Ballwin, MO asked in Health Care Law and Insurance Bad Faith for Missouri

Q: Health Insurance misleading or non-responsive to q's

My health insurance company continually refuses to answer direct questions I have re: claim denial. Specifically, what codes were used. In addition, they also provide false/misleading answers to questions re: claims, my policy. My Q: what laws could they potentially be violating with this tactic?

1 Lawyer Answer
Tim Akpinar
Tim Akpinar
  • Insurance Claims Lawyer
  • Little Neck, NY

A: A Missouri attorney could advise best, but your question remains open for two weeks. In terms of the codes you mention, the billing companies for the medical providers that treated you input those. You should be able to see those line-by-line on your bills, which you could request copies of from your physician (or other health care providers). One really needs to see your file to determine what happened here, in terms of the carrier's denial, EOB (explanation of benefits), peer review, or other supporting documentation. Even a local attorney would have difficulty giving you meaningful input based on the brief post here. They would likely want to see your file. You could reach out to attorneys who handle health insurance denials to go through your options. Good luck

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