Insurance denies coverage

[Still Learning]

What is the name of your state? Florida

I purchased health insurance coverage in August 2002, in person. The agent called for authorization to charge my credit card, and issued a signed receipt stating the dates and type of coverage. I submitted a claim in December, and got the usual postcard confirming that it was received and being processed.
Now my spouse is in hospital and although the insurance has verified coverage several times by phone, the hospital is unable to get predeterminations or accurate billing info, because the insurance co. tells them they have no record of coverage.
Latest news. Thursday Feb 27 - six months after the date I bought the insurance - the insurance company says my credit card was denied and I am not insured.
Note credit card authorization went through - I was there. There is no reason the credit card co would have refused the charge. I have a receipt stating amount paid and coverage dates.

How do I get them to accept the hospital bills.

 

[cbg]

Is this individual coverage, or group coverage through your employer? If group, contact someone in your HR Department for assistance. If individual, contact the agent or broker who sold you the policy.

 

[Still Learning]

insurance denies coverage

It is a student health insurance program via my university.

The insurance company itself had me on file with no policy dates.

It is the agent/broker who contacted me (after six months) to say that my credit card "did not go through" and that I am not covered.

My question is: Does the signed receipt saying paid in full and stating dates of coverage create, legally, liability on their part to pay my claims? The receipt says "paid".

They did not follow through to collect the funds after receiving the charge authorization. I believe that they never processed the charge at all, for one of two reasons:

1. simple inefficiency.
2. deliberate inefficiency (We had claims last year. They cannot deny coverage based on medical history, but perhaps this is a way to do it?)

 

[JETX]

The key issue to me is, was this charge EVER reflected on your credit card bill and was that charge paid?? If it wasn't, then the premium was never paid and you have no insurance coverage.

However, if the credit card bill does show the charge and you paid it, then use that as proof that the premium was paid and that you should have coverage.

Simply putting it on your card does not mean it was paid.

 

[Still Learning]

insurance denies coverage

The charge was not made as far as I can tell from going over old credit card statements from six months ago. Nor was such a charge ever denied. I had no way of knowing that the insurance company did not collect the funds that were authorized. I believed that the charge was made on the spot. The agent took my credit card, processed it in some way, and issued me a receipt that says "paid" and the start and end dates of insurance coverage.

Let's say it was a check instead. If they did not cash the check, can they deny coverage on that basis?

Are they legally entitled to let me walk around for six months believing that I have coverage (note that they confirmed receipt of my earlier claim in December, stating that it was being processed and I would receive reimbursement in approximately
6-8 weeks) and THEN tell me, only when I have a larger claim, that they did not collect the funds on the authorized credit card transaction?

Having issued the coverage, is it legal for them to rescind it without informing me?

 

[JETX]

It doesn't matter whether you paid by check or credit card, if they did not receive payment, you have not paid your premium. And they do not have to provide coverage if you haven't paid.

"Having issued the coverage, is it legal for them to rescind it without informing me?"
*** The point is, they made a mistake. They THOUGHT you had paid the premium and issued a statement of coverage based on that statement. However, they were incorrect. And you were also remiss..... in not noticing that this charge was not on your statement at the end of the month. If you had taken the time to review your charges against your charge slips (as you should have) you would have noticed the fact that the insurance company premium was NOT paid.

Depending on the full facts here, this does not mean that you might not have a claim against the insurance company for their denial of coverage, only that if I were representing them, my defense would be, "you never paid the premium".

UPDATE: I found that you have already posted this IDENTICAL issue on the forum earlier.
The other thread was started 03-01-2003 10:58 PM and was under the subject "Credit Card not charged". So, it is clear that in that post, you already knew that you had NOT paid the premium!!
However, in THIS thread (which you started a few hours later, at 03-02-2003 01:01 AM), you make NO mention of this critical non-payment!!

It is obvious that you are trying to scam the insurance company into providing coverage that you didn't pay for, and they aren't going to fall for it, just as we won't!!

Have a hap-hap-happy day!!

 

[Souix]

It doesn't matter whether you paid by check or credit card, if they did not receive payment, you have not paid your premium. And they do not have to provide coverage if you haven't paid.

"Having issued the coverage, is it legal for them to rescind it without informing me?"
*** The point is, they made a mistake. They THOUGHT you had paid the premium and issued a statement of coverage based on that statement. However, they were incorrect. And you were also remiss..... in not noticing that this charge was not on your statement at the end of the month. If you had taken the time to review your charges against your charge slips (as you should have) you would have noticed the fact that the insurance company premium was NOT paid.

Depending on the full facts here, this does not mean that you might not have a claim against the insurance company for their denial of coverage, only that if I were representing them, my defense would be, "you never paid the premium".

UPDATE: I found that you have already posted this IDENTICAL issue on the forum earlier.
The other thread was started 03-01-2003 10:58 PM and was under the subject "Credit Card not charged". So, it is clear that in that post, you already knew that you had NOT paid the premium!!
However, in THIS thread (which you started a few hours later, at 03-02-2003 01:01 AM), you make NO mention of this critical non-payment!!

It is obvious that you are trying to scam the insurance company into providing coverage that you didn't pay for, and they aren't going to fall for it, just as we won't!!

Have a hap-hap-happy day!!

Bravo JETX.....just curious, though, if Still Learning's claim was ever paid from December.

 

[JETX]

"just curious, though, if Still Learning's claim was ever paid from December."

I would assume that, since 'Still Scammin' earlier post said that the December claim was still "being processed", that it was not paid. And it very probably never will be. It is also possible that there never was a claim from December and that was just tossed in to try to give some credibility to his claims of coverage. (I know that if I had a claim remaining from 3 months ago, I would sure know a LOT more about it than, just 'being processed')!!

 

[Still Learning]

insurance denies coverage

OK. What if you were representing me?

You did not answer the question of what would happen if I gave them a check and they did not cash it. They received the payment, but did not collect the funds.

If I give you a check on the 2nd of the month, and you don't cash it until the 30th, does that mean I am not covered when I break my leg on the 15th? Surely the contract is established on the date when the payment is tendered, not on the date when the agency feels like taking it to the bank.

Look at it this way. Say I sell you my car with a legal bill of sale on the 2nd, but you leave it sitting in my driveway until the 30th. Whose car is it on the 15th?

You will also note that I acted in good faith. I gave them my credit card, valid, with sufficient funds, etc. and fully expected them to carry out the authorized transaction. I had reason to believe that they did so. They issued a receipt. They issued me a policy with the effective dates 8/03 to 8/03. They have confirmed that they are processing an earlier claim. They have never said anything that would lead me to believe that there was any problem.

I have an idea! Let's you and me go into the insurance business! We'll do it like this: First, we make everybody pay up on the 1st of the month, but we hold the checks until the end of the month. If they had no claims, we cash the check. If they do have claims, we just give them their check back and say, Oops, sorry, we forgot to cash your check, so you weren't covered. Too bad. What do you say? Think that would work?

Is there anybody here who knows something about contract law? When is a contract established? Is it the date when both parties sign it? Or is it some other time?

 

[JETX]

Sorry, but from your obvious attempt to scam the insurance company.... and this forum.... you have been "voted off the island and must leave immediately".

As for your issue regarding 'contract law', look up 'conditional contract'. Oh, and read YOUR contract with the insurance company. Their obligation is not incurred until PAYMENT is made.

Bub-bye!

 

[Still Learning]

May it happen to you

To the persons who think that I am trying to scam the insurance company.

a. I am not. I purchased health insurance for myself and my husband in good faith.

b. I don't know what kind of people YOU are, but I did not have my husband rushed to hospital on an emergency and on life-support in the hospital for 24 days so that I could scam an insurance company. I believe that lawyers may be capable of such things, but I am not.

c. I cross-posted this question on both the Contracts and the Insurance forums, because it pertains to both.

I stated clearly in both posts that the insurance company did not complete the credit card transaction.

I maintain that I did pay my premium when I gave them my credit card, signed the contract, and watched, in person, real time, as the agent call for authorization of the charge. My credit card company authorized it. I authorized it. The insurance company did not process it. This is not my fault.

All I can say is, may it happen to you. May the people that you ask for help treat you the way you have treated me. May the people you love lay dying while your dreams of a happy retirement are sucked dry by a corrupt health system. May you get what you give. It's up to you whether you take that as a curse or a blessing.

My husband, when facing the prospect of dying, said that the best thing about dying was never having to deal with the nasty people that the world is so full of these days.

By the way, about the claim in December. I received a postcard on January 22nd saying it was being processed and to allow 6 to 8 weeks. It hasn't been 6 weeks yet.

 

[Still Learning]

Remedial Reading

JETX
Please sign yourself up for some remedial reading instruction. I made it clear in all posts that the credit card transaction was not processed. Are you a lawyer? I took the LCAT once, and I seem to recall there was a reading comprehension part. How did you get around it?

 

[Souix]

Re: May it happen to you

To the persons who think that I am trying to scam the insurance company.

a. I am not. I purchased health insurance for myself and my husband in good faith.

b. I don't know what kind of people YOU are, but I did not have my husband rushed to hospital on an emergency and on life-support in the hospital for 24 days so that I could scam an insurance company. I believe that lawyers may be capable of such things, but I am not.

c. I cross-posted this question on both the Contracts and the Insurance forums, because it pertains to both.

I stated clearly in both posts that the insurance company did not complete the credit card transaction.

I maintain that I did pay my premium when I gave them my credit card, signed the contract, and watched, in person, real time, as the agent call for authorization of the charge. My credit card company authorized it. I authorized it. The insurance company did not process it. This is not my fault.

All I can say is, may it happen to you. May the people that you ask for help treat you the way you have treated me. May the people you love lay dying while your dreams of a happy retirement are sucked dry by a corrupt health system. May you get what you give. It's up to you whether you take that as a curse or a blessing.

My husband, when facing the prospect of dying, said that the best thing about dying was never having to deal with the nasty people that the world is so full of these days.

By the way, about the claim in December. I received a postcard on January 22nd saying it was being processed and to allow 6 to 8 weeks. It hasn't been 6 weeks yet.

This still does not change the fact that you "charged" your premium. When you "charge" something to your credit card you are actually borrowing money from the bank or credit card company to pay the bill. The bank, in turn, sends you a bill for repayment of the loan. You then either pay the amount owing or you make the minimum monthly payment.

It was your error that you did not notice that the charge was on your bill. Even if you had written a check, you would see on your statement that the check had not been cashed. Most people would call and find out either why the check had not been cashed or why the charge had not appeared on the credit card statement. If you had done that back in September, you would have known you were not covered and would have been in a much better position than you are now.

You are now trying to collect on something that isn't there and blaming others for your own negligence. Hopefully you will learn something from this. Can you get some sort of assistance from your State to pay your spouse's hospital bill?

 

[Still Learning]

Responsibility of insurance co

What is the responsibility of the insurance company in this case. They were given all necessary information and an authorization to collect. They issued a receipt and a policy. The payment was good. What is their excuse for not collecting it, and will it stand up in court as a reason for denying coverage.

By the way, I purchased similar insurance from the same agent last year. I went to the office, filled out the forms, gave my credit card, they called to process it, they issued a receipt and a policy and gave me instructions for filing a claim. I filed claims, and got postcards back saying they were being processed. It took months before I got reimbursed, but I did get checks. I had no reason to suspect that it would be any different this year.

Re the suggestion that the State pick up the tab. Why should taxpayers be expected to pay when I have purchased insurance for this?

 

[Souix]

Re: Responsibility of insurance co

What is the responsibility of the insurance company in this case. They were given all necessary information and an authorization to collect. They issued a receipt and a policy. The payment was good. What is their excuse for not collecting it, and will it stand up in court as a reason for denying coverage.


Answer: Call them and ask them.



By the way, I purchased similar insurance from the same agent last year. I went to the office, filled out the forms, gave my credit card, they called to process it, they issued a receipt and a policy and gave me instructions for filing a claim. I filed claims, and got postcards back saying they were being processed. It took months before I got reimbursed, but I did get checks. I had no reason to suspect that it would be any different this year.


Answer: They must have charged your credit card, did you check? Did you pay the credit charge back?


Re the suggestion that the State pick up the tab. Why should taxpayers be expected to pay when I have purchased insurance for this?

But you didn't purchase it - thats the point. Just offering you some alternatives to a policy that was never in effect. If you don't have insurance these days, hospital bills can put you into bankruptcy real quick.