Question:
Can insurance companies change their mind about paying?

My insurance co. is saying they will not pay for the surgery I had last Dec.IMy surgery was approved by my insurance Co. I has surgery DEc 27, 2001. Now they are telling me they will not pay. Can they change thier minds after the surgery is done??I don't know what to do next to fight this. I need help.    — linda P. (posted on December 27, 2002)

December 26, 2002
If you or your surgeon has a letter of approval stating they will cover, and your contract you had did not have any exclusions I would say they should cover. Check out those areas then take it to the Department of Insurance in your state. File a complaint with the DOI and they will get it paid. Good Luck.
   — Jeana S.

December 26, 2002
Dig out your approval letter and kindly mail it to them. I can't believe they haven't paid your bill yet. No wonder doctors are requiring people to put down deposits up front. One year to process and pay is ridiculous in my opinion. God Luck!
   — zoedogcbr

December 26, 2002
Yes, yes, yes! Jeana is right! Go right to the State, they love this stuff! I did just that in NJ and, although it might take a while, so far I've been reimbursed for a dexascan, which was supposed to be a covered procedure, and I also expect more good news in the mail (I hope). :)) I simply called the NJ Dept. of Banking & Insurance, told the guy the problems I was having with Oxford, and he just said, "We'll take care of it for you." What sweet words! LOL Good luck!
   — Leslie F.

December 26, 2002
I work for a Managed Care Organization and see this kinda thing all the time. Let me first tell you that as long as your premiums have been paid and you have an approval letter from your insurance company then you have nothing to worry about. Take your approval letter and your insurance companies denial to pay letter to your states department of insurance and they will take care of it for you. That's what they are there for.
   — Annette S.

December 27, 2002
I work in insurance and have also seen this happen many of times.. make sure you keep the hard copy of the approval letter that you recieved from them. As long as you got your authorization first and the surgery was done by that dr. on the auth, and done at the hospital it was suppose to be done at, then they have to pay for it. Most importantly if your dr. is a contracted dr. with the insurance co. then it is his responsibility to take up the financial matters, you have done your part by paying your premium and getting all of your preop testing and authorization. That is the only thing that you are responsible for. Did the insurance say why they have decided to not pay now?
   — lisar02169