C
cinis
Guest
In Ohio. My wife's leg went numb last Dec. 5th. She went to the doctor and found out she has spinal stenosis over the next couple of weeks. Found out it was progressive and had it operated on in February when her other leg started to go numb. Insurance compay ok'd surgery. It was HPA (a temporary health plan through the Direct Marketing Association) that we had gotten in October (I had health insurance up until the end of August so there was a 32 day lapse in insurance. When we received the hospital bills ($29,000) the insurance company denied it because my wife had told the doctor that she has had some back pain most of her life so therefore, according to the insurance company, it was preexisting. We appealed several times and even had doctor write that this was progressive and wasn't due to any back pain, in fact my wife went to the doctor only because of leg numbness, not back pain. The insurance company said they can make up there own definition of 'pre-existing' instead of following the standard medical definition. My wife had never seen a doctor for back pain. Also, we appealed on the ground of HIPPA because we had insurance with no break in coverage longer than 45 days. Their letter back denying the appeal said they do not have to abide by HIPPA. We appealed to the State Insurance Commission who told my wife they had to cover it. But they got a letter back from the company and so they said there is nothing they can do. Are we stuck with the bill only because my wife was trying to give the doctor information that she (like 80 - 85% of the US population) has had back pain in the past? Is there any recourse?