Legal Question in Insurance Law in Missouri

Insurance company refuses to pay bill, but doctor said they would!

Visited ENT specialist 3 months ago for

Difficulty breathing due to growth in nostrils and deviated septum; Continuous drainage at back of throat; Periodic sour throat,infections,blocked nose; Wheezing/whistling

Diagnosis

A growth in nose; Deviated nasal septum; Drainage at the back of throat

My insurance policy excludes Treatment where no Injury or Sickness is involved/Elective Surgery

Doctor said that, Treatment was 'Required' (not elective), hence insurance company must pay. He said he would forward a letter to insurance company to explain the situation if required. Treatment included �septoplasty�, 'turbinatrophy' (removing the growth)

I am now confused. I have to pay $2000 to my doctor, $750 to my anesthetist, $3500 to the hospital. I never anticipated a bill amounting $6250

I am a student with no job (1 more year at school). I can�t afford so much. Even with family support, I can only pay part of the bill

Is this all my fault? Am I legally doomed to pay the bill? Whom should I approach for help? Can the legal system help me out?

I can forward my full insurance coverage information to anyone willing to help me out

Please help


Asked on 11/20/01, 9:25 pm

1 Answer from Attorneys
Michael R. Nack Michael R. Nack, Attorney at Law

Re: Insurance company refuses to pay bill, but doctor said they would!

This may indeed be a problem that I could help you staighten out, but there would certainly be no guarantees. I would require a small retainer fee to hire me and I would apply it against time spent on your problem. I would need to review the actual health insurance policy itself. I would determine what claims have been submitted by the health care providers and how those claims were responded to by your health insurance carrier. I may need you to sign medical authorization forms so that I can obtain copies of the medical records themselves if I need to use them in efforts to convince the insurance company to pay the bills. If you are entitled to coverage (and payment) and the insurance company still refuses, then you would be entitled to file a lawsuit against the insurance company both for payment of the bills and for money damges for their "vexatious refusal" to pay. If we would ever get to that point, we would certainly need to enter into some agreement regarding payment of attorney's fees, but I would probably consider a contingency fee agreement at that point. If you would like to discuss this further, please call me for a free telephone consultation at 314-727-2822. Thank you.

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Answered on 11/21/01, 10:05 pm


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