Help- Insurance experts (med claims)!!

[susy]

Hi1
On Nov 26 my son went for his check up and immunizations, which his school gave me a deadline for (he was 5 on nov30).


So, just got a letter from our ins co. denying the claim . The reason is" Well child care of $1000 lifetime exhausted".

The letter says I can appeal . I will , based on the fact that I never received notice stating that I exhausted my benefits. Why did they wait until we went to the doctor? It's too late now for me to "not go".

 

[susy]

I now see that I posted this on the UK board.
Moderators- help! Can you move this for me?

 

[Terry&Janet]

Oooerr !

Thank goodness for our National Health Service !

Please dont move this thread, this should serve as a reminder to us Brits that we should appreciate our National Health service more.

The alternative is not inviting.

 

[Mskanga]

You can say that again Terry, medical coverage here in the US is VERY expensive and everytime you get less coverage. You can't get sick here!

 

[WDWfan uk]

..... sorry to be late moving this Susy ...... your wish is my command

 

[becka]

I may be wrong but I don't think the ins. co. is under any obligation to let you know that you have reached your lifetime benefit for a particular coverage. They expect you to keep track of your benefit usage. You can certainly appeal but I would say your chances of winning the appeal are 0 unless they state somewhere that they will let you know when you have exhausted a benefit.

They waited until after you went to the doctor because they didn't know about the claim until after it was filed. I am a little confused about why you think this is a problem. Ins. cos. cannot predetermine when you are going to file a claim. I can only assume this goes back to you expecting to get a letter letting you know that your well child care benefit had been exhausted.

 

[Briar Rose 7457]

exactly. it's not their obligation to predetermine if you're going to file a claim, it's your obligation to keep track of your benefits.

 

[jfulcer]

what becka said.

 

[TheLionKing]

Medical care is not free.

Someone is always paying whether it is the government (which is really us taxpayers), the employers (which we really pay for when we buy their products) or self employed people.

I understand how you felt surprised that you had reached a limit. It is difficult reading all the fine print and restrictions.

Since the vaccinations were mandated, you probably would have gotten them anyways, whether it was covered by your insurance or not.

If you want higher well child coverage, then you you will probably have to spend more out of pocket for a better coverage policy.

So, you will be paying something in either case.

 

[Toby'sFriend]

Does your state or county offer any kind of immunization program?

I know that in Illinois there is a program that anybody can use to get immunizations at a very low cost if their insurance does not cover them.

 

[TheLionKing]

Good thought TF...

That would be definitely something to look into.....