Pre existing conditions

My mother visited here for a period of 3 months and we covered her with insurance from "India Network Foundation". She arrived here on 9th june. On 22nd june she complained of problem in discharging her fluid in the rest room. We consulted some doctors here. They checked her fluid bladder etc. and did not find any problem. Then in ultrasound they saw some unwanted cells which may be causing the problem. They did out patient surgery to remove that. It helped my mother and she is well now. But Insurance companys EOB shows that it is not covered and are not paying anything. They said they donot cover for pre existing conditions. No body knew the problem until the doctor here found that. If insurance does not help I will have to pay 12000 dollars from my pocket. Your suggestions are appreciated.

This is always a tricky and a catchy subject. As in some circumstances , a condition which is not really known to the person can be considered as Pre-existing condition like what seems to happen in your case.
Because if Insurance company asks the Dr. He/She will always say in the report that conditions were pre-exist and not over nightly appeared. But actually the fact is that the patient was unaware of it.
Now when it comes to claim Insurance companies always try to Save there end by going with their PLAN guidelines and Dr report.
Now the Question is How to prove it that, it was not a pre-exisition ? Tough but I would like to encourage you to fight for it.
Here is what you should do :

#1. Talk to the hospital and if possible meet the hospital account dept. supervisor explain the situation , tell them you are working on it and borrow some time ,and request them to not to give your case to “Collection agency” so that you are not troubled by those people by Telephone and making your life miserable.

#1. Talk to the Agent/Agency from whom you bout it, and see if they can suggest you any solution. They might be a good help as they are experienced in such kind of cases and knowing is there nay solution or work around.
On the other hand They may not be big help as Agent is jus a Agent and financial Claims are normally controlled by the actual company.

#2. Talk to the Company and try to explain them in polite manner. Remember never ever try to fight or raise your voice at very first time, as the people handling phone calls are not always good to take it coolly.
Ask them what the ways to “Appeal” it . I guess there is possibility where you can appeal in writing.
#4. Complain it to BBS and see they can be help. Most of time they do.

Good luck !
And final words …
Important , PLEASE come back to this forum and put your experience here for others to take advantage.

Thanks
Raj

[sudhagark]

What is BBS means?

[suresh]

I think he meant BBB, which means Better Business Bureau. They are a non profit organisation who help negotiate problems.