How can I make our health insurance companies agree on order of coverage?
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How can I make our health insurance companies agree on order of coverage?
For over 12 months, my son’s 3 health insurance policies refuse to pay a dime on any claim submitted due to the fact they have another policy. They did pay for claims after I remarried prior to stopping last year. I am a teacher and have coverage through my employer. My 3 sons live with me full-time along with 2 stepsons. My ex-husband and current husband both have my sons covered through their identical health insurance trust. Despite hours and hours on the phone and even receiving an email stating that the insurance companies agreed on the order of coverage, claims are still denied. At one point an insurance representative told me to email her the bills going to collections and she would contact them to stop the collections process. They have asked for my marriage certificate 3 times in 2 years, each of our parenting plans twice, and birth certificates for all of our sons at least 2 times even though they had them on file previously claiming they were misplaced. One insurance company paid out on 1 random claim for my 19 year old this summer but not my 17 year old who required extensive medical care last year. Last October, he had a side effect to an anti-anxiety medication he was prescribed- suicidal ideations followed by an attempt. A long hospital stay followed with regular counseling sessions. His counselor has made a tremendous difference but has not been paid a dime in a year. Her practice is to stop seeing a client with such a balance $8000 I think but she has continued treating for now. I worry that if she has to stop seeing him, he may become suicidal again. I have not been able to sleep a full night since the evening I found him near death. These insurance companies are ruining my credit, my sanity, and putting my sons life at risk.
Asked on October 8, 2019 under Insurance Law, Washington
Answers:
SJZ, Member, New York Bar / FreeAdvice Contributing Attorney
Answered 4 years ago | Contributor
If you believe that the medical expenses are covered under these policies, then you need to sue the insurers whom you believe should pay for "breach of contract," or violating their contractual obligation(s) (since insurance policies are contracts) to pay, and also for violation of the "implied covenant of good faith and fair dealing," or the legal obligation that a party to a contract not deliberately act in such way as to deny the other party the benefit of the contract. You don't worry about order of coverage: you name in your lawsuit all insurers whom you believe would have to pay (if coverage order were not a factor) and let them fight it out about who pays first, etc. You sue them for all costs they should have covered but have not.
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