Insurance denies coverage

[ladyc4]

I wish I could answer this question but I'm not qualified...what I DO want to say is that everyone reading this thread should regard it as a valuable lesson. You need to look at your checking account and credit card statements every month and if you see that a check has not been presented or a credit card transaction paid, you should follow up on that issue immediately if not sooner. Especially if it is for important items like insurance, utility bill payments, your mortgage or rent payment- otherwise, whatever may have happened,technically payment has NOT been made. Now MAYBE whomever was supposed to receive this payment will be good enough to notify you if the check never arrived, or the CC company declined the charge,but DON'T count on it. They may simply hold this missing payment/uncompleted transaction like a grudge until the opportunity to screw you,the consumer over. The only way you are going to know that something is amiss is to go over your checking account and credit card statements regularly, and follow up on anything that does not seem to have made it all the way through the payment process. Do this in writing, send your inquiry RRR so you have a "paper trail".
Does this sound a little extreme? It well may be;but you can't trust anybody these days.

 

[tammy8]

So you have the orginal reciept with the authorization/reference number on it printed out on the company computer? If so then go down to the insurance company and see what happened on their end. I have several times had a payment on one of my insured's policies come back "refer to maker" which means that although there was an authoraztion code given, the bank did not transmit the actual payment. Therefore if payment is not made again, the payment never went through.

I agree with one of the posters who said you thought you slipped through the cracks and got free coverage. Big mistake especially in the world of the legalities of insurance.

 

[Still Learning]

thank you crusheroz

I have been reading your post, and I have to say this: Your approval code, authorization number will not hold up. The Insurance company made a mistake a DID NOT process your card or maybe the credit card company system was down for maintance or updating and the charge did not go thru. If it happened that way, it could have come back declined. Therefore you never really paid for the insurance, therefore you are not covered. If you had checked your statement you would have noticed that it never charged. Or you noticed that it never charged and hoped you had gotten free insurance coverage. That is why you always double check everything. I had a similar thing happen to me a couple of years ago, I paid a bill with my debit/credit card, got the approval code, but for some reason the transaction never posted to my account. Here is where common sense kicks in, IF IT DOES NOT POST, YOU DID NOT PAY FOR IT! Therefore, I had to repay the bill. All the approval code did for me was it proved I attempted to pay the bill, so I was not charged a late payment fee.

Thanks for your input!!

I have no problem with repaying the bill and have instructed my attorney to offer to do so. I think proving that I attempted to pay is important.

In my case, it wasn't me who got the approval code, it was the company. It authorizes them to collect the funds. That's a slightly different thing than the confirmation code you're talking about, although I appreciate your point. I was there in person when they got the authorization code.

The idea that they might have tried to process when the system was down is one I hadn't thought of, but it doesn't seem likely. CCCs tend to do this in the wee hours of the morning and have appropriate messages. It would have affected more people than me, since this was their busiest day of the year for enrollment in this group plan, and I used a very common card. I used it for four other charges on the same day that all went through with no problem.

On the advice of the counselor at my credit card company, I am reporting the incident to the Insurance Commisssion.

 

[Still Learning]

Re: Re: Susie Baby stick to real estate

QUOTE]Originally posted by Still Learning
Susie, sweetie, please stick to real estate. I appreciate your desire to give this "mommy knows best" kind of advice on a legal forum, but it isn't as useful as you think it is.


You are probably right, Still Scamming =) I just don't understand scam artists I guess *sigh*.

Your first step to understanding anything, even in your business, is listening.


Re-read my posts. There is nothing contradictory. I think YOU misunderstood something in one of the initial posts, and now every time I repeat it, you think it's me contradicting myself, when in fact I am merely contradicting YOUR misinterpretation every time I try to explain the same thing over and over. Check it and see.


If you feel you are right, and you did not double post and contradict yourself over and over again, why do you keep coming back here and arguing the point?

LOL!! Since it is my post and my problem, I think my perserverance here is more easily explained than yours! What possesses a real estate agent in Oregon to think she is remotely qualified to give legal advice about insurance in another state? Do you give advice about divorce and incorporations, too? Why? It does baffle me. What's in this for you? Maybe you are hoping to find a boyfriend here? Or what? Why are you here?

I double posted because I misunderstood the structure of this site. I thought I would find a specialist in contract law under contracts, and a lawyer who specializes in insurance under insurance. I didn't know it was going to be people like you with nothing better to do than give their uninformed opinions on other people's problems in both places. It's weird. But if this is your hobby, I guess it's harmless enough, I'm not critizing you. Have fun.

 

[Souix]

Re: Re: Re: Susie Baby stick to real estate

QUOTE]Originally posted by Still Learning
Susie, sweetie, please stick to real estate. I appreciate your desire to give this "mommy knows best" kind of advice on a legal forum, but it isn't as useful as you think it is.


You are probably right, Still Scamming =) I just don't understand scam artists I guess *sigh*.

Your first step to understanding anything, even in your business, is listening.


Re-read my posts. There is nothing contradictory. I think YOU misunderstood something in one of the initial posts, and now every time I repeat it, you think it's me contradicting myself, when in fact I am merely contradicting YOUR misinterpretation every time I try to explain the same thing over and over. Check it and see.


If you feel you are right, and you did not double post and contradict yourself over and over again, why do you keep coming back here and arguing the point?

LOL!! Since it is my post and my problem, I think my perserverance here is more easily explained than yours! What possesses a real estate agent in Oregon to think she is remotely qualified to give legal advice about insurance in another state? Do you give advice about divorce and incorporations, too? Why? It does baffle me. What's in this for you? Maybe you are hoping to find a boyfriend here? Or what? Why are you here?

I double posted because I misunderstood the structure of this site. I thought I would find a specialist in contract law under contracts, and a lawyer who specializes in insurance under insurance. I didn't know it was going to be people like you with nothing better to do than give their uninformed opinions on other people's problems in both places. It's weird. But if this is your hobby, I guess it's harmless enough, I'm not critizing you. Have fun.

Your hostility is baffling ......

Why are you continuing to spew hate and discontent? All I did was try to be be nice to you and give you the benefit of the doubt. There have been plenty of attorneys that have passed through here, I wonder why they haven't responded to you? I agree with everything everyone else has said, except you. Maybe you need some professional help that has nothing to do with the law???? But, of course, now you have no insurance so good luck with that.

I do understand where you are coming from, though. You thought the insurance company had billed your credit card and they did not. Now you are trying to pass the buck by claiming you never noticed that the charge was not on your billing statement. If it seems like I am being condescending its only because I feel like I am talking to my 10 year old granddaughter.

And not that it is any concern of yours, but I find this website to be both entertaining and amusing. I can't believe there are so many people out there trying to get something for nothing. Thankfully, there are attorneys on this site with enough integrity to stop that sort of mentality.

I am done talking to you now, if you continue to harrass me I will report you to the moderator.

 

[CIAA]

You may be able to maintain a cause of action againdt the agent and/or the insurance company under your states' consumer protection act for not providing the type, quality or benefit of consumer services or goods that you were entitled to expect. Discuss this with your attorney.

 

[Still Learning]

Re: Re: Re: Re: Susie Baby stick to real estate

Your hostility is baffling ......

Why are you continuing to spew hate and discontent?

Susie, sweetie, I have suggested that you stop trying to give advice on subjects you don't know anything about. I am sorry if you have interpreted that as hostility. It is merely my advice.

All I did was try to be be nice to you and give you the benefit of the doubt.

Right. Calling me a scam artist and so on? That counts as nice on your planet?

I am done talking to you now, if you continue to harrass me I will report you to the moderator.

You are very funny. You come to my thread where I have asked for legal advice, dole out many insults, and it's me harassing you?

You keep coming back when you've been told your advice has been gratefully received and further input is not required. If you answer this, maybe I'll report YOU to the moderator.

 

[ladyc4]

I'm not an attorney, real estate broker, insurance agent, but what I'm about to say is dictated by the general laws of common sense.Please check the laws of common sense in your state before taking any action.
I agree that following up with the evidence in hand is certainly a good idea, it does sound like this is a situation where completion of the payment process got lost in the shuffle. Maybe the Insurance Commission can intercede,it's worth looking into.Might not be a bad idea to consult an attorney in your community.

That being said, the insurance company is now faced with a huge claim...and by the fact of the payment transaction not being COMPLETED,they also have a LOOPHOLE that your grandma could drive a tractor-trailer rig through. Now, set aside "doing the right thing" and think like the bean counter whose job it is to maximize the insurance company profits. Just who do you think is going to win???This is what's known as "getting off scot free on a technicality."

By all means, Still Learning, follow up with investigating any avenue of legal recourse that might be available. Perhaps this particular company has a pattern of sitting on checks/credit card transactions as a means of "insuring " against having to pay out on large claims? Can they do that? I don't know but I'd guess it depends on who has the most money for smart lawyers.

But I have to tell you, you also need to be working with the hospital billing department to see what kind of payment plan can be worked out.They may have awareness of other options or resources available to you. I'm inclined to believe that you are walking proof of "Murphy's Law",and this situation IS the result of an oversight or error,but if this insurance company is looking at a huge claim on your policy they sure aren't going to trip over themselves rushing to correct it.
The next time you renew your health insurance, pay cash in the presence of witnesses and get a written receipt. Put the receipt in your safe deposit box.
You may think I'm kidding about going to these lengths to cover your *ss but you gotta learn to look out for your own interests, because we live in interesting times. I sure hope this situation works out OK for you but it very well might not.

PS this was edited to correct the spelling of "smart LAYERS" to "smart LAWYERS". I'm sure there are instances when a member of the bar has indeed laid an egg,but did not want anyone to take an inference that egg production and the practice of law were one and the same.

 

[Still Learning]

Good advice

Thanks for the tips, Colonel Cindy.
I have engaged an attorney.
I have a couple of things in my favor. They did not inform me in August that my card was denied (my credit card company says otherwise, but let's just follow the insurance company's side here) or give me any opportunity to repay. I submitted a claim in December, which would have been a good time for them to say I did not have coverage and request repayment. They didn't. They sent a card saying my claim was being processed. I had a mammogram in January. They verified coverage. When my husband was admitted to hospital, they verified coverage. In other words, they have had several opportunities to inform me that there was a problem with the payment and lack of coverage, but did not do so.

By repeatedly failing to inform me, they prevented me from taking any steps to secure proper coverage.

 

[ladyc4]

I'm glad that you are consulting an attorney. This whole situation is beginning to have a peculiar odor-coming from the insurance company. There certainly seem to be instances- prior to this big claim for your hubby,where the non-completion of the credit card transaction should have come up on SOMEBODY'S radar,and appropriate steps taken to notify the policyholder, the TIMING here is what's waving a red flag,as far as I'm concerned.But don't forget to keep the hospital billing office in the loop,especially if they charge interest on unpaid balances. They may be sympathetic to your situation, and do what they can to help-but ultimately the responsibility for a hospital bill rests on the consumer/patient.
I hope this turns out to be a "valuable" lesson, NOT an "expensive" one as well.

 

[Still Learning]

hospital staff

I'm glad that you are consulting an attorney. This whole situation is beginning to have a peculiar odor-coming from the insurance company. There certainly seem to be instances- prior to this big claim for your hubby,where the non-completion of the credit card transaction should have come up on SOMEBODY'S radar,and appropriate steps taken to notify the policyholder, the TIMING here is what's waving a red flag,as far as I'm concerned.But don't forget to keep the hospital billing office in the loop,especially if they charge interest on unpaid balances. They may be sympathetic to your situation, and do what they can to help-but ultimately the responsibility for a hospital bill rests on the consumer/patient.
I hope this turns out to be a "valuable" lesson, NOT an "expensive" one as well.

The hospital has been very helpful. This morning they got together everybody who had dealings with the insurance co and compared notes and dates, who got "yes" and who got "no" for what and from whom so they could give me a log of who said what when. It's getting pretty nightmarish for me. We're trying to adopt a handicapped child and if this hospital bill wipes us out I don't know if we'll still qualify, especially if my husband ends up disabled himself, and I don't know how he'll handle the stress of all this.

 

[JETX]

Are you STILL here?? If you had devoted one-tenth of this effort on making sure that your credit statement was accurate (as all should), then this problem would NEVER have occurred.

 

[Still Learning]

you're back?

and if you spent as much time improving your personality as you do harassing people here, you'd be a prince.

 

[JETX]

Prince JETX!! Sounds good.
Thanks!!

But above all, remember one thing.... I have insurance and you don't! Na-Na!!

 

[Still Learning]

tee hee

i have to admit you have a quirky sense of humor that makes me laugh, prince jet.