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portliz's avatar
portliz
Explorer
Jun 29, 2015

Medical claim Denied

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.

17 Replies

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