I have a question about the likely liability of my insurance company's for my treatment.

When I was diagnosed I worried that my insurer would try to decline payment on the ground of pre-existing condition. While it is clear to me and the doctors that this was NOT a pre-existing condition and there would have been no way for me to have known of this during the year prior to my coverage inception, it was also during the first year of coverage and thus subject to examination.

My question is this. Now that my insurer has paid some of the claims related to my treatment, can anyone think of a way that they may decline to pay for other parts of it? Seems to me that once they pay for part they admit liability for all . . .

Needless to say, this has been a major source of stress . . .

Thanks for any insight.

Tim

Hi Tim,

Seems to me if they paid for the start of treatment they should continue to pay for all of your bills. Minus any co-pays or deductibles.

They may ask for authorization from the insurance company before scheduling treatment.

Hope it goes your way and you have a speedy recovery.

All my Best, Danny Boy

Treatment is pretty much complete. Not much they can do after chemo, rad., and surgery! :-)

They continue to pay more and more. It just took forever to get started . . .and I did stress during that time. I didn't want another fight on my hands.

Tim

Not to inject a scarey thought here, but John's ins. co.-John Alden- has paid for most of the stuff so far[we are 3 mo into this] but has denied the feeding tube nutrients, the anesthesiologist during cancer surgery, the removal of John's teeth during the same surgery,and when I question them, I get nowhere. We have no clue about the rdx or the dental visits for flouride trays, etc. The last time I challanged John Alden, the response was that they couldn't possibly include in our policy, everything that was not covered. How do you respond to that? Amy

At this point they have begun to pay the big ticket items too. I guess I don't need to worry too much anymore. Kudos to the folk at the CCC billing department who dealt with the insurance co.!!! :-)

Tim

Amy, if you have dental insurance, they will most likely be responsible for flouride trays, at least mine was. Dental also paid for teeth extracted, EXCEPT for those pulled during the actual cancer surgery, and that was paid by Medical. Read your policies carefully. If you do not see exclusions for things denied, you can contact your state insurance commission(er). Called something different in every state, but you can ask for assistance and/or arbitration. Sometimes the insurors have to be reminded to toe the line and live up to the agreements they made when collecting your premiums. The last thing you need right now is yet another thing to straighten out, but if you are persistent, this situation can be corrected. You just need some muscle behind you. It is an unfortunate fact, but insurance companies save money every time they can intimidate someone into accepting their verdict. If you think you are right, do not back down. This is really a case of squeaky wheel getting the grease. I worked for an international insurance brokerage for decades, and know whereof I speak. I also interceded on behalf of my parents, and myself, so it can be done. I wish I could help you too. Go get 'em!

Joanna, thanks for the "boost". I wish you were here too. We do not have dental ins., but John's oncologist has written a strong letter to the ins.co. stating that the removal of John's teeth and part of his jaw bone were part of the cancer treatment. I still have not gotten any reply to that. I do plan to get into arbitration or a lawsuit if necessary- but I want to use my energy now to help John cope. I hope I'm not waiting too long, but I can't seem to marshall the energy to deal with it right now. Amy