Tuesday, December 4, 2012

Denial Letters Without Using Facts

Earlier this year I posted a blog with a denial letter I received stating I was denied coverage, because.

No, I didn't forget to finish the above sentence. The denial letter I received said I was denied coverage "because." No further explanation.

It turned out the reason I received the denial was because of an inter-insurance-company problem having nothing to do with me. So when the insurance company didn't pay my claim, they had no reason for why it was denied, and therefore left the section blank. Leaving me to panic, call them, and wait until they cleared up their error and pay the invoice prior to me ending up in collections for something that should have been covered through insurance.

Ready for something to top not giving a reason for a denial.....

Drum Roll Please.....

Yesterday, the insurance policy I have held since I had to stop working due to my arteriovenous malformation and chronic myelogenous leukemia sent me a letter listing off several reasons why they have decided to stop honoring their obligation to my claim. They included not hearing back from my doctor (although my doctors name was spelled completely incorrectly and I can only wonder if she even received the documents she was asked to fill out). Partial information from a report done by a doctor who in a video taped interview stated he did not treat either condition I have. Video taped surveillance showing me go into a local business for 3 hours (without mentioning it was a dental office)...And the piece de resistance....

 because my oncologist informed the company that I was in complete remission from AML.

You can imagine my relief to hear I was in complete remission from a condition I was never diagnosed with.

Here's the portion of the letter:

Yes, this denial letter stooped so low as to deny my claim using completely false information.

AML is Acute Myeloid Leukemia. It is a really terrible blood cancer that is difficult to control. I have known two young adults who have battled this disease. One survived it and one did not.  AML is treated with aggressive traditional chemotherapy and often a bone marrow transplant.

I have Chronic Myelogenous Leukemia-- a completely separate condition that currently has no proven "cure" outside of a bone marrow transplant. Fortunately for me, as long as I take a daily chemotherapy pill my chronic leukemia is kept at bay in the body. It is not a traditional "remission" as suggested by this letter. It is a conditional cytogenetic response to a daily chemotherapy drug.

I sent in the appeal letter today correcting their misinformation and requesting my policy to be reinstated. Should this company deny the claim a second time my only recourse is to hire an attorney.

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