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if you come out of surgery and the doctor, who based on your insurance is 100% covered, applies or orders a device for your usage that costs $100,000, then you are responsible for it?
Yes. Is there some part of this you don't understand?
These surgeons have a good idea what the plans cover and...
Pretty simple response. Device was ordered for your care. You took delivery and used the product. You owe the bill.
I haven't read your contract, but my guess would be this is considered durable medical equipment and is a covered item subject to deductible and coinsurance.
On the other hand...
One other thought . . .
It is unusual for identity theft to be used in such a way . . . to steal "benefits" under a medical plan. It may be the fraud goes deeper by filing false claims in an attempt to steal from the carrier. There may be others involved here, such as medical practitioners...
I am the eldest AND there was court order for me to provide PRIMARY health insurance for the children
Then you need to provide these documents to your carrier.
tehy wanted to know if the child was covered by medicaid or similiar. That is question I cannot answer
You need to get the answer if...
Most plans follow the "birthday" rule where the elder parent is the one who is considered primary for insurance. In other words, if you have a group health plan and your ex has a group health plan, if your ex is older he is the one who is supposed to be carrying the coverage.
The divorce decree...
Your carrier is prohibited under federal law from disclosing any information to you about claims made by another individual.
Put your complaint in writing to your carrier along with supporting documentation of the identity theft. If this is an employer sponsored plan, copy HR
Breezing through and ran across this, so it may be a moot point by now.
Some carriers have delivery requirements that include a statement by the insured indicating there has been no significant change in their health since the date of the application.
At one time CWA (cash with application)...
Medical transport companies, anesthesiologists, labs, outpatient clinics (primarily chemo & radiation), physical therapists are all considered hidden providers. They rarely participate in any network discounting.
As such they are free to charge whatever they wish.
You can attempt to negotiate...
The owner retains all rights to the policy, including the right to assign benefits, change ownership of the policy, make loans against the policy, change the beneficiary . . .
Until you have control (ownership) of the policy, your employer is in complete control.
If you are unable to get the...
From your post it appears the claim is still under investigation, not denied.
Without access to the policy language, I can only guess as to why the carrier may deny the claim.
If there is a misreprentation of fact on the application, the policy can be rescinded and all monies refunded.
If...
I see this situation quite often . . .
When your wife was treated by the facility she most likely signed a financial responsibility form. In essence, treatment was rendered and the facility is entitled to their fees, REGARDLESS of who pays.
The carrier has a contractual agreement with the...
Normally- the insurer would collect the inappropriate payment from the facility/physician.
Call your insurance carrier and ask them to deal with the doctor's office to recoup their money. Tell them that you forwarded the payment on - you should not be required to re-imburse them out of your...
I suggest you review the terms of your policy, perhaps with the assistance of the agent who sold you the plan. Compare benefits and exclusions in the policy with the submitted claim and the EOB from the carrier.
It may be that the claim was indeed paid in error . . . or that the claim was...
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