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How can I make my employer pay for health care claims

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dragana

Junior Member
What is the name of your state? Pennsylvania
My employer that provides self-funded grop health plan coverage did not pay health care claims for services that occured in 2004. For more than a year the HR director has been promising that those claims will be payed, but payment hasn't been sent yet. The doctor's office, I have deliquent account with, threatens to turn my account for collection if I don't pay soon. I changed my job one month ago and my former employer HR director refuses my calls and doesn't reply to my messages. How can I make my former employer pay for those claims.
 


cbg

I'm a Northern Girl
What reason do they give you for not paying?

If, for example, the services are excluded from coverage under the plan, they have no obligation to pay them.

If they are in need of additional information before the eligibility, then they don't have to pay it until they receive the information.

But if they have simply not paid because they haven't bothered to get around to it yet, that's a different story.
 

dragana

Junior Member
They have no reason for not paying the claims which they promissed to pay. The services provided are covered under the plan and they have all information needed. It is just taking too long to pay those claims, and now that they don't respond to my phone calls, I am in doubt that their intentions are serious. I would lilke to know what my options are if my employer doesn't pay for the claims after all.
 

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