General Question

chelle21689's avatar

What would you do if you were told you have coverage but then they change their mind?

Asked by chelle21689 (7907points) September 24th, 2013

Before I had taken this job I needed financial aid assistance for my medical check ups trying to find out what was wrong with me. So I have assistance from the government. My doctor ordered me to wear a holter monitor for my heart which was a pain in the butt and useless.

Anyways, I was told by the financial aid company they would cover it and just to send the heart company (ecardio) the reward letter and it’ll be taken care of.

Fast forward 2 months later I get a bill yesterday that says I owe a whopping $500 for wearing a stupid heart monitor! I was so angry.

I called them and now the financial aid company says “Well your doctor just requested a part which isn’t associated with us so we can’t cover it” even though a couple months ago I was even given instructions!

I have no written statement so I guess I have no proof. =\ I’m not sure what to do here. I’m just so mad they said they would cover it and then don’t!

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16 Answers

Katniss's avatar

Damn. I’d be raising some hell. That is a lot of money.
I’m not sure there is much you can do without some kind of proof, but I’d certainly give it a try.
Put on your bitch pants and tell them how it is.

Good luck!!

chelle21689's avatar

I know right..I wanna know what I can do to prevent this issue.. they have a low payment plan like $5/month lol no interest but STILL!

zander101's avatar

Situations like that always have two sides to each story, sometimes the agents that you speak on the phone with will tell you anything based on what they are experiencing that day i.e. maybe calls were high that day, they had a run-in with their supervisor etc. I know what was mentioned has nothing to do with you further more that should not excuse them as they should have did their due diligence pertaining to the matter and should have not given out the wrong information. Another side to this is possibly the agent was right and based on the file you were eligible, but your company may have ran some figures based on their financial audits and decided that they were no longer going to cover that aspect of the program. Best way to handle this is to look at the policy you are covered under, call them and let them know you were not notified that any changes to the plan that should scare them cause they will realize that they were wrong. Stand your ground on this issue and let them know how you feel.

chelle21689's avatar

I demanded to talk to a supervisor lol. I know I sounded mean but that’s the only way she would’ve connected me. I am still waiting for them to call….I guess I’ll do what I can do to have me not pay but if I have to then I will unhappilly do it.

Next time to avoid this, should I get a written statement from the company sent to me whether something is covered or not so that I can use it against them one day if it were to happen again???

zander101's avatar

Well, this could possibly rear it’s head for anything i.e. car payments, house lease etc. Always document, take names, write down times, read contracts, ask questions do anything to cover your basis. Sometimes when you talk to customer services reps on the phone they are not trained on all company protocol and procedures or frankly they don’t care it’s a job to pay the bills….don’t be too hard on yourself….take this as a learning experience.

Katniss's avatar

Good advice from @zander101.

I really hope they resolve this issue for you!

chelle21689's avatar

Thanks guys. Lesson learned :’[

YARNLADY's avatar

Be sure to put all this in writing and send it to every one who is involved, the doctor, and the company who should be paying the bill.

tedibear's avatar

I’m about to go through this with my dental insurance. They’re claiming that they won’t pay for my last procedure because it wasn’t done on a tooth with a root canal. Um, yes it was. Just because they didn’t pay for the root canal doesn’t mean it’s not there. (It was done before I had this insurance.) And the letter I got says that their decision is final. We’ll see what they say tomorrow when I call to tell them that my dentist can send them a copy of the x-ray.

I do hope that you can get your insurance to ante up!

dabbler's avatar

Was the coverage mentioned in the job offer letter?

Supacase's avatar

Ask the supervisor if the call was recorded. The insurance company I work for will eat the cost if one of the reps clearly gave incorrect information.

@tedibear I work in dental insurance, actually. Approvals and denials are based on information submitted with the claim, history on record and the details of your insurance policy. Appeals based on additional information happen all the time and are typically approved for this type of situation. It gets frustrating (on both ends) but try to be patient because it sounds like this will just require a correction/adjustment to reverse the denial. You would not believe the crazy things people call to complain about. That is the reason for the strong wording – don’t be bothered by it. Good luck!

tedibear's avatar

@Supacase Thanks. I know they don’t know, it was (as you pointed out) the wording that bothered me. I guess I wonder why they couldn’t just ask if the tooth had a root canal before they sent out a denial. Would have cost the same in postage. I didn’t find time to call, but will try today.

@chelle21689 – Let us know what happens!

chelle21689's avatar

I would tell them to check the recording but honestly I have no idea when this was. Some time in July I believe or end of June.

And it’s not particularly insurance it’s more so government assistance I have until October

chelle21689's avatar

And honestly at this point I doubt I will hear from the supervisor because I haven’t been contacted

chelle21689's avatar

So I called back and no one will let me talk to a supervisor.

And I even talked to the lady who did admit June 17 I called about it and she even told me that I should check with ecardio to see if they accept the heap which ecardio said they would!

Idk how to get to a supervisor if they won’t let me! This one lady was down right rude to me, the others tried to help but she was a biatch.

chelle21689's avatar

Talked to the supervisor and they won’t pay. I feel like even though the rep said something else he twisted it around to cover her butt.

I guess I’ll pay through the payment plan :(

I lost this battle. He even told me writing won’t help if someone told me wrong info

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