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Lotus123
Guest
Oregon
Hi, I have a question regarding a situation wherein my employer switched healthcare providers without prior notification to any of the employees. My wife, who is covered underm y plan, was in the middle of a dental crown procedure at the time. Crowns are a two part procedure. She had the first part under the coverage of the old insurer, the second under the new, by necessity. We had no chance to finish it under the old. My employer assured me, verbally of course, that there was a rider to cover this situation. Turns out there wasn't a rider and both insurance carriers have refused to pay (apparently legally so). Now, my question is, do I havve any legal recourse here to get my employer to pay the amount still owed (the amount the insurance should have paid) since they led me to believe the procedure would be covered, and have a fiduciary oblication to administer the plan responsibly? Or is there other grounds I can stand on in this case? Any help most appreciated.
Lotus123
Hi, I have a question regarding a situation wherein my employer switched healthcare providers without prior notification to any of the employees. My wife, who is covered underm y plan, was in the middle of a dental crown procedure at the time. Crowns are a two part procedure. She had the first part under the coverage of the old insurer, the second under the new, by necessity. We had no chance to finish it under the old. My employer assured me, verbally of course, that there was a rider to cover this situation. Turns out there wasn't a rider and both insurance carriers have refused to pay (apparently legally so). Now, my question is, do I havve any legal recourse here to get my employer to pay the amount still owed (the amount the insurance should have paid) since they led me to believe the procedure would be covered, and have a fiduciary oblication to administer the plan responsibly? Or is there other grounds I can stand on in this case? Any help most appreciated.
Lotus123