Insurance denied my wife's disability

[Big Phil]

Well the bloodsucking leaches at "Trustmark" denied my wife's disability. My son was born 4 weeks 2 days early and they said since it wasn't an emergency c section they wouldn't cover it. We are going to file an appeal.

Anybody have experience with this?

 

[Sugar Land]

Sorry to hear that. Sucks big time. Perhaps a lawyer.

 

[hkusp1]

That sounds crappy.


Sent from a creepy ass cracka.

 

[cbigclarke]

That is crazy.

 

[matefrio]

Tejano Scott may chime in... he's keen on these things.

 

[Big Phil]

It sucks but luckily we have family close to help us out. God has always provided.

 

[cbigclarke]

It sucks but luckily we have family close to help us out. God has always provided.

And always will

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[Tejano Scott]

Request a copy of your policy immediately. Also request any benefits manual etc. that might lay out the appeal process. Request a copy of the denial in writing. Speak with agent (calmly) as to why the claim is denied. Contrary to popular belief, this is not the time to go shit balls crazy. I would not wait long to file an appeal. There is also a complaint process through Texas Department of Insurance. Get all the facts, etc. and request medical records now from your healthcare provider. You will probably want to consider consulting an attorney ASAP.

 

[Sugar Land]

He would know...

 

[ROGER4314]

After Hurricane IKE, I got jacked around so badly by my Homeowners Insurance, I'll never allow it to happen again. They also delayed the payment of my claim for 5 friggin' months. At the first HINT of insurance company BS, I will lawyer up from now on. They are not in business to help or protect you. You must look after your interests yourself.

Flash

 

[Texas42]

Your son doing ok? Why did they do the C-section so early?

Hope you get things straightened out.

 

[Big Phil]

He's fine. They didn't perform a C section that's why they're denying the claim. Thanks everybody, I will definitely get on that right away.

 

[Texas42]

Well most health insurance doesn't cover maternity, you have to get a maternity rider, it usually only covers basic stuff (above your deductible), but emergency stuff and big pregnancy stuff is really where your regular health insurance kicks in. Not unusual.

 

[vmax]

even if they had approved t, they will hound you every day for paperwork and threaten to cut you off.
They give you deadlines to get the same papers signed by your doctors, over and over and over.
Its all a plan to upset you and make you give up ....

I'm no being funny.. I'm serious.

 

[Big Phil]

Well most health insurance doesn't cover maternity, you have to get a maternity rider, it usually only covers basic stuff (above your deductible), but emergency stuff and big pregnancy stuff is really where your regular health insurance kicks in. Not unusual.

It's not through our health insurance provider, it's through her work.

 

[Tejano Scott]

Well most health insurance doesn't cover maternity, you have to get a maternity rider, it usually only covers basic stuff (above your deductible), but emergency stuff and big pregnancy stuff is really where your regular health insurance kicks in. Not unusual.

I was under the impression state law requires commercial health plans to cover first 30 days.

 

[Tejano Scott]

It's not through our health insurance provider, it's through her work.

Are they a self funded ERISA plan?

 

[Brains]

For self-insureds / individual policy holders, there's no maternity coverage in Texas. Your choices are group coverage (e.g. through an employer) or Medicaid if you quality. Texas allows insurance providers to opt-out of offering maternity coverage, so guess what - they all opted out. It stinks, but them's the breaks. Those of us who insist on doing things the right way end up paying through the nose. We're in the middle of this too - my choices were to pay $18,000/year for my work's family insurance plan premiums (plus deduct. plus 20% co-insurance), or pay who knows how much (can't get an answer on that up front, of course) for the prenatal care + delivery + after care completely out of pocket.

Also, as you would expect, anything the ins. co. can label as being pregnancy related will have their claims denied if you have an individual policy.

 

[Big Phil]

Update! Her bosses called the insurance company and they confirmed they would not pay. So her job stepped up and is paying her anyway! Thank God!

 

[cbigclarke]

Update! Her bosses called the insurance company and they confirmed they would not pay. So her job stepped up and is paying her anyway! Thank God!

God bless...but they are being bad actors, and still need to be punished

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