Hi I just wanted to ask if it's legal or illegal for a health insurance company to deny a hospital claim just because you have secondary insurance. I reside in NY state if that matters
answered on Mar 29, 2023
It's difficult to comment whether there was an insurance law or policy violation without knowing the types of insurance, policy conditions, sequence in which hospital billed or otherwise coordinated the claims process between the two carriers. There are health care attorneys who handle billing... Read more »
Emblem was my former insurance through my former employer. I suffer from hip pain. I was approved for an X-ray of my hip which showed normal. However the pain was severe. My PCP requested an MRI on my behalf several times, but Emblem denied the request each time. My coverage ended with Emblem on... Read more »
answered on Oct 5, 2022
I'm sorry for your ordeal. You ask if you could sue. I think it would be difficult to find a law firm to handle such a matter on a contingency basis. MRIs are often initially denied as a knee-jerk reaction in many instances. They are big-ticket items compared to other less-sophisticated... Read more »
I am on a monthly medication paid for by my insurance, I switched jobs and thus got new insurance, but the pharmacy kept billing the old insurance.
The old insurance continued paying for my medications for 5 months. Now they're charging me a hefty ammount for the months they paid for... Read more »
answered on Apr 19, 2022
I'm sorry you find yourself at the end of a collection action with the medications. It's difficult to comment definitively on your position without seeing the terms of the policy and other paperwork. However, it sounds like they may be relying on the position that the patient has a... Read more »
So my dilemma is I have a car accident reported on my car accident history last year. I have never been in an accident in my life. My mom got in an accident last may and i was in the car. She called me a week later and told me her insurance wanted to speak with me i explained the situation to them... Read more »
answered on Mar 12, 2022
Some elements of the scenario are not fully clear, but from the brief facts, it does not look like a case of insurance fraud. Insurance fraud cases generally involve deliberate conduct with the intent to deceive the other party. This looks more like it could be an administrative or communications... Read more »
A dentist office accepts my current insurance. But make me pay full price, bills my insurance separately then sends me a check for less than 50% of what I payed when my insurance covers 80% of the total visit. They also only make some people who have the same insurance pay. So if you and I both had... Read more »
answered on Feb 11, 2022
It could be difficult to speculate why a dental or medical office would apply different billing protocols. As a convenience to the patient, some offices do not bill patients but instead, have them complete paperwork enabling their billing staff or contractor to bill on patient's behalf. When... Read more »
Hi,
I have a very large chest and as such I also suffer from crippling back pain. It has gotten to the point I can no longer function normally and cannot even get out of bed some days due to sciatica. I tried to get my insurance company to pay for a breast reduction and they denied me. In... Read more »
answered on Dec 16, 2021
I'm sorry for your ordeal with the back pain. In terms of having a case on which to sue, a law firm could offer a more meaningful response after reviewing the file with the input of medical professionals. What you are really probably wondering is whether you could sue in a manner where a law... Read more »
I am the third party in a product liability insurance claim. The claim was denied earlier this month and just yesterday, the adjuster called me wanting to "resolve" the claim by offering payment for "pain" from the injury.
Before the insured sent the complaint over to... Read more »
answered on Sep 30, 2021
It's difficult to say what the cause for the change in position on the part of the insurance carrier was without seeing the file and all communications. But what you describe is not uncommon. A claim could initially be denied because the examiner has not been presented with sufficient evidence... Read more »
If somebody claims that got hurt in front of my house how can request to be paid by my house liability insurance? My security system is old and cannot record, just view. Out of nowhere you just try to get money from your neighbors ?
answered on Sep 25, 2021
Your homeowner insurance company will thoroughly investigate the matter. It is not enough for someone to simply fall. They must show that it resulted from a defect in the surface or negligence on your part. The claims adjustor or defense attorney from your insurance company should be able to... Read more »
So I live with my grandmother. I’m 19 years old and moving out in august. She loves having control of everything! The thing is she has my insurance cards and refuses to give them to me. I’m going to need them when I move out. My college requires me to have my own insurance and I would like to... Read more »
answered on Jul 7, 2021
One option might be to contact the insurance carrier to request duplicate cards. Good luck
Tim Akpinar
year 1968 participating $5,000 whole life policy. no dividends for last 15 years. Prior to that, div increased each year (to $96) then decreased in the next 4 yrs to zero; for 12 yrs $0 , however cash value increased each yr ($3,900 currently and increases a small amount each yr), no loans ,... Read more »
answered on May 31, 2021
I'd recommend looking into New York's State's Unclaimed Funds registry, which can be found by clicking on this link:
https://www.osc.state.ny.us/unclaimed-funds
If you're entitled to funds that are unclaimed, they might be held by the State in escrow.
Good luck with your case!
My father's bank refuses to pay me by telling me that my father did not contributed the last months before his death without giving me any official paper or proof. My father contributed to this insurance for more than 30 years and it's a shame not to get any penny..
answered on May 9, 2021
I'm sorry for your ordeal that makes a difficult situation even more painful. It appears you've already requested records. It's difficult to offer step-by-step instructions here, as the next step could possibly require litigating the claim, depending on the situation. Reach out to... Read more »
answered on Nov 12, 2020
There is a resource on the case here on the Justia site. Enter the following page link in your browser:
https://law.justia.com/cases/north-carolina/court-of-appeals/1987/8715sc224-1.html
Good luck
Tim Akpinar
We Filed a couple of homeowners claims several years back and they kept exorbitantly upping our premiums year after year Annually I would call them and ask what could be done to better our rates. They offered nothing. our Renewal policies came in through the roof For oct 2020 so we decided to... Read more »
answered on Sep 29, 2020
Multiple claims could cause a significant rise in premiums. In terms of the other matter, you may need to review the file with an attorney in terms of the basis for the retroactive assessment - whether stemming from representations upon which their underwriters assessed the risk. Based on the... Read more »
They declined covering me each and every time i need medical service claiming all are preexisting conditions without adequate proof?
answered on Jul 2, 2020
I'm sorry that your procedures were denied. There wasn't a question, but a starting point for your situation could be to start contacting attorneys who handle health insurance claim disputes. Depending on the policy, there could be provisions for appeals. Good luck
Tim Akpinar
My bathroom ceiling is dripping meriatic acid due to an upstairs neighbor pouring it down the drains. The entire apartment filled with smoke due to the chemical reaction when in contact with metal. What is the protocol for a situation like this? Is it the landlords responsibility to provide us with... Read more »
answered on May 13, 2020
Your landlord should fix the issue. Your first step should be to let your landlord know so they can fix it.
My wife's condition is dire. She is in near constant pain and takes a lot of morphine. Novavirus restrictions have added to the anxiety. The insurance company has to make an exception in her case. Can you help?
answered on Apr 20, 2020
If you qualify for Medicaid, you can apply for that. You can also sign up for Obamacare exchange coverage at New York State of Health. But you are going to have to pay.
answered on Dec 7, 2018
Bad faith law is governed by state law. Depending on your jurisdiction there may be avenues to pursue through the state or ultimately through litigation. Many insurance lawyers will speak with you at no cost to give you some idea of your options and avenues to pursue.
answered on Oct 29, 2018
Third-party bad faith consists of actions on the part of someone else’s insurance carrier. It is distinguished from first-party bad faith, where the conduct involves someone’s own insurance carrier.
Tim Akpinar
can I do?
answered on Sep 15, 2018
It isn’t stated what type of loss the non-reimbursement involves, or if non-payment involves a deductible. In some cases, when an insurance carrier issues a denial, it lists available options. These include litigation, arbitration, or complaint with the Department of Insurance. In other cases, a... Read more »
answered on Sep 4, 2018
If by approved you mean that there is a court order by a judge, the order could stipulate a time period for payment. If you mean settled, then it could depend on how quickly third-party liens (if applicable) are identified and lienholders (medical providers, government agencies that paid health... Read more »
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