Insurance dropped us, anyone have same experience?

[fedupmom]

My husband recently retired and we have to pay out of pocket for an individual insurance policy for myself, my husband and our 18 year old son.  When he was younger, he complained of a large breast, the doctor said it was puberty and would go away by 18.  At 18 he came to us and said it was getting larger and wanted to surgury.  We never had this officially diagnosed and did some research on the internet and saw that liposuction could be an option.  We went to see the lipo doc, and he said he would not do it, that it didn't look like fat to him and he recommended a mammogram for cancer and to see a plastic surgeon.  We had the mammo, and went to the surgeon who recommended we do a combination of surgury and lipo.  He also said insurance may or may not pay for it, but he would submit a letter to the insurance company anyway.  In the meantime we scheduled the surgury, because regardless, for his mental health he needed it.  Today we called to get an update on the insurance claim, the surgery is Friday, and they told us they completely dropped us from Blue Cross Blue Shield as of June 30.  We were never called, never notified, did not have a clue any of this was going on.  After several phone calls, they said it was due to information from the surgeon doing the surgery on Friday, and that we had hid a condition from them and instead of denying the claim, they were dropping us from all insurance care.  We are flabbergasted!!  We are now without insurance, over the holidays, and have no recourse.  We are all three healthy, no previous illnesses and can't fathom why they would do this.  

Is anyone out there who has had a similar experience or who can give us some advice!  

[flex1appeal]

WOW....not sure what to say on this. I assume you can deny knowing about this condition or denying that you knew it was a condition prior to now. I do know insurance companies can drop you if you don't disclose a condition already in existance and then file against that condition. But I really would not call gyno a condition worthy of cancelling you over. I'd contact a lawyer.

[tsjas]

I can't believe that the insurance company would treat you in this matter. I can understand them denying the claim for gyne surgery. I guess that you can explain to them that you never knew about this condition when you got insurance. Important factor in explaining them would be the amount of time that you have had this insurance.

[lopher]

It's amazing that Americans have forced this system of private medical insurance on themselves  

Wow you guys are crazy. I live in a 3rd world country and my gyne operation was covered under our standard governmental health insurance plan which is paid for by all employers. No arguing or squabbling. Waiting time for op... one week.

The NHS in the UK is getting faster than it used to be, but you Americans are positively stuck in the dark ages when it comes to health care. For a rich nation i'm amazed you've allowed your health care to be put in the hands of profit making big companies.

In fact Americans seem to love burdening problems on themselves... I shall say no more before this turns into a flame!

Madness,

lopher

[Worrier]

Well I can tell you what I think and I did use to work for an advice service in the UK, giving legal advice on minor issues.. ( neighbour disputes , parking arguments ) .Now Iam going to be impartial and may play devils advocate a bit but please note that from reading about insurance companies in the states both here and on the news they seem to be money grabbing sharks and it would not surprise me one bit if what you were saying is the correct version of events. I suppose it is the realms of possibilty they dropped you for making a claim.

First thing is to contact the plastic surgeon and find out exactly what he told them. The insurance company are claiming on the strength of this conversation that you have mislead them about your childs health. That is a serious accusation and if you KNOWINGLY did this they are quite within their rights and correct to drop you from their policy. See it from their point of view , I don't know what the condition they believe has not been mentioned but they stand to lose alot of money if something went wrong in the surgery.

Now I see a number of issues here. , the PS or his staff got your son mixed up with another of his clients and there has been a major admin mix up. And in fact your son is  perfectly healthy.This could be resolved quickly I feel by speaking to the PS who would be obligated to sort this mix up out with the insurance firm.

Two I am not sure how insurance works but certain medical conditions would rule your son out of surgery or make it have a high chance of not being successful, ie they would have to spend more money correcting it. I presume at some stage you had to list medical aliments for both your son and family to the insurance firm. The insurance firm believes you ommited a condition that would have barred him from surgery. This may have been done unknowingly by you as I am sure insurance firms have 'small print' and all sorts of rules and get out clauses so they pay out for the least number of claims .

What I believe you should do

1 keep all correspondance with the insurance company concerning this issue.

2 get copies of the health questionaire or notes made by the PS concerning your sons medical history.

3 Speak to the PS as I have mentioned as it was from HIS conversation with them that you have been dropped. Find out exactly word for word what was said.

4 Find the policy documents. (Iam not making you out to be stupid , I have advised all sorts of people don't realise how important this stuff is. Unitil they get shafted) . Which will list the conditions covered and not covered and what illness's bar someone from surgery for a breast reduction.

5 Speak to the insurance firm again, if this has been a mix up get the PS to speak to them and appeal against this. Find out who to send an appeal to. I suggest doing this first because lawyers are very expensive and court cases are stressful( that is if you have a case which I am not certain  about.)

6Perhaps if you have the time and money see a lawyer. I I don't know if you have a legal aid system in the states we do in the UK for people on benefits or low incomes to get free legal advice.

This all seems terribly unfair.  And if this is the right version of events the insurance firm should be taken to court.We are lucky in the UK to have a national health service. Yes it is inefficent but anyone no matter what their financial status should get acceptable health care. And when you are stressed with an illness/ medical conditions the last thing you need to deal with is money grabbing arseholes. Who only care about making pots of cash  .See I tried to be impartial but I failed  



 

 

[lopher]

Worrier I think you missed the point a little.

I didn't bother reading your whole post as it seems you didn't bother to read the first post on this matter.

fedupmom said:

When he was younger, he complained of a large breast, the doctor said it was puberty and would go away by 18.

I just took it for granted, but I think i'd better spell it out to you  

1. The son had gyne in puberty.
2. The Dr said it would go away.
3. The parents believed the Dr and thought no more of it.
4. The parents take out a health insurance policy at a later date not thinking about the gyne as a medical problem, so don't list it.
5. The Dr was wrong and the gyne doesn't go away by the time he's 18.
6. Their PS submits a claim for a gyne operation.
7. The PS would file in his report how long the patient had had the condition from. (puberty)
8. Blue cross look at the dates the policy was taken out and realise it (gyne) was there before they started the insurance policy.
9. Technically an undisclosed pre-existent medical condition.
10. Policy cancelled.

Worrier i'm amazed you gave anyone legal advice. I'm not involved in any kind of legal profession, but this was blatantly obvious what had happened. I guess you must be the call centre muppet that I always get on the end of the line when I need to ring home and sort any stuff out.

Fedupmon the best thing for you to do would be to try and get your premiums refunded that you have paid your insurer. Argue on the basis that the policy was set up in error (not disclosing the gyne was an error) and hence if it (the insurance) was unable to pay out for a claim because of this error, then you should be entitled to a refund of your premiums. Check your policy terms and conditions under non disclosure.


lopher