My question involves insurance law for the state of: New Jersey I am on Corporate Disability under Long Term Disability with a major fortune 500 company. Under my status, I have XYZ Health Insurance and my alternate during the 2014 year was that XYZ was first and medicare was second. This year it is Medicare and now ABC Insurance, another company.
In February 2014, I was in Connecticut, and I fell, and no the basis of my question is not a lawsuit based on fall. The injury was that I badly bruised my knee but I was unable to walk and put pressure on it, and I wanted to be sure it was not more serious. Due to inclement weather and icing on ground, and snow, I felt more comfortable getting an ambulance. I called XYZ Insurance before calling, and I was informed I was covered. From what I gathered, the ambulance company billed XYZ Insurance Company and Medicare and XYZ Insurance paid the billed with a deductible that was deducted since it was early in the year. I was ok with that. They paid 500 of the 656 bill. But a few months later, unbeknownst to me, XYZ Insurance demanded money back from Ambulance Company because they determined I was not an Active Employee with my employer. This is a false statement as I fall within the guidelines of my Employers Company as an active employee. When I found out, by being billed for full amount by Ambulance Company, I called XYZ Insurance Company and found out they considered me not an active employee, so my COB was Medicare First and XYZ Insurance secondary. I called my employer HR department, and they indeed confirm that I am considered Active and we had conference call with XYZ Insurance Company and they needed my employer to send a file confirming this.
Needless to say after a few months of my employer sending file, XYZ Insurance Company still reverted my status to not active. I again did conference call with employer and XYZ Insurance Company, and after 5 attempts to get this done, it was still not completed. Finally in March of this year 2015, we finally determined that my employer needed to send file based on my active status. We determined that they just kept sending XYZ Insurance the COB which was not solving the problem .When it seemed it was finally resolved, the only bill that XYZ Insurance Company could not SEE, was the Ambulance Company which was strange since they demanded there money from them. So they asked me to have them resubmit. So I called Ambulance Company, and they did just that. Resubmit the bill and it was rejected because it was a year after the event, and XYZ Insurance Company denied claim. I am at a complete lost as to what to do. I have done at least 15- 20 conference calls, etc to resolve the bill, and I am at a quandary as what to do. How do I get this rectified. I am unable to afford a 656 dollar bill as I am on a limited income. it appears I cannot trust anyone to resolve this situation. I did call XYZ Insurance Company, and they said they would rectify, and several months later, I get a bill again. Any thoughts on how I can finally rectify this situation, and what legal grounds do I have as I don't want to burden my credit report on this matter. Any thoughts on how to proceed. ???
In February 2014, I was in Connecticut, and I fell, and no the basis of my question is not a lawsuit based on fall. The injury was that I badly bruised my knee but I was unable to walk and put pressure on it, and I wanted to be sure it was not more serious. Due to inclement weather and icing on ground, and snow, I felt more comfortable getting an ambulance. I called XYZ Insurance before calling, and I was informed I was covered. From what I gathered, the ambulance company billed XYZ Insurance Company and Medicare and XYZ Insurance paid the billed with a deductible that was deducted since it was early in the year. I was ok with that. They paid 500 of the 656 bill. But a few months later, unbeknownst to me, XYZ Insurance demanded money back from Ambulance Company because they determined I was not an Active Employee with my employer. This is a false statement as I fall within the guidelines of my Employers Company as an active employee. When I found out, by being billed for full amount by Ambulance Company, I called XYZ Insurance Company and found out they considered me not an active employee, so my COB was Medicare First and XYZ Insurance secondary. I called my employer HR department, and they indeed confirm that I am considered Active and we had conference call with XYZ Insurance Company and they needed my employer to send a file confirming this.
Needless to say after a few months of my employer sending file, XYZ Insurance Company still reverted my status to not active. I again did conference call with employer and XYZ Insurance Company, and after 5 attempts to get this done, it was still not completed. Finally in March of this year 2015, we finally determined that my employer needed to send file based on my active status. We determined that they just kept sending XYZ Insurance the COB which was not solving the problem .When it seemed it was finally resolved, the only bill that XYZ Insurance Company could not SEE, was the Ambulance Company which was strange since they demanded there money from them. So they asked me to have them resubmit. So I called Ambulance Company, and they did just that. Resubmit the bill and it was rejected because it was a year after the event, and XYZ Insurance Company denied claim. I am at a complete lost as to what to do. I have done at least 15- 20 conference calls, etc to resolve the bill, and I am at a quandary as what to do. How do I get this rectified. I am unable to afford a 656 dollar bill as I am on a limited income. it appears I cannot trust anyone to resolve this situation. I did call XYZ Insurance Company, and they said they would rectify, and several months later, I get a bill again. Any thoughts on how I can finally rectify this situation, and what legal grounds do I have as I don't want to burden my credit report on this matter. Any thoughts on how to proceed. ???
Health Insurance: Paying a Claim That Insurance Company Denies Paying
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