Legal Question in Insurance Law in New Jersey

I feel that my wife and I have been subject to a systematic and calculated effort by our insurance provider Magellan, for them not to reimburse us for out of network expenses.

I have a question concerning an ongoing fiasco I'm having trying to get reimbursment for out of network counseling. This has been going on since July, and every time I call the Magellan Network to see what's going on, I get some excuse, lost fax, or they didn't get the fax, or they can't read the Doctor's writing, or the Doctor's not in the system, and that I have to get all these forms filled out and fax them back to Magellan, which they loose, or say somebody else has them, but then it never surfaces or they aren't there when they went to get them. Then the 2 weeks is up, and they say they can't back date more than 2 weeks, so I'm have to appeal this, and on and on it goes. This has been happening since July.

I have valid insurance with Horizon BC/BS, and Magellan is responsible for the Mental Health aspect. The counselors I was seeing were not in Network, but Magellan said I have to provide them with a very complicated bit of paperwork for them even to consider repaying.

Is there anything a lawer could do? I'm betting they do this to a lot of people.

thnx!


Asked on 10/23/09, 1:54 pm

1 Answer from Attorneys
Robert Davies The Davies Law Firm, P.A.

I have now fought against health insurance companies three times, and it is tough. You can sue them for what they should have paid, but getting your lawyer's fees and punitive damages to punish them is very difficult!

you need a lawyer near you to take action. good luck to you.

Read more
Answered on 10/28/09, 2:04 pm


Related Questions & Answers

More Insurance Law questions and answers in New Jersey