insurance denied after paid claim

[hdhnurse]

What is the name of your state? Ohio


I had a dog that bit my landlord's child. He was taken to the local emergency room and got several stitches. I agreed to pay the co-pay.

My landlord called today and said that the hospital bill had been paid by his insurance company(minus the co-pay). But that he received a letter from the insurance company today saying that they wanted the money back that they paid the hospital because they do not pay for dog bites.

How can this be legal? If the insurance paid the bill already how can they change their mind after the fact?

Can my land lord fight this or am I stuck paying for a 1200 dollar hospital bill.
My landlord already made it clear to me that he is not paying the insurance company back and that I would be responsible for the entire bill.

[somarco]

Just a wag, but it seems landlord filed under his CGL or other (non major medical) plan. Can't think of a situation where a medical carrier would deny a claim because of a dog bite.

If you have renters insurance, there MIGHT be some coverage there if liability is part of the policy benefits. If not, get your checkbook out.

You can also suggest he file with his medical carrier (assuming that was not already done). Bottom line, it's your dog and your responsibility.

I do have a problem with this statement . . .
My landlord already made it clear to me that he is not paying the insurance company back and that I would be responsible for the entire bill.

So . . . he is (in effect) keeping the money paid by his carrier AND asking you to pay him.

What's wrong with this picture?

[hdhnurse]

ohio

He submitted it to his major health plan that he pays for. He is retired. But the big thing is how can an insurance company pay the hospital directly then turn around and say "OOPS we want our money back?" That should not be legal.

Has anyone heard of an insurance company doing this?

[somarco]

Submitted to health insurance, huh? Are they exercising their right of subrogation? If so, you (or your renters policy) are liable.

[purple2]

Yes, it is legal for an insurer to review a claim and retract payment. It happens every day and is perfectly legal.

It is also legal for a health insurer to retract payment when their review of the claim and records prove it was not a covered condition. It is quite normal for a health insurer not to pay for a liability case such as a dog bite. This is probably spelled out in the health insurance policy. Health insurance usually pays for health conditions not caused by another party. If the girl fell in the grocery store, the grocer would have to pay for her injuries and treatment. If the girl had fallen at her job, it would be covered under Worker's Comp, and so forth. This is the same scenario, except you as an individual are the responsible party.

If your landlord received monies from the health insurer, then he is obligated to reimburse them. However, it's not your problem. That's between him and them.