Please Help my Dad, ASAP!

[tracyhaven]

What is the name of your state? CA

My dad is scheduled to have an aortic aneurysm surgery next wed 1/29/03. The problem is that he's currently covered by two insurance claims: (1) blue cross of CA which covers up to $70K and (2) American Medical Assn. (my mom's a doc) which has a $20K deductible but covers up to $120K.

Neither insurance wants to be the "primary" and refuses to pay for the operation. My dad tried to drop the Blue Cross one (so that AMA will be the primary), but they refused stating that he has paid his dues till the end of the month and can't drop his coverage. The crux is that neither one will pay for the upcoming surgery!! Is there anything we can do?!! We are at wits end - Please help!!! THe sx is this coming Wed!

Many thanks in advance for your time and consideration.

Warmest regards,
tracyhaven

 

[CIAA]

tracyhaven,

We certainly wouldn't suggest dropping ANY coverage under the circumstances.

It would certainly seem that either both must fully pay or one will be the primary. This will depend on the exact policy language in each policy.

The first thing you can do is file a complaint with and seek assistance from the California Dept. of Insurance. we are pretty sure they will get to the bottom of your problem.

If you need to file the claim before the issue is resolved, file with both companies, properly declaring other insurance if requested on the forms to do so.

All the best to you, your Dad and the family.

 

[lkc15507]

I certainly agree not to drop any coverage. There are rules governing who is the primary payer when dual (or even more) coverage exists. It depends on how your father qualifies for the BCBS coverage. In my opinion (based on usual practices of benefit coordination), neither company can base coverage on the coverage provided the other. ie, they must base benefits available according to his eligibility under THEIR OWN policy. Coordination of benefits can be hashed out later. I would suggest having your father's physician submit an urgent predetermination of benefits to each insuror. Failing a quick determination, (NOT BASED ON COORDINATION), do not postpone medically necessary surgery!

lkc15507