Complaint / review text:
This company has come up with every excuse to not pay every claim submitted.
Both of my doctors have provided necessary forms requested by insurance company on prior treatment.insurance company keeps telling me that codes have flagged my case as potential pre-existing. Every time I call the insurance company I get a different reason why the claims have been denied or closed.
I am being told they are investigating for pre-existing conditions and have sent me forms to have filled out by the lady that read the blood work results at the lab and the radiologist that read the report at the medical facility asking for treatment information even though these are not treating physicians and their form clearly states if you are a diagnostic provider and/or radiologist disregard this form.
They have also noted on all EOB's services not covered under plan and unable to process. The letters from the insurance company state that the claim has been closed and/or denied as well.
I called in to the insurance company to advise them of my intent to appeal each and every claim they have denied and was told that there was nothing to appeal since they are still investigating; however, all paperwork shows denied/claim closed. I believe they are trying to ride out the time limit to file an appeal.
They have even gone as far as to claim pre-existing conditions and not pay a claim on a bladder infection 3 months after effective date of insurance. The claim representative had the nerve to tell me that they could not process the claim until they determined what caused the bladder infection and verification that it was not a pre-existing condition.
Right now they have not paid any money on one single claim out of 11 claims submitted.