Question:
insurance denial my claims after having surgery

blue shields approve my surgery on 9-15-03. 4 days after surgery i received a certified letter stating my ins. will be cancell as of 10-1-03 due to false info. on my original application from 8-02. need to know what to do they are refusing all medical bills total around $40,000.00.    — edith B. (posted on November 1, 2003)

November 1, 2003
Gosh, I don't have an answer, but what type of false information are they talking about? I would be frantic. Hope all goes well for you.
   — D. K.

November 1, 2003
Wow, what a spot. Firstly I'd be worried they may try to recoup their expenses for the 1+ year they've been covering you since they are saying that the insurance was obtained by fraud like means. (read here: get lawyer). Otherwise I'd deal with this just like they canceled you for any other reason. Since they gave you an actual cancellation date to me that implies that they are acknowledging that you have coverage through that date and thus they would still be responsible for the surgery which they already committed to by issuing you the approval for your surgery. I think I'd be getting a lawyer's take on this though, especially considering the amounts at stake here. Good luck!
   — Shelly S.

November 1, 2003
That is not right for your Ins. company to now want to cancel you. I don't know what state you are in but if i was you i would write a letter (and have it certifed) to your state Insurance's Commissioner about your case. Keep a copy of your letter for yourself and if you do not get the answer you need. Take your letter and theone from the Commissioner to your lawyer. Hope this help I know it's hard but try not to let this bother you cause your body needs to be healing right now take care Janet
   — JANET C.

November 1, 2003
I'm assuming this is not a group policy. I'm guessing this will all come down to what the false info was. If it was directly related to weight then your denial of payment may actually be upheld. However, even if everything had been disclosed, you had the policy for 13 months before you had WLS. Normally there is only a pre-existing conditions clause for 6 months, so even if you had reveled everything you would have been fine. But the problem here is fraud which is a legally chargeable offense. I hope things work out for you but if not it will be a huge lesson learned. Most things people lie about come back to bite them in the ass.
   — zoedogcbr

November 1, 2003
Edith - you MUST hire an attorney ASAP. Insurance fraud is a very serious offense and you need someone to investigate this charge and defend you. If found to be true, they can go after you for ALL medical payments paid for you and your famiy's since the inception of the policy. It can also hinder you from getting insurance in the future.
   — Cyndie K.

November 2, 2003
Hi, sorry to hear about your troubles. Not sure if it will help, but check out www.obesitylawyer.com if they can't help you make sure you find a lawyer who deals with obesity and insurance companies on a regular basis. Looks like they are just trying to back out of paying those medical bills. Fight it!! Good luck!! ((hugs))
   — [Deactivated Member]

November 2, 2003
You need to first find out what the problem is with the insurance company. There is not enough info here to hire an attorney or go forward. Make sure you talk to a supervisor and get the name/# for consistancy. Good Luck
   — ZZ S.

November 2, 2003
Did you have false information on your application? I know when I filled out my insurance application it stated that if they discovered any information to be false in the first 2 years they had the right to cancel the policy. Sounds like you had a similar clause. I think the first thing you need to do it to find out what information you gave them they claim is false.
   — Patricia T.

Click Here to Return