health insurance claim rejected

[Lizard]

My 80 y.o. mum had a procedure carried out in hospital last Jan. She received a letter from the hospital recently informing her that her claim was rejected by the insurance co., and she was subsequently billed for 1,500 euros! She contacted her insurer and they told her that the consultant in the hospital could not be contacted, or else refused to respond to the insurer with regard to her claim, so her claim could not be processed. She pays heavily out of her pension for her health insurance. This has never happened to her before. Why would a consultant refuse to speak to a patient's insurer? And how should she proceed? Thanks.

 

[truthseeker]

My 80 y.o. mum had a procedure carried out in hospital last Jan. She received a letter from the hospital recently informing her that her claim was rejected by the insurance co., and she was subsequently billed for 1,500 euros! She contacted her insurer and they told her that the consultant in the hospital could not be contacted, or else refused to respond to the insurer with regard to her claim, so her claim could not be processed. She pays heavily out of her pension for her health insurance. This has never happened to her before. Why would a consultant refuse to speak to a patient's insurer? And how should she proceed? Thanks.

Tell her to contact the consultants secretary and ask why they are not responding to the insurer.

Presumably the insurance company was contacted prior to the procedure to check was it covered and they would have checked the consultant was registered with them and that the particular procedure was part of her cover? (They made me do this for a recent procedure anyway).

So if thats the case, then the procedure is covered and its up to the consultants secretary or whoever looks after his paperwork to fill it out.

I also had the same scenario happen with the procedure I had, but it so happened they had written to him on his 2 week holiday - which his secretary also takes at the same time, so no one had addressed the paperwork.

Really I think its disgraceful how much running around the insurers expect the individual to be doing these days!

 

[Lizard]

Ok thank you for that. I asked her if she was sure she was covered, and she said she was told at the hospital that if she had health insurance that she might as well use it as she would get it done quicker. I dont think they checked if she was covered or not. Maybe that's up to the patient? But at 200 euros a month you would imagine she would be covered for quite alot. Good idea to contact the secretary. Thanks again truthseeker!

 

[truthseeker]

Ok thank you for that. I asked her if she was sure she was covered, and she said she was told at the hospital that if she had health insurance that she might as well use it as she would get it done quicker. I dont think they checked if she was covered or not. Maybe that's up to the patient? But at 200 euros a month you would imagine she would be covered for quite alot. Good idea to contact the secretary. Thanks again truthseeker!

A lot of the time they know by the name of the plan whats covered. I didnt know which plan I had so that could be why I had to check myself. Although my FIL has had to check himself as well - could be due to plans changing etc...

Yeah, they secretary is the best person to contact.