How to sue Blue Cross?

[judith621]

My 9 yr old son is a type I diabetic. He went to Diabetes Camp last year, which was great for him; and helped him alot. But it cost $650 !!

The Camp told us to submit a claim thru our Blue Cross/BS-the Camp said, some of the cost might be covered as it is a medical camp. We submitted it FOUR times, with no response!! Every time I call, they say they "have no record of a claim being filed", even though I sent it Certified Mail and had a letter of Medical Necessity from a doctor. I want last year's claim considered and a coverage determination for next summer, but they keep blowing me off. Can I sue for bad faith; and what forum do I sue in, Small Claims?? I live in New Jersey.

 

[I AM ALWAYS LIABLE]

My 9 yr old son is a type I diabetic. He went to Diabetes Camp last year, which was great for him; and helped him alot. But it cost $650 !!

The Camp told us to submit a claim thru our Blue Cross/BS-the Camp said, some of the cost might be covered as it is a medical camp. We submitted it FOUR times, with no response!! Every time I call, they say they "have no record of a claim being filed", even though I sent it Certified Mail and had a letter of Medical Necessity from a doctor. I want last year's claim considered and a coverage determination for next summer, but they keep blowing me off. Can I sue for bad faith; and what forum do I sue in, Small Claims?? I live in New Jersey.

My response:

You had better read your policy and / or contract, first.

If there's an Arbitration clause, that's your first route to take.

IAAL

 

[failenn216]

Note that you first must receive a RESPONSE before invoking the arbitration process. No Response has been received re: the claim;
Doesn't the health plan have a duty, under contract, to consider the claim submitted??.

 

[judith621]

I do not have an arbitration clause; Even if i did, I did not receive a coverage determination to arbitrate. I have a major medical/fee for service Plan, not an HMO. This is just a situation where they are not even willing to admit they RECEIVED the claim!