misleading insurance. i have bills upon bills. what should i do? doesnt hipaa apply?

UPDATED: Jun 12, 2009

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misleading insurance. i have bills upon bills. what should i do? doesnt hipaa apply?

i am 20 years old and i am covered under my mothers insurance till im 23. i was receiving prenatal care for my pregnancy and then claims started to get denied. i called and they said they had my birth date wrong and that was the reason why. i then continued with prenatal care for months until my doctor said that they were still denying the claims so i called and the rep said i was covered and that the doctor was putting in the wrong claim number. So i then continued prenatal care again until i called once again to find out the problem and they said i was not covered because i was a dependent.

Asked on June 12, 2009 under Insurance Law, New Jersey


J.V., Member, New Jersey Bar / FreeAdvice Contributing Attorney

Answered 13 years ago | Contributor

What you need to do is get all the paperwork together for the insurance coverage. read the coverage terms, see what they say is covered and what is not covered. Once you do that you need to call a manager at the insurance company, speak with them to get things straightened out as much as possible, explain the information you received based on the wrong birth date and wrong claim numbers. If this does not solve your problem you should think about hiring a local attorney

At that point the attorney can review everything with you and together you can decide if you have a valid cause of action. Based on the coverage terms and all other facts you provide it can be decided how best to proceed.

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