HSA for America Personal Advisor Helps Client Fight Blue Cross and Win Healthshare

HSA for America Personal Advisor Helps Client Fight Blue Cross and Win

winHSA for America is committed to helping you save money on your health insurance, and we are equally committed to helping you receive the best possible care from the insurance company you choose. Our commitment to helping our clients in every way extends to helping them deal with their insurance company when problems arise after their purchase.

The Backstory

We recently had the opportunity to provide helpful advice to one of our current customers who ran into some issues with Blue Cross Blue Shield of Texas. When this client purchased a Blue Cross plan to replace the insurance policy he had carried for years, he purchased a high-deductible policy. He filled out his application, documenting the medical conditions for which he had been treated in the past as well as the conditions for which he was currently being treated. Blue Cross of Texas approved his application and provided a premium amount, which he paid on a monthly basis.

The Issue

The problems began to arise when Blue Cross began receiving claims for our client. Even though he had not yet met his deductible and the company had not paid out on any of the claims, Blue Cross decided that our client had not fully disclosed pertinent medical information. They said that the condition for which he was being treated would have been covered at a higher premium than he had been paying, and they requested he pay back premiums in the amount of nearly $2000. In addition to this, his premium was going to increase considerably.

When our client received notice of the decision made by Blue Cross, he was understandably very upset. Unsure about what steps he needed to take, he contacted Wiley Long, the president of our company, and explained the situation. Wiley in turn referred him to Fred Adams, our Chief Client Resolution Expert on staff.

The Solution

After Fred had reviewed the information provided by our client, he was able to offer some useful advice. The chance of Blue Cross reversing the decision was slim. However, Fred advised the client to provide documentation from his attending physician regarding whether or not his condition had been diagnosed and treated prior to his Blue Cross policy inception, as well as documentation supporting the client’s original disclosure of the condition. If the client could prove that his condition was not pre-existing and was in fact the result of a condition he fully disclosed on the application, there might be a chance.

Fred also provided the client with some options he had in case the company refused to reverse their decision to charge back premiums and increase his current premiums.

The Result

Recently, Fred received notice from the client that he had provided the documentation from his physician, and had sent a reply to both Blue Cross and the Department of Insurance.  Much to the surprise of everyone involved, Blue Cross reversed their previous decision. As a result, our client was able to continue his current coverage with no premium increase. He was also not charged any additional amount for coverage already provided.

Why This is Unusual

Health insurance companies are notorious for finding ways to avoid covering claims turned in on their customers’ behalf. They are also adept at discovering a variety of reasons for increasing the premiums for customers. Typically, once they have made a decision regarding whether or not a customer has disclosed the correct information, they are unwilling to bend.

Most of the time, people either do not know how to fight the company, or they are unwilling to put forth the effort to do so. Also, the majority of decisions made by health insurance companies are never reversed, no matter how arbitrary they may be. They like to hide behind technical and deliberately confusing wording in order to intimidate customers into thinking theirs is a lost cause.

In our client’s case, not only was he willing to do whatever footwork it took, he also knew that the Personal Advisors at HSA for America would be able to provide advice that would help him navigate the confusing waters of the insurance industry. Although it is extremely unusual for the reversal of a previously made decision to occur, in this case it did. Had our client attempted to fight this on his own, it very well may have gone the other way.

HSA for America Can Help

The health care industry, especially when it comes to insurance companies, changes on a daily basis. For this reason, it can be very difficult to fully comprehend what these changes mean and how they affect them on a personal level. At HSA for America, our staff keeps current with all of the health care regulations, and they can help with any aspect of your policy.

With luck, you will not run into the same issues that our client did. If you do, though, rest assured that HSA for America will do everything to help you. Remember, our services are entirely free, and there is no obligation for you to purchase anything. Please contact us at 866-323-1441 with any questions.

Author: Jim McFadden
I have been in the health insurance business for over 12 years. I’m passionate about Health Savings Accounts and enjoy blogging about them. I am also a husband and father of 2 beautiful children.
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