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My insurance company has been accepting and paying claims for several months and suddenly the identical billing code was rejected recently. I called the insurance company to find out why the claim was no longer being processed. I cited a couple claims that were covered.

The representative told me the past claims were incorrectly paid for by insurance as well, and they'll have to reprocess them and bill me for those as well.

I was stunned. Is there any recourse here? I stopped going to the doc after my claims were no longer being covered. I would have stopped much sooner had I known they wouldn't have been covered.

  • 3
    What country are you in? What kind of policy do you have? What kind of medical services are they saying aren't covered? – Chris W. Rea Dec 7 '17 at 19:27
  • I'm the US. It's a PPO plan. Basically it's an office visit that was rejected because my diagnosis isn't covered. It's sort like the response below regarding LASIK. They're treating it as LASIK and not covered now, but I was strung along because it sure is nice when insurance says something like LASIK covered. – Michael Palmer Dec 8 '17 at 6:44
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Unfortunately, there is no definite recourse. Health insurance reversal is a thing, and it sucks. However, you do have some options:

  1. Talk to your care provider, and have them start reaching out to the insurance company on your behalf. Usually, the description of the ailment or treatment may have some weight. Take Lasik eye surgery for example. For some, it may be a cosmetic choice - "I don't want to wear glasses, they're ugly." For others, surgery may be a medical necessity. If your claims are framed as necessities, you may have a better chance.

  2. See if you can negotiate the bills, either with your insurance company or the healthcare provider. Both of these are run like businesses, and they would rather have some of your money than none of your money. So, if you call them up and say "Okay, I will pay ____ right now if we close this out" they may be willing to negotiate with you. Obviously, you'll still have to pay some money, but it may be worth it just to be rid of the issue. If you choose this path, make sure you get everything in writing.

  3. Start reaching out to lawyers. A lot of insurance coverage is case by case, and internet folk will not be equipped with the knowledge nor the expertise required to handle such specific cases.

As with any interaction with customer service, be polite and civil. This will make any customer service rep you talk to more willing to work with you. Good luck.

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