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Insurance Wrongly Claiming Pre-Existing Condition

Discussion in 'Health Insurance, HMO, HIPAA & Disability' started by DJFrustration, Sep 19, 2005.

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  1. DJFrustration

    DJFrustration Law Topic Starter New Member

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    My 66 year old mother had to have her gall bladder removed this past May. She has never had any symptoms of gall bladder problems and switched insurance companies back in December of 2004. A month and a half ago, the insurance company decided to refuse payment on her gall bladder surgery so my mother requested a review of the denial. A day or so ago, the insurance company still upheld their decision stating that she misrepresented herself in two questions on the insurance application dealing with prior liver health. She has no record of ever being diagnosed with fatty liver or gallstones and is really getting worked up about the fact that she may have to pay over $100K. In addition, the insurance company wants to increase her premium (she'll now be paying $1K/month) and has requested back pay on the increased level. My mother and I feel like the insurance company is taking advantage of her and we need some help. Can anyone offer any assistance as to the course of action she should take? We've already disputed the denial with the insurance company and my mother is in the process of requesting information about what medical info was included in her application.



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