M
MeMStrong1
Guest
What is the name of your state? New York
Pardon the lenghtiness of the preface. Last summer I went to work full-time and found that my graduate school's insurance provided much more full coverage for psychological care than my job's did. Trying to be careful, I purchased insurance from both for the year.
When I filed my first claim with the school insurance, I received notice from them that they needed information on my other insurance provider before they could pay my therapist. I sent the information, but apparently my therapist was paid even before they received this.
When I filed a second set of claims, I received nothing in the mail and my therapist had not been paid. I called and I was told that I would need to send information about the other insurer again. I asked them to send me the form. It did not come. I called a week later, was promised it would come and it did not. I called a third time and was told that this information was not needed at all, but that rather what was needed was an explanation of benefits from my other insurer. I called the work-based insurer and was told that by "explanation of benefits" they understood a form they would send to other insurers provided that I had filed a claim with them and had been denied or paid less than full out-of-pocket cost. I called the school-based insurer back and they said, "Well you need to file one with them first before you can file with us." I asked why and was told - on the fifth call and months after the claim was sent mind you - that they were the secondary insurer and the job-based insurer was my primary provider. When I said I never made any such designation of primary versus secondary, they said I had no choice in the matter and that the designation was theirs to make.
So - 1) am I being dealt with in bad faith or is there a legal, contractual foundation for this distinction? 2) is my "primary" insurer likely to pay anything on such late claims, especially since they require notification before I actually see a therapist before paying anything? 3) Is the insurance company still liable for the bad information they gave out over the phone? and 4) Is there grounds for legal action or threats of legal action in any of this? I am frustrated, broke and trying to not let my anger interfere with my capacity to articulate the complications. Help!
Best to you,
Pardon the lenghtiness of the preface. Last summer I went to work full-time and found that my graduate school's insurance provided much more full coverage for psychological care than my job's did. Trying to be careful, I purchased insurance from both for the year.
When I filed my first claim with the school insurance, I received notice from them that they needed information on my other insurance provider before they could pay my therapist. I sent the information, but apparently my therapist was paid even before they received this.
When I filed a second set of claims, I received nothing in the mail and my therapist had not been paid. I called and I was told that I would need to send information about the other insurer again. I asked them to send me the form. It did not come. I called a week later, was promised it would come and it did not. I called a third time and was told that this information was not needed at all, but that rather what was needed was an explanation of benefits from my other insurer. I called the work-based insurer and was told that by "explanation of benefits" they understood a form they would send to other insurers provided that I had filed a claim with them and had been denied or paid less than full out-of-pocket cost. I called the school-based insurer back and they said, "Well you need to file one with them first before you can file with us." I asked why and was told - on the fifth call and months after the claim was sent mind you - that they were the secondary insurer and the job-based insurer was my primary provider. When I said I never made any such designation of primary versus secondary, they said I had no choice in the matter and that the designation was theirs to make.
So - 1) am I being dealt with in bad faith or is there a legal, contractual foundation for this distinction? 2) is my "primary" insurer likely to pay anything on such late claims, especially since they require notification before I actually see a therapist before paying anything? 3) Is the insurance company still liable for the bad information they gave out over the phone? and 4) Is there grounds for legal action or threats of legal action in any of this? I am frustrated, broke and trying to not let my anger interfere with my capacity to articulate the complications. Help!
Best to you,