Insurance not paying bills

[laladeda84]

What is the name of your state (only U.S. law)? NC

I signed up for Continental American Insurance Company's (CAIC) Mid Med health insurance plan in May 2009. In June 2009 I went to an ophthalmologist for an enlarged pupil and to the OBGYN for a pap smear. After my ophthalmologist visit, CAIC started a "preexisting conditions investigation" and sent me a letter asking for a list of Doctor's I had seen in the past 6 months. Well, I hadn't had insurance and had only been to 2 doctors, once for anxiety and once for ringworm. I put this in the letter along with the doctors' addresses and phone numbers and mailed it in on June 16th 2009. In July I started receiving bills saying my insurance hasn't paid for anything. I called CAIC and they said they were still investigating for "preexisting conditions" and had sent letters to the doctors I had mentioned in my letter and were still waiting for a response. I called the doctors and they said that had not received any letters. I had CAIC resend the letters. Now it is September and CAIC is still refusing to pay my bills and saying that they have not had responses to the letters. The doctors still say they have not received the letters. The ophthamologist and OBGYN want their money. I can't afford to pay them their money. Is there anyone I can file a complaint about my insurance company with? I've never had a company take this long to pay... I really think that they aren't sending the letters out. Both doctors knew the second letter would be coming and were looking for it and it has not shown up in either one.

[ecmst12]

Well, they are allowed to investigate but it sounds like there is a communication breakdown between them and the doctors you have referred them to. I would try the insurance company one more time (speak to a supervisor) and give them a reasonable time to get the faxes sent out (3-5 business days at most), if the drs still don't have the paperwork, the next step would be an insurance commision complaint. Assuming of course that this is an individual policy; if it's through your employer, then your HR department could also be a resource.

[laladeda84]

Thank you. I'll try a supervisor.