Insurance Question Help Needed!?
Posted on May 04, 2008 under Insurance Information |I had Weight loss Surgery. My primary insurance denied the surgery stating I diet. I did provide detail information about failed diets. My secondary Anthem approved. The insurance person in my Drs. office stated I'm good to go because I got the approval letter from Anthem. Now Anthem is making Cigna pay for everything and I'm afraid they aren't going to pay for the surgery. What should I do? I've already had the surgery so the bills are rolling in the house - BIG BILLS are coming and I don't have that kind of money.
May 4th, 2008 at 7:11 am
sue your second company for not providing the service they agreed to provide.
May 4th, 2008 at 7:11 am
Insurance has a term called "estoppel," where once they tell you they will give coverage or pay for something, they have to, even if it was a mistake. The only two conditions are that you didn't lie in the first place or facts come forward that they could not be aware of beforehand.
If you did not tell them that your primary Insurance carrier denied coverage, that may be part of it. Or they may only need proof of the denial to support the claim.
I would follow up with them and see exactly what is going on and what they are doing with your claim.
October 30th, 2011 at 10:48 am
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