What to do if I had a hysterectomy earlier this year and my insurer has refused to pay because it said that it was an existing condition even though they gave me a pre-approval?

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What to do if I had a hysterectomy earlier this year and my insurer has refused to pay because it said that it was an existing condition even though they gave me a pre-approval?

I turned it over to my state’s Dept of Insurance. They have reviewed the case and said that the insurance company did give my doctor’s office a pre-approval but later called back and retracted it. The Dept of Insurance said that they would have had to pay since they pre-approved it had they not called my doctor back and retracted it. The problem is that my doctor’s office never called me and told me that they had retracted the pre-approval. Right now it has gone to a medical external review but I don’t think they are going to pay. Do I have a case against my doctor’s office?

Asked on September 13, 2013 under Insurance Law, Kentucky

Answers:

FreeAdvice Contributing Attorney / FreeAdvice Contributing Attorney

Answered 8 years ago | Contributor

I suggest that you consult with an attorney that practices in the area of medical insurance law and contracts to see what your legal recourse is against your treating physician. If you do not know of one, one in your locality can be found on attorneypages.com.

FreeAdvice Contributing Attorney / FreeAdvice Contributing Attorney

Answered 8 years ago | Contributor

I suggest that you consult with an attorney that practices in the area of medical insurance law and contracts to see what your legal recourse is against your treating physician. If you do not know of one, one in your locality can be found on attorneypages.com.


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