insurance issue

[lbeesmer]

My daughter had gastric bypass surgery in 2006 that was pre-approved by my insurance company who said that they would pay the out of network provider 80%. Two years later there is a $24,000 judgement being filed against her because they did not pay the amount that they said they would. She would not have had the surgery if they did not say that they would pay. When I ask them why they are not paying they only say that they did. Yes, $6,000 of the $29,000 bill. Do I have any legal recourse against this insurance company? Is there someone who I can report my complaint to? Perhaps a federal agency that regulates these sorts of things? My daughter is 20 years old and just starting college and I'd hate to see her life as an adult begin this way. Please provide me with any information you can to assist me in my battle against this insurance company.

 

[presutin]

You should start your case by collecting all the paperwork created by the hospital and the insurance company. The key here is going to be the preapproval code given to the hospital authorizing the procedure and payment of 80% to the network provider. You then will have to take the case to a caseworker with your insurance company and backtrack all the charges so they can see where the mistake was made. Make sure that you are communicating with the insurance company at all times so they will not take further actions against you. Good Luck!