Center Valley, PA asked in Insurance Bad Faith for Pennsylvania

Q: How accurate should consulting with a health insurance provider before getting something done be?

My wife and I consulted with our health insurance provider to see what our costs would be to do a home birth with a mid wife. We went over figures related to our plan and what we anticipated. We decided to do the home birth because the consult with our insurance company determined that we would get 70% back. When we submitted the claim we only got 20% back. They are now saying only 70% of the allowed amount will be given. They never mentioned this allowed amount when we went over the figures over the phone. They denied our appeal of which states this consult history. Do we have any recourse here? This is in Center Valley, PA if that matters. Edit: I'm assuming that I need to meet with a lawyer to discuss the details but was hoping to get an answer on whether or not this seems like a valid case? Should I have known this allowed amount even though it wasn't mentioned during the consultation discussing figures?

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1 Lawyer Answer
Mark Scoblionko
Mark Scoblionko
Answered
  • Insurance Claims Lawyer
  • Allentown, PA
  • Licensed in Pennsylvania

A: You would need to consult with a lawyer to answer this question. A lawyer would presumably want to review your plan and any correspondence. An office conference would be necessary so that you could discuss with the lawyer all things that transpired and any conversations that you had with the insurance company.

1 user found this answer helpful

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