Health insurance rescinded due to alleged material misrepresentation(there wasn't any). What should I do?

Question

I have a long history of migraines and on my application I submitted that history and the medication used for treatment. I then had no less that three phone interviews regarding the migraines. We agreed to an exclusion of benefits for migraine treatment AND a higher premium. BCBS of Texas is now trying to rescind my policy based on my migraine history. This is following a claim submitted for an emergency 1 night admission to an out of state hosipital while travelling. I have submitted an appeal to the company and they are saying it takes 30 days to process. My husband's policy will be rescinded on March 26th unless he signs an ammendment of his enrollment which essentially agrees to rescind my policy and delete me. We haven't signed the paper because that would basically be giving them permission to saddle us with what my rough estimate would be 60-90 thousand dollars (since Sept 07). I'm in the process of submitting a complaint with the Texas Department of Insurance. Advice?

Answer 1

Was your admission based on a migraine incident?  If it was NOT - they should pay the claim.  If it WAS (or could be anything closely related to a migraine issue) you may be out of luck.

As far a material misrepresentation, that would indicate that you LIED on the application and this does NOT seem to be the issue - if everything was done the way you said it was.

What does your agent have to say? Has he gone to his regional office and asked them?

What are all these other bills for? $60-90K worth of medical bills since 9/07 seems like a LOT.....they may be looking for something to prevent the number of claims - thinking that you are "claims conscious."

I would rush my complaint to TDI - claims forms are available on line at http://www.tdi.state.tx.us/

Good luck and I hope this helps!

Answer 2

Hiring a lawyer to advise you and possibly handle this would be a smart thing to do.

Good luck.

Answer 3

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Answer 4

Material misrepresentation may not necessarily mean the migraines. Was there anything diagnosed during the ER that BCBS didn't know about? Smoking, obesity, alcohol usage... hypertension, heart disease. I'm not saying you participate in those activities or are obese, I'm just saying BCBS may be looking at that history given to them by you versus what the ER billed them for. Make sure you were diagnosed correctly and agree with the diagnosis. If you went to the ER because you broke your toe you don't want your insurance billed for an appendectomy.