help in writing appeal letter to medical insurance company

[peterbrews]

failed to notify hospital and primary insurance company but i gave information about sencondary insurance comapny to hospital and got pre-certification from them
1. shall i agree that i had no idea who is primary and who is sencondary
2. will the secondary will cover penalty charges imposed by
primary insurance
3.what is best way to appeal
4. what do i do now

 

[cbg]

A little more information, please?

 

[CIAA]

peterbrews,

One of the first things is to set out exactly what the insurance company has told you in writing, as to why they are denying your claim.

It sounds as if you are saying that they are denying benefits based on late notice of claim. If this is correct, the denial may be overcome on appeal, depending on the specific circumstances.

Most importantly, don't let any appeals time limits pass.

 

[Beth3]

1. Only if that is true.

2. Highly unlikely but you can always submit the claim to them and see what happens.

3. Write a letter.

4. Throw yourself on the mercy of the insurance company.

Listen, you messed up. And the hospital (who will typically make sure the pre-cert is done) couldn't even help you because you never gave them the info.

All you can do is write a letter explaining your confusion, that the pre-cert and approval was performed by the secondary carrier so your stay WAS being monitored by an insurance company (even if the wrong one) and therefore they can be assured no unnecessary procedures or in-patient days were scheduled. Give them contact info for your secondary carrier and then hope for the best.