Although it sounds absolutely ridiculous, the very same health insurance company that you (or your family) pay for years and year to provide health coverage may, at the very moment that you need them, decide that they don’t really need to pay for the health needs of you and/or your family. Of course this is grossly unfair and an absolute disgrace but it happens quite often. At the time that I’m constructing this website, ‘Obamacare’ still exists but is getting quickly unraveled in the federal court system. Ultimately the US Supreme Court will have to render an opinion on the future of health care in America.
For now, if your health insurance company refuses to provide coverage for any reason outside of non-payment of your premiums, then your only remedy is to sue the insurance company in Court. The concept of filing a complaint with the NY Dep’t. of Health is not a bad idea, but it certainly does not bring any quick results, especially when your family’s health is hanging in the balance.
In the late 1990s, the brother of a good friend of mine had a medical emergency and was rushed to the hospital. At that time, the entire family including my friend and her brother had CIGNA health coverage. Upon being discharged from the hospital, my friend immediately forwarded all the hospital bills to CIGNA. After about 8 months, CIGNA mailed the family a letter that stated the following:
“After review, we have determined that you will not be responsible for charges occurred on _________________________ with _________________ Hospital. Although CIGNA Healthcare has denied charges for these services, the balance will not be your responsibility, as this is a contractual issue between the HealthPlan and the Provider.”
After receiving this letter, the family justifiably believed that this matter was behind them. But sure enough, a few years later this same hospital, who was represented by an ‘attack dog’ debt collection law firm, sued the family for the balance owed for the emergency room bill.
I had to file a “Third – Party Complaint” on behalf of the defendants (the parents of my friend and her brother) against CIGNA in order to compel them to provide payment to the plaintiff hospital. This case ended in Court with a settlement that had everybody smiling and feeling good. But the insurance company was absolutely to blame for this pathetic failure to pay the emergency bills right away. Once again it took a lawsuit for a huge commercial entity to take action.