Legal Question in Insurance Law in California

My insurance company through the federal government (Blue Cross Blue Shield Federal of Van Nuys, CA) withdrew payment from a hospital that was 30 months old and that had been paid nearly 2 years ago. This claim was for a medical procedure for one of my step children. BCBS stated they NOW were not responsible as primary insurance carrier because they had made a mistake in determining their position with respect to my step children's father's insurance company. BCBS has taken position as secondary insurance with respect to step children. The biological father's insurance company cannot pay this bill now because PEHP Insurance Company of Utah does not retroactively pay claims older than 24 months, but they have agreed to take over the position of primary insurance for new claims since Jan 2010. The hospital is sending me to collections because they want paid for this old debt of $5554.40. I had double insurance on my step kids at the time of the claim, and I provided BCBS all the information needed to determine their positions, but they made the supposed "mistake" of accepting their position as primary insurance in August 2007. Now neither companies will accept the responsibility for this claim, and my credit is about to be damaged. I have filed a formal complaint with the federal government's benefits center, but they have informed me that they cannot do anything about this and recommended that I consult legal services. Do I have a valid case to sue for this claim plus damages? My wife and I have been fighting with BCBS for over a year now and we are fed up!


Asked on 1/04/11, 7:50 pm

1 Answer from Attorneys
Herb Fox Law Office of Herb Fox

You may have a claim against the carrier for bad faith denial of coverage, which could entitle you to consequential damages (emotional distress, damages for loss of credit rating, out of pocket expenses) in addition to the amount of the hospital bill itself. An attorney would need to see the documentation of the dispute and a chronology of your dealings with Blue Cross/Blue Shield, as well as a copy of the policy itself. You should consult with an attorney who handles bad faith claims immediately, however, as your time to sue may run out soon, if it has not already, Feel free to call my office for further information.

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Answered on 1/09/11, 8:20 pm


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