Health insurance claim denied

[phyatt4304]

What is the name of your state? What is the name of your state? Indiana

My health insurance company paid a claim for my daughter's bunionectomy in 2002. She recently had the same surgery on the other foot, and the claim is being denied because the insurance company claimed the first claim in 2002 was "paid in error". Do we have any recourse? Our benefits booklet does say that "treatment" for corns, callouses and bunions is not covered, unless related to diabetes or circulation. We were told by someone that "treatment" could be interpreted differently than a "procedure" as she received. Can our insurance company come back on us for the 2002 surgery and demand payment?

 

[cbg]

Can they? Yes. Are they likely to? No.

In my experience (and I have a lot of it, with different companies) most companies, when they pay a claim in error in the way you describe, will not require reimbursement (especially not two years after the fact) but will not, and are not required to, compound the error by paying any further claims of the same type.

 

[Beth3]

"We were told by someone that "treatment" could be interpreted differently than a "procedure" as she received." Your someone is trying to make this a game of semantics and it won't work.

"Treatment" means ANY medical attention of any kind: office visit, medication, surgery, lab work, x-rays, physical therapy, etc. Your daughter's condition just is not covered by the particular health plan you have.