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Govt health insurance contractor

Discussion in 'Health Insurance, HMO, HIPAA & Disability' started by Kennyfour, Dec 23, 2007.

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  1. Kennyfour

    Kennyfour Law Topic Starter New Member

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    I am a retired military living in the Philippines. The govt contractor that processes claims for military health care overseas has routinely failed to abide by the regulations. They have wrongly denied claims, failed to mail check for 36, 81 and 83 days after the check is written, They have downgraded the billed items to a lower allowed amount even though the appropriate documentation was submitted, (one time claiming the processor could not read the prescription name so she downgraded it to an office visit in order to pay me something on the billing). They have lost billings from the claims (numerous times), lost claims that were sent via DHL and signed for, lied about why they canceled a claim payment, failed to verify that drugs are FDA approved and then, (after paying the same drug over a 8 month period), decided that the drug is not approved and denied over $800 for this drug. They delayed certification of medical providers, (which is required prior to payment of claim), failed to follow regulations concerning other health insurance coverage and failed to accurately calculate claim payments.

    My question. I believe that I can sue them, (possible class action), for their failure to timely pay, lack of due diligence on FDA approval, failure to accurately calculate payments, etc. I know that they will ask for summary judgement based on govt contractor immunity, but by their failure to comply with the regs, (which I have the govt acknowledging the contractor did not follow regs), I believe this can be defeated. Innocent mistake defense should also be easy to defeat. Do I have a case and does it have to be filed in Fed court or can it be filed in the state they are located in? Also, If it has to be Fed court, can it be in the state I used to reside in aned still have a valid drivers license in?

    Any Lawyers or firms that anyone can suggest to take the case?

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