What can I do? Not notified of pre-existing waiting period & now ins co wants refunds
What is the name of your state (only U.S. law)? Illinois
Hello All Helpful People,
I have several problems with my BCBS PPO policy in Illinois and I'm not sure how to proceed?
1) First, I was never notified that I had a pre-existing waiting period on my policy. To be more specific, I worked for a small business in 2010 and my PPO policy with BCBS went into effect May 1, 2010. The business used an insurance broker. Prior to this policy, I was on my dad's HMO plan Jan. 1-April 30 2010. I did not have insurance before that. The broker for the business sent me an email (which I have a copy of) with my temporary insurance card. On it, there was a section highlighted that said I had a pre-existing waiting period until 4/30/2011, but my broker clearly stated in the email that as soon as I faxed him my Dad's HMO insurance info., this would go away. So, I got the info from his company and faxed it. I never heard anything from the broker, so assumed it was fine. I started seeing a therapist in march 2010 using self-pay, but in May I began using my new PPO insurance for my therapy sessions that were once/week. This continued through October and I received explanation of benefits every month showing that BCBS covered every session with my therapist, less my copay. All was well. I still did not know that I had a pre-existing waiting period on my policy. Everything was being approved and my broker never told me anything had changed. I received no written notice of anything. However, in October of 2010, I was hospitalized for two weeks and after returning home from the hospital, i started receiving multiple letters every day from BCBS saying they were investigating my hospital bills further for pre-existing. I started making phone calls, and it was only then that I found out I even had a pre-existing waiting period. I asked the insurance company how I was supposed to know that I had that, and they said my company should have provided me with this information. Is that correct? Is anyone legally responsible to tell me I have a pre-existing waiting period?
2) The saga continues...After talking with BCBS multiple times, I finally convinced them that my hospitalization was for a new illness that was not pre-existing, so they finally paid the claims for that and subsequent treatment. All this time, they were continuing to pay all claims for my therapy appointments as well. Here comes the wringer...last week (March 2011), I moved to a new state and upon arriving at my new apartment was greeted with at least 20 thick letters from BCBS stating they were copies for my records and that BCBS was requesting refunds for all of my therapy from May 1, 2010 to Dec 31, 2010 due to pre-existing condition. They were also requesting refunds for my hospital care and subsequent treatment. My therapist's office called and I asked if they had submitted the claims incorrectly and she said, no, they had listed the first date of treatment as March every time and BCBS paid them. Now, my therapist has to pay BCBS over $3,000 and then I will owe her this amount of money, not to mention what I will owe for hospital bills and subsequent treatment. Is it legal for BCBS to just change their mind and request a refund over 10 months later from when the first claims were submitted? If I knew I would have to pay the full fees, I would have never continued to see that therapist or I would have made different treatment decisions (i.e. find a therapist w/sliding scale or see less often). My friend says that I should contact the Illinois Insurance Commissioner and file a complaint. Is this my next step or do I need to get a lawyer (which I really don't have money for and I am now living in another state).
I appreciate any advice you have. Thanks for reading.What is the name of your state (only U.S. law)?
What is the name of your state (only U.S. law)? Illinois
Hello All Helpful People,
I have several problems with my BCBS PPO policy in Illinois and I'm not sure how to proceed?
1) First, I was never notified that I had a pre-existing waiting period on my policy. To be more specific, I worked for a small business in 2010 and my PPO policy with BCBS went into effect May 1, 2010. The business used an insurance broker. Prior to this policy, I was on my dad's HMO plan Jan. 1-April 30 2010. I did not have insurance before that. The broker for the business sent me an email (which I have a copy of) with my temporary insurance card. On it, there was a section highlighted that said I had a pre-existing waiting period until 4/30/2011, but my broker clearly stated in the email that as soon as I faxed him my Dad's HMO insurance info., this would go away. So, I got the info from his company and faxed it. I never heard anything from the broker, so assumed it was fine. I started seeing a therapist in march 2010 using self-pay, but in May I began using my new PPO insurance for my therapy sessions that were once/week. This continued through October and I received explanation of benefits every month showing that BCBS covered every session with my therapist, less my copay. All was well. I still did not know that I had a pre-existing waiting period on my policy. Everything was being approved and my broker never told me anything had changed. I received no written notice of anything. However, in October of 2010, I was hospitalized for two weeks and after returning home from the hospital, i started receiving multiple letters every day from BCBS saying they were investigating my hospital bills further for pre-existing. I started making phone calls, and it was only then that I found out I even had a pre-existing waiting period. I asked the insurance company how I was supposed to know that I had that, and they said my company should have provided me with this information. Is that correct? Is anyone legally responsible to tell me I have a pre-existing waiting period?
2) The saga continues...After talking with BCBS multiple times, I finally convinced them that my hospitalization was for a new illness that was not pre-existing, so they finally paid the claims for that and subsequent treatment. All this time, they were continuing to pay all claims for my therapy appointments as well. Here comes the wringer...last week (March 2011), I moved to a new state and upon arriving at my new apartment was greeted with at least 20 thick letters from BCBS stating they were copies for my records and that BCBS was requesting refunds for all of my therapy from May 1, 2010 to Dec 31, 2010 due to pre-existing condition. They were also requesting refunds for my hospital care and subsequent treatment. My therapist's office called and I asked if they had submitted the claims incorrectly and she said, no, they had listed the first date of treatment as March every time and BCBS paid them. Now, my therapist has to pay BCBS over $3,000 and then I will owe her this amount of money, not to mention what I will owe for hospital bills and subsequent treatment. Is it legal for BCBS to just change their mind and request a refund over 10 months later from when the first claims were submitted? If I knew I would have to pay the full fees, I would have never continued to see that therapist or I would have made different treatment decisions (i.e. find a therapist w/sliding scale or see less often). My friend says that I should contact the Illinois Insurance Commissioner and file a complaint. Is this my next step or do I need to get a lawyer (which I really don't have money for and I am now living in another state).
I appreciate any advice you have. Thanks for reading.What is the name of your state (only U.S. law)?
