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Ameriben solutions Complaint - health insurance denial of claims
Complaint
WASHINGTON -- My 10 yr old son has a seizure disorder and has recently begun to have nocturnal seizures.As research shows , 1/3 of all people with seizure disorders have some form of sleep apnea.His neurologist sent him to have a sleep apnea test done and it did come back negetive.Now our insurance has denied the claims for about $3000.00 . They are telling us that its not a covered benefit.The doctor faed the insurance company some records showing that my son had a DIAGNOSTIC test done and that he has never been TREATED for sleep apnea.Here is what my benefit book states......Pg.24 , Treatment of or related to sleep disorders , except as specified under covered medical equipment and supplies.......Pg (Covered services) diagnostic , x-ray and lab services.They have sent these claims to their review department and they still deny them. The bills now have late fees and collection charges not to mention they are affecting my credit now.
To help keep me as a potential future customer, I would like the following:
I would like the insurance company to pay the claims , the late fees , the collection charges and right a letter accepting responsibility for the collections to help me get it off of my credit report.I think I am also due some kind of compansation for my time spent making the phone calls (sitting on hold for endless periods of time and arguing my case) and my stess not knowing how to pay these bills so the neurologist will keep treating my son for his regular needed visits.
At the very least I would like a response from your company regarding this incident. Thank you for your time.
To help keep me as a potential future customer, I would like the following:
I would like the insurance company to pay the claims , the late fees , the collection charges and right a letter accepting responsibility for the collections to help me get it off of my credit report.I think I am also due some kind of compansation for my time spent making the phone calls (sitting on hold for endless periods of time and arguing my case) and my stess not knowing how to pay these bills so the neurologist will keep treating my son for his regular needed visits.
At the very least I would like a response from your company regarding this incident. Thank you for your time.
Comments:
Posted by Anonymous on 2002-02-27:
You do not have an insurance company. Your employer is self-funding the benefit. AmeriBen Solutions is not denying your claim, your SPD is. AmeriBen CANNOT create an exception, only your employer can.
Posted by Anonymous on 2002-03-15:
I also cotacted the employer and was told that it needed to be worked out with ameriben. after 3 appeals it went to the employer who also denies it.the company(employer)has been sold to a larger company and they are still denying it and have not even provided us with any benefit books.because of the size of this company , I really didnt expect them to do things the way they are.
Posted by HaroldSays on 2006-10-29:
I would like to know more about your situation as I encountered a similar problem and I was able to get it resolved positively and satisfactorily for the person. If you are legally entitled to the benefit then you should receive it. Do not let them get away with this. Another thing, you must be certain that your doctor wrote the right Insurance Payment Code for his billing. If he did not bill it properly, the company will not pay the claim either. If I can help you further, let me know. Harold, HaroldSays.
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