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Re: What happens when travel insurance rejects your claim said by peterboro:I posted about the $80,000 bill for three days in the hospital for a relative last year who had private insurance.
Insurance denies as failure to disclose previous condition. Insured states no previous condition as x-ray at Ontario hospital says so.
X-ray technician misread x-ray. Insured hires lawyer who threatens to sue hospital (Ontario gov.) and insurance company.
Insured starts to challenge all the ridiculous charges from US hospital and gets bill down to $35,000.
Insurance company and OHIP eventually settle and pay the 35k.
That is an unusual situation and the insurance company probably went with what was provided to them. If you submit a report that says you have cancer to the insurance company and then you are denied cancer treatment because you didnt disclose, and then it turns out it was a misread blood test, then how is that the insurance fault? Blame the hospital and the Dr's who mis-diagnosed, the insurance had every right to deny coverage for misrepresentation.
In the real world, these do not happen that often, and when they do, they usually get settled after. Usually on misreps, if it quacks like a duck...
Was the 80K in a USA hospital? if so, seems about right. | | |
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peterboroAvatars are for posersPremium
join:2006-11-03
Peterborough, ON | said by OverrRyde: That is an unusual situation and the insurance company probably went with what was provided to them. If you submit a report that says you have cancer to the insurance company and then you are denied cancer treatment because you didnt disclose, and then it turns out it was a misread blood test, then how is that the insurance fault? Blame the hospital and the Dr's who mis-diagnosed, the insurance had every right to deny coverage for misrepresentation.
In the real world, these do not happen that often, and when they do, they usually get settled after. Usually on misreps, if it quacks like a duck...
Was the 80K in a USA hospital? if so, seems about right.
Yes US hospital. I wasn't involved in the case but the impression I got was that the dollar amount was low enough for them to settle out of court.
The interesting part was how fast the price dropped when the hospital thought they were not insured. When they got the bill for 80k they went over it with a fine tooth comb and with the help from a consultant in Florida challenged every procedure and fee. | |
| said by peterboro:said by OverrRyde: That is an unusual situation and the insurance company probably went with what was provided to them. If you submit a report that says you have cancer to the insurance company and then you are denied cancer treatment because you didnt disclose, and then it turns out it was a misread blood test, then how is that the insurance fault? Blame the hospital and the Dr's who mis-diagnosed, the insurance had every right to deny coverage for misrepresentation.
In the real world, these do not happen that often, and when they do, they usually get settled after. Usually on misreps, if it quacks like a duck...
Was the 80K in a USA hospital? if so, seems about right.
Yes US hospital. I wasn't involved in the case but the impression I got was that the dollar amount was low enough for them to settle out of court. The interesting part was how fast the price dropped when the hospital thought they were not insured. When they got the bill for 80k they went over it with a fine tooth comb and with the help from a consultant in Florida challenged every procedure and fee. Oh yeah, common practice! As soon as they see the patient has insurance, the bill is easily 2-3 times inflated.
What happens when they lower the cost after either a denial or a self-pay patient is that they rather get something than nothing at all.
This has started with other tourist area too, Dominican, Mexico and other are doing the same, i think it's worse there! | |
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