Can they change the certificate of insurance after the fact??

What the Hey????

My doctor's office called the insurance company to get clarification on an exclusion that said:

"This exclusion does not apply to conditions including but not limited to: myocardial infarction; excessive nausea/vomiting; pneumonia; and exacerbation of co-morbid conditions."

They told the doctor's office that it was an all inclusive exclusion to cover all bariatric surgeries and that the certificate was worded incorrectly. But they told me to go ahead with the process so they could deny it and I could appeal the decision.

I went unto the web site for my certificate of coverage and now it says: ......exacerbation of c-morbid conditions during the procedure or in the immediate post operative time frame.

They all of a sudden changed it. Can they do that? I printed off my copy of the certificate on june 10, 2009.  Now today it says effective 6/01/09 but I have a different certificate. HELP!!!!!

I don't think so...you might check with www.obesitylaw.com. Good luck!
Holly

I'd be on the phone and faxing someone!  I hope it turns out to be their mistake and you move forward with this process!  Good Luck!

 

Vera-Ellen  

Oddly... I've seen a post alike yours = so I guess it does happen you being the 2nd one I've seen with this issue.  Certainly, appeal with your original letter.   And you might want to contact your State's Department of Insurance to get them involved should you run into a road block.

Best...