posted
Just found out my insurance is cancelling me,since I answered a few questions wrong. I did not disclose I had bodyaches,lower back pain and have been on Zoloft(which I get from south America),for social anxiety. I truely did not know I had Lyme.Now they are saying my IGG and IGM tests in 2002 and 2005,were both positive for the 23KDband and 41 IGG band. When I asked the dr's they said thats nothing you have to have 5 bands (CDC) crap. My LLMD does not take insurance,but I thought insurance would pay for some of the meds and my IV treatment. I am so upset today,now my daughter and I have no insurance. It seems easier to just call it quits! I suppose this is all for a reason.Life... Atheana
Posts: 196 | From from a far | Registered: Jan 2008
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Geneal
Frequent Contributor (5K+ posts)
Member # 10375
posted
If your doctor who did those old WB's didn't diagnose you,
I don't think the insurance company can...
Appeal.
Bettyg knows all about insurance issues and denial.
She is our expert.
Hopefully, she will be along to help.
Hugs,
Geneal
Posts: 6250 | From Louisiana | Registered: Oct 2006
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Athena...
I think you meant to say...
They only THINK they have cancelled your policy due to Lyme disease.
You will fight this. You have no other choice. You need to do it for your daughter and yourself... and many others who will be in the same boat if you let them walk all over you.
I would start by making a call to the FLorida Attorney general's office. Immediately. Ask for the Health Care Unit and tell them you want to file a complaint.
I would also write up a VERY brief summary of what happened... and keep it to send to them and to the FL Insurance Commissioner.
If you need help... let us know.
I think to appeal this you only have XX number of days.. so don't wait.
The fight won't be easy... but if you set your mind to it... you CAN win.
posted
...breaking this up for neuro lymies like me to be able to read and comprehend; betty
quote:Originally posted by atheana:
Just found out my insurance is cancelling me,since I answered a few questions wrong.
I did not disclose I had bodyaches, lower back pain and have been on Zoloft (which I get from south America), for social anxiety.
I truely did not know I had Lyme.
Now they [ATHENA, WHO IS THEY...HEALTH INSURANCE CO. OR WHO] are saying my IGG and IGM tests in 2002 and 2005, were both positive for the 23KDband and 41 IGG band.
When I asked the dr's they said thats nothing you have to have 5 bands (CDC) crap. ************************************
My LLMD does not take insurance, ******************************
but I thought insurance would pay for some of the meds and my IV treatment.
I am so upset today, now my daughter and I have no insurance.
It seems easier to just call it quits!
I suppose this is all for a reason.Life... Atheana
hi atheana,
do you have a LETTER THEY SENT YOU? scan this to send with your inquiries to florida insurance commissioner.
oh, you said you have NO COMPUTER EXPERTISE. do you have a older child, neighbor, or family member who can help you on this...hope so!
since you wrote me a pm, i hope what i was telling you in the PM you can follow on what I did above in order for folks like me to be able to read what you wrote ok.
we're here to help you IF we can able to comprehend/read posts.
personally, i've never run into INSURANCE CO. DROPPING YOU! so i suggest you take TINCUP's advise on calling attorney general's office, etc.
did your lyme literte md make you sign an OPTING OUT OF MEDICARE form .... meaning they will NOT submit bills to medicare.
Since MEDICARE ISN'T DENYING YOUR BILLS, they are NOT sending your health insurance a bill .... thereby, you can NOT submit a bill to them that medicare didn't pay !!!
are you getting social security disability insurance benefits AND MEDICARE? IF NOT, what i talked about in above sentences about OPTING OUT OF MEDICARE DOES NOT APPLY TO YOU!
i learned this the hard way of 20 months of fighting health insurance company and involving iowa's insurance commissioner.
you can send an email to florida's health insurance commission, here's their email page
Do you have a question about a insurance company not paying on a claim or reinbursing you?
If so you will need to fill out a complaint form on line at http://www.iid.state.fl.us DO NOT TRY THIS LINK; NOT WORKING; INCORRECT! betty
ABOVE LINK TO FLORIDA IS INCORRECT; i can't figure out what i did wrong!! HELP anyone!! I used what the iowa insurance commissioner's sent me back on their email and just changed 2 letters of state only! uffda.
to all others, to reach YOUR state's insurance commissioner's office, just change the 2 STATE ABBREVIATION to YOUR STATE'S 2 letter!
so I took mine of iowa, ia, AND REPLACED IT WITH FL for atheana. it should work, and look for CONTACT THEM on their home page.
i hope BUGG will stop by this post, and offer his expertise as well!!
DO NOT GIVE UP; we'll help you all we can ok! **********************************************
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Bettg,thanks so much for all the help you give to everyone!
Even when your ill. Posts: 196 | From from a far | Registered: Jan 2008
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Bugg
Frequent Contributor (1K+ posts)
Member # 8095
posted
Atheana--
I'm assuming you have an individual health insurance policy rather than one through your employer. In most states, although I don't know Florida law, your health insurance company has a right to "look back" (usually 2 years from the effective date of coverage) to see if you made a "material misstatement" in completing your application.
A "material misstatement" is really, ultimately, a matter of law. Many health insurance companies will try to find a reason to cancel your policy and will "twist your words" or omissions to suit their own purpose. You can fight it. They are hoping you don't!
If you choose to fight it, I would start by contacting a representing at the Florida Department of Health Insurance Regulatory Division (as was suggested by another poster above)to report your insurance carrier. Make notes from this call.
Don't SIGN ANYTHING FROM YOUR INSURANCE COMPANY AGREEING TO THE CANCELLATION or cash a check as "settlement" for the cancellation.
I would contact a healthcare attorney in your area who is experienced in dealing with bad faith claims in the health insurance industry. This attorney will help you review your medical records and your application and can fight the insurance company's claim of a "material misstatement". You may have a VERY GOOD CASE.
In fact, in some instances, just the insurance company learning that you are hiring an attorney and contacting the State Health Insurance Division is enough to get them to "change their minds." It really comes down to money for them....Is it worth the legal costs of trying to battle your attorney vs the cost of keeping you on as a beneficiary....
Also, of course, they are "slightly" concerned about their reputation in Floria as a bad-faith insurance company (really depends on the size of the company and how rigorous the State of Florida is about penalizing insurance companies...)
If you so choose and the facts of your case merit such a claim, you and your attorney can pursue an action for bad faith deanil of the claim or bad faith recission....
Make sure you keep meticuouls notes regarding conversations.....
The aforementioned, of course, isn't legal advice but just advice from a fellow lyme patient...
Take Care!!!!
Posts: 1155 | From Southeast | Registered: Oct 2005
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bettyg
Unregistered
posted
....atheana, you are most welcome.
i tracked down bugg; and sent him way.
WONDERFUL, detailed advise bugg; thanks a million for stopping by with words of wisdome!
print out this entire post so you don't lose it ... valuable info here!! good luck! ******************************************
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daise
Unregistered
posted
Hi Atheana,
It's hard. I don't know if anyone has mentioned another option: your state insurance commission board.
Some states' boards have an outside appeals process. Insurance companies really don't want you to contact these state boards. They really don't ...
States keep track of who calls to complain about an insurance company and which companies have been brought to a states' outside appeals process.
Somebody nationwide keeps track of these figures and it doesn't do the insurance company's sales department any good.
posted
Hi Guys, I hired a lawyer,but he feels I left to many things out about my medical history. I didn't disclose I had body pain,brain fog,was diag with fybro. My ex changed our insurance in Nov and told me to just put no to everything. And like a fool I did.
So now it's all out of pocket,bling,bling.
Atheana Posts: 196 | From from a far | Registered: Jan 2008
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