What can I do regarding a delayed and denied claim?
Question Details: I had health insurance and I went through preventive service, a colonoscopy, but my plan delayed the payment by saying they were investigating if I had pre-existing condition or not. Then they told to facility that they denied payment. The facility billed charges to me and is now threatening to send to it to collection if not paid.
1) If you believe that under the terms of your health insurance plan, which is a contract, that they should have paid, you could sue the insurer for "breach of contract." If you can establish in court that they should have paid, the court can order them to pay youl.
2) But pending the outcome of the above litigation, if you choose to sue, you still have to pay the facility: the patient is always ultimately responsible for medical bills, even when his/her insurer should have paid but did not. If you don't pay them, they can send you to collections. You need to pay them, then seek the money back from your insurer.