Q: I am a member of a non-profit called Christian Healthcare Ministries.It is a ministry where members share members health
insurance costs.It is not an insurance company so they have a pre-existing condition limitation.Pre-existing is defined as having symptons, signs or treatment within 1 year of joining.I joined in April 2016.I had a condition in Aug 2014 and last visit for it was Dec 2014.I had another incident in Aug 2016.They have applied the pre-existing limitation and will not pay all of my bills for a hospitalization in Aug 2016.They did not give me a reason why,so I have asked for appeals.I have been working on the appeals blindly since I don't know the basis.I just received an email from the CEO this morning.He gave an explanation which was not factual and not based on my medical records.Apparently,it was an assumption.He informed me it would be his final review.I responded with an email and more medical records to substantiate my case.If they will not reverse the decision, do I have any legal recourse?
A: Whether you have any legal recourse depends on the contents of your contract with the organization and with their own established past practices. You should take your paperwork to an attorney familiar with contract law and review it with him or her in detail.
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