A bacterial infection is not a long term illness. She may have to hire a lawyer to get the insurance company to pay.
That sounds illegal under Obamacare
If you fight them and win you can write a letter to Obama thanking him :)
Obama said they wont fine companies for doing this to you for existing policies but it seems like you can sue because its against the law now. Consult with a lawyer.
I suspect she’s not telling you something. The timing sounds awfully coincidental.
I would definitely advise her to speak with a good attorney who specializes in this sort of thing. Depending on the facts of her case, the attorney may be willing to take the case on a contingency basis -- which means your friend wouldn't have to pay the legal fees out of her own pocket.
If she meet in person with an agent, who did not disclose that the issues might be excluded, she might be able to sue by going after the agent and insurance company.
If nothing else, and regardless of the above 2 considerations, she should call to the insurance commissioner's office for her state, and tell them her situation, ask if they have any advice or recommendations.
Another thing she might look into, is to try to establish that the e-coli infection was NOT caused by the prior female health issues. Possibly she could contact ? the county health department or some germ-specialists at a local university to ask about what would be needed to follow such a path.
How did she reveal the information of her past history? Is it in writing?
I’m not in the health insurance business, so I don’t know if the health contract might include any disclaimers for pre-existing conditions, even those disclosed.
Wait until the company gives the reasons in writing.
Even though it seems like your sister should be completely covered, it looks like it’s going to take an attorney writing a threatening letter at minimum. Chose someone who specializes in health insurance related issues.
A legal consultation is in order. But it generally takes $5,000 down and $500/hour to operate the legal system. Insurance companies know this so it’s easy to deny a large claim and not risk a suit. She should start by enquiring of everybody medical she knows what options might be available. Start by plugging this into Google. “Humana denying claims.” That generated a LOT of hits and articles.
Good luck to her.
Appeal it. And do it quick. If her policy was like mine, you have only a short time period in which to appeal. Get a lawyer and arrange a meeting with them. In my case they were bluffing, and payed the day before the scheduled meeting. Good luck.
Not knowing anything else about it I would say to first follow the policy proscribed appeal process. Just in my 13 person office myself and two others have had insurance denials that were later approved without any lawyers involved. I believe the ins. companies are quick to deny claims becuase it doesn’t cost them anything to string you along but if you have a legit case they will pay in the end.
All I can tell you is what worked for hubby. After being denied denied denied his doctor personally called the insurance company and talked to someone higher up in the chain and told them........when mr. sheana sues you, which he is going to, I will be on the stand and testify for him. Approve approve approve. Within a couple of days.
She developed vomiting 24 hours before her insurance policy started? They could be denying it because it was a preexisiting condition- it started a day before her insurance was in effect. She needs an attorney to review this case, if she cannot afford it, ask the insurance commissioner in her state to look at the issue.
From your description it is certain she contracted the infection before the policy went into effect, unfortunately.
I think the problem they’re having is with the reason a hysterectomy was performed if the admitting diagnosis was a bacterial infection inside the gut. That’s something for the doctor to explain to insurance in the appeal. They’re seeing it as someone getting rear ended and claiming to need a new headlight.