from a news channel or TV station in your area involved. Sometimes, they respond quite well to the thought of any bad publicity.