Legal Advice

Z., You have time but do NOT delay. I did and lost thousands of dollars due to my inaction! Call a lawyer today! Good luck! Ali

Not sure about your state, but with many health insurance companies you would have up to 1 year to file a claim to recoop your expenses. However, assuming you win the appeal to the employer and are put back on their program (or you purchase COBRA at full cost), you will be responsible for all of the back payments of your portion of the premium. So if his employer charges him $50 for a single plan and $150 for a employee+spouse plan, you'd be responsible for $100 x 6 mos. Plus whatever the additional premium is to move to the family plan once your daughter was born. If you purchase COBRA (essentially the same plan, but you pay the entire premium rather than the employer), you'll have to pay retroactively to when you were taken off the plan. So if the EE+spouse plan cost $450/month, you'd pay $2700. This is generally still cheaper than hospital bills. Also, you have only 90 days to enroll in COBRA, so unless they hear your appeal, you have missed that window. Good luck!

I'm not sure about the statute of limitations, but 6-month doesn't seem to be that long. I would definitely pursue the matter. While I haven't had this particular issue, I did deal with one of my insurance companies to pay out (in-full) a claim they kept wanting to deny. It takes diligence and very good and detailed notes. Always write down the time you called, whom you spoke with, how long you were on hold and exactly what you were told. Do not let them just say someone will get back to you, get a specific name and date. If you feel you are still getting the run-around, speak with whatever manager they have, inform them that you want to resolve this matter as quickly and easily as possible, however if it is not resolved in 30-days, you will be forced to take the matter to court. Then, follow-up with a CERTIFIED letter stating the same. And, follow through. Do not be afraid to jump up levels of management; do an internet search and find out who the VP or President or CEO is of the company and start calling/emailing/writing to them too. Also, there are certain advocacy groups you can utilize (google them up and look into your insurance policy, there is usually a clause in there stating that by accepting the policy, you accept the terms to go through mediation as opposed to suing in court). Become VERY familiar with your policy (as it was in effect during the time frame, it may have changed since then)and copy any portions of it that are applicable to your situation so you can easily access them. As with any complaint you file, state your problem and the solution you want, this is always better then just telling them to 'fix-it'. Good Luck to you and congrats on the healthy baby!

Hi Z.! It is inexcusable that you had to go through your joyous occasion with that ugly issue hanging over your head. We had a very sick baby and I've had my share of dealings with insurance companies and medical billing personnel. My daughter is fine, but I know what a pain it can be to deal with the insurance bureaucracy. =-)

I am an attorney, although I haven't practiced in quite some time and did not specifically practice insurance law. What I can confidently tell you is that statutes of limitation for non-government cases (meaning that you are not suing the government) are never shorter than one year. You're good now, but don't waste any time finding legal help. Call your local bar association for referrals to attorneys who handle insurance coverage disputes. You might even have more time than a year, but you need this confirmed by experts in the area.

You might also google phrases that are related to your situation and find another family who went through the same thing. Google would have media accounts or blog posts.

Good luck!

I had issues with HPN about 12 years ago. They sent a letter of authorization for my daughter to have a surgery at UCLA (we live in Vegas). After the surgery, I started receiving late notices and when I contacted the insurance, they said they were not going to pay the claim because it was not pre authorized. I gave them the approval code and they said it had to be in writing. I faxed them the letter, they kept saying they didn't have it. Then they said it was out of network, however the authorization said it was authorized at UCLA. It took me about 7 months of fighting with them before they paid the claim, but they did. Everyday, before I called them, I would fax a copy of the letter and tell them to check the fax machine. Everyday, they placed me on hold for 20 - 35 minutes and then said a manager had to speak to me. I finally told them to tell their management that they agreed to pay and I would not call anymore because the next time we spoke would be in court. They paid the claim. Fight them if you know you are right!

Heather makes a good point. I googled the California Statute of Limitations:

Personal Injury: 2 years.

Fraud: 3 years.

Libel / Slander / Defamation: 1 year.

Injury to Personal Property: 3 years.

Product Liability: 2 years.

Contracts: Written, 4 years; Oral, 2 years.

Hi Z.,

You might look into Pre paid legal services. They handle pre-existing cases like this for a monthly membership fee of
$35.95 per month.

If you would like more info, let me know.

Good luck and best wishes,
R.

Hi there, Z.:

Congratulations on the birth of your baby girl. It really is an amazing experience, isn't it? My son is going to be four in April and he is such a joy. However, I find myself looking at his baby pictures quite a bit these days more than he lets me hold him - so please enjoy your daughter while you can still hold her. At least my son still loves the hugs.

Regarding the legal advice, I hope that the information in the following website might be useful to you:
www.prepaidlegal.com/hub/mochaij
Please click on the different bullets and watch the videos.

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N. M.

Not to late, you have a year or 2.

If the insurance company was wrong and re-enstated the insurance, already they should of back dated to the day they terminated you , then what you could of done is taken the bill to the billing department at the hospital and they would of given you back what you paid out, although although some places gives you 14 days, others 30 days, once in a while you get 90 days to submit for refund, now I am sure your out of pocket at least well over $ 15,000 triple. If this amount is right, you did not want to fight over that much money... Girl, fight for your money back...

Z., congrats on your baby. Was this a group insurance plan? If yes, and if you were an eligible dependent,and the charges were covered benefits, seek assistance via the employer/holder of the group policy. Perhaps their insurance consultant can work the issue on your behalf. If this was individual insurance, and you were an eligilbe dependent, and maternity was covered under the plan provisions, in writing appeal to the insurance company. If you bought the policy throught the internet, without an insurance broker/consultant (rates are the same for buying direct or with assistance of a licensed producer) you need to take action. For more info to find out about consumer protection rules, check out the CA Dept of Insurance website. Go to the employer, the plan, the state DOI, then a lawyer if you were entitled to coverage...best of luck. (just advice from a long time insurance lady)

which insurance company? i know healthnet was sued for this behavior and the class action lawsuit was won. i would contact a lawyer that specializes in this type of lawsuit.

In California (perhaps nation wide) they have something called "The Office of the Patient Advocate" it is a non profit organization that rates/ranks healthcare and helps people just like you when HMO's deny coverage etc. Look them up online - although I have never had to use them I have heard that they can be a good resource.

Good luck to you.

~H.

Z.,
Getting legal advice is only valid if the moms are attorneys specializing in insurance laws in your state. We can give you all the support and prays we have. I'm a SAHM with a home based business that gets families unlimited contact with attorneys from your area in all legal fields.Go to the website and look at it. It will help you decide what to do next. www.prepaid.com/go/donahue83. The cost is monthly which makes it more affordable than doing it alone, and safer. Good luck and congratulations on your baby girl.

Hi Lucy,

Congratulations on the birth of your daughter. I have an 18 month old girl and it is so much fun. Hopefully you are getting some good sleep these days!

I haven't experienced anything like this before. I can only imagine how frustrating this must have been so close to your delivery.

If you are still interested in pursuing legal action, I offer affordable legal plans for as low as $ 26/month that covers you and your family. You can consult with the attorneys on this issue over the phone and if they feel it is worth pursuing, you would receive a 25% discount off your legal fees. Had you been a member before this happened, it most likely would have been covered, but this is pre-exisiting.

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Have a good day!

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