Medical claim Denied

They'll be needing a lawyer. If your friends are also in Canada, they are in deep waters, due to the US insurance and US medical plans.


Gary Haupt

Why is a Canadian having his insurance deny coverage a U.S. Insurance/medical plan issue?

It sounds like they are Canadians and carried a U.S. supplement while spending time in Texas. The medical emergency occurred while in Texas and the U.S. insurance plan is denying coverage having determined it involved a pre-existing condition they knew nothing about.

That's what I am reading.

Dale

Scottiemom wrote:
It sounds like they are Canadians and carried a U.S. supplement while spending time in Texas. The medical emergency occurred while in Texas and the U.S. insurance plan is denying coverage having determined it involved a pre-existing condition they knew nothing about.

That's what I am reading.

Dale

That's the way I read it as well. Anything to do with insurance is a nightmare. The insurance companies will do whatever is necessary to deny a claim. I wish your friends good luck.

portliz wrote:
Friends of ours have had their medical claim denied. Lots of money after a medical emergency in Texas. They have exhausted the appeal process with the insurance company. They are determined to fight this to the bitter end. They did not knowingly leave Ontario with a pre-existing condition. They did not think to ask to see what doctors were writing in the medical reports and consequently notes were made that were untrue. Any personal experiences that might be helpful? Any people fighting the same battle? We often hear scary stories and then we never hear the resolution.

There seems to be a growing number of this type of story in the news - CBC's "Go Public" has carried several of them and the circumstances you describe may be the kind of case they would be interested in:

http://www.cbc.ca/news/gopublic


Jay

The only solution is a legal battle. Oh and they don't have to pay the bills... that is part of the legal battle. Call an attorney.

If they had a US suplimental plan why would it not pay since Obamacare stipulates no exemptions for preexisting conditions. Or is that another flaw in Obamacare?????

spadoctor wrote:
If they had a US suplimental plan why would it not pay since Obamacare stipulates no exemptions for preexisting conditions. Or is that another flaw in Obamacare?????

It would be a Canadian supplement for coverage in the U.S., nothining to do with 'Obamacare'

portliz wrote:
Friends of ours have had their medical claim denied. Lots of money after a medical emergency in Texas. They have exhausted the appeal process with the insurance company. They are determined to fight this to the bitter end. They did not knowingly leave Ontario with a pre-existing condition. They did not think to ask to see what doctors were writing in the medical reports and consequently notes were made that were untrue. Any personal experiences that might be helpful? Any people fighting the same battle? We often hear scary stories and then we never hear the resolution.

If their doctors were writing up conditions that they never revealed to the patient, surely there must be some recourse against the doctor. I am sure their insurance policy CLEARLY states that pre-existing conditions are not covered. Given the long waits for some procedures that I hear exist in the Canadian Heath system, if the policies didn't exclude them, people would just buy a supplemental policy and come to the states for instant surgeries and care. Somewhere in the back of my pea-brain I hear an alarm going off that your friends aren't exactly telling you the truth, the whole truth, and nothing but the truth regarding what exactly they knew about their health condition before they went to Texas.

tsetsaf wrote:
The only solution is a legal battle. Oh and they don't have to pay the bills... that is part of the legal battle. Call an attorney.

Whoa....You are going to stiff the doctor that provided the care? These folks are Canadians who bought an Insurance policy that apparently is faulty, or they are a bit shaky on the facts that led to the insurance company denying the claim. The doctors, hospitals, nurses and all the others that provided the services to these people have no connection to the insurance company. They did what they were asked to do and rightly deserve to be paid. Stiffing them only adds to the costs every American pays for their medical care.