IMG insurance denial

[Spike1]

Hi,

My dad had an eye infection after about 4 months since he came to the US and was covered under IMG insurance. But IMG is not covering the treatment. My dad was treated at the ER and had an outpatient eye procedure. IMG is saying that it is a pre-existing condition. He has not had an eye infection prior to the coverage date so I don’t understand why it is being denied as a pre-existing condition. The eye infection was a new onset acute infection and required immediate treatment. This is really frustrating given that this is not the first time we have bought IMG insurance for our parents on their visits to the US. Although this is the first time we have made a claim with them. Any one have any suggestions what to do here? Really appreciate any input.

[insubuy]

I am sorry to hear that you are having a claims problem.

Please contact me so that I can collect the necessary information from you so that we can look into it further.

[insubuy]

Unless you contact me, there is no way for me to you help find out what exactly is going on.

At this moment, I don't have any details about you. What insurance plan you purchased, what is your certificate number, what your name is and other details regarding the treatment or claim.

And without any details about your case, I can't really make any comments whether your claim denial was legitimate or not.

Therefore, as you stated in your initial posting, if you would like us to help you out, contact me as soon as possible.

[insubuy]

I was able to track down this customer and contact him immediately, on the same day. He called back and confirmed that it was indeed him. I provided him with the necessary privacy release form to be signed by his father so that I could get the confidential information about this claim.

I received such authorization late night yesterday and I have been working on this today.

Sir,
To protect your privacy I am not at liberty to address your claim detail in a web blog, but I want to explain that conditions that are related to, or caused by, a different condition that is pre-existing are also considered as pre-existing. Please call me and I can explain the determination on your claim in more detail. Also, I can request that the company send your claim file to an outside peer review firm to be reviewed by an independent physician who does not work for the company, if you wish to have this done.

[Spike1]

I must say Narendra is very good and quick to reply to e-mails, etc. He has been asking for as much information as possible and we have provided quite a bit. Not trivial to get all the medical reports, etc. necessary; bear this in mind for future reference. He definitely has been responsive.

On the claim itself, I'll call him to hear his explanation. I see the point regarding the privacy issue. It would not make sense to add anything until then.

[insubuy]

I have talked with this person and described the exact situation. I have explained to this client why I believe the company's decision is correct, and provided with exact terms for him to look up on the internet and understand it.

I offered to get this claim evaluated by an independent third party team of doctors. (Even though, I am very convinced that the possibility of reversal of the decision is next to nothing because it is clearly due to pre-existing conditions.) And anyway, the customer has not got back to me expressing his desire for doing this in about one week after our phone conversation.

Therefore, I believe that he was convinced that the claim denial was legitimate.

It is amazing that people don't write the complete story and inappropriately blame the insurance company for not paying the claim.

In this case, it was concluded that the insurance company acted correctly on this and therefore, I consider this case closed.