My insurance allows one physical per 24 months.I get another one at 21. Any possibility my insunrance will pay

Question

I get a physical checkup 21 months from my last exam and my insurance refused to pay because their policy is one per 24 months. I know it is my fault that I did not notice the fine difference between 24 months and 2 calendar years. But I really dont see a big difference here. I did not abuse my benefit and my PCP recommended the exam. I would like to hear some suggestions before I call the insuance company. Is it possible that I can get the payment approved? Thanks.

Answer 1

Honestly, I wouldn't even bother appealing.  If it makes you feel better that you gave it a shot, then go ahead.  But just don't expect it to be overturned.

That's a pretty cut and dry application of your benefits, and your insurance policy (including the 24 month stipulation) is a contract for the services as spelled out in the policy.  The insurer is well within their rights to deny your appeal, and frankly in all my years working in the field, I've never seen someone get that overturned for a routine physical exam.

Sorry.  :(  (But as I said, if it makes you feel better to submit an appeal, then send in your letter.)

Answer 2

Um, no.   I seriously doubt this will be approved.

It's kinda like saying, OK, I have liability on my car, but no theft coverage.  My car got stolen, do you think the insurance company will pay.

You don't have coverage for that second physical until 24 months have passed.  Not 21, 24.

Sorry.