Public Mediation

Co-ordinated Benefit Plans, Inc-Dispute-#1666479

M. J. vs. Co-Ordinated Benefit Plans, Llc
P.O Box 26222, Tampa, Florida, 33623, United States
    • Status: In Negotiation
      This claim has posted for public comment and negotiation. It will remain posted until resolved to the claimant's satisfaction. Suggest a resolution to help these parties reach a settlement.
    • View response from: Co-Ordinated Benefit Plans, Llc
    • Claimant Seeks: View.
    • Claim #: 1666479
    • Amount Involved: 15,964.01
    • Filed On: Nov 04, 2011
    • Posted On: Nov 20, 2011
    • Complaint(s):
      • Bad business practices
      • Problem with a service
      • "I just feel ripped off."
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Statement of Claim
Claimant says:
"I was in the hospital on March 30-31, 2011. This company has been processing my claim for 7 months and has now denied the bill saying it was because of my "pre-existing" problem. I did NOT have a pre-existing problem that put me in the hospital. My heart was racing and my blood pressure was high for what turned out to be a problem with my medication. When the medication was changed, the problem resolved itself. How could that possibly be pre-existing? I had never been in the hospital with that problem before or even gone to the ER with that problem. I have never missed a premium payment and have paid this company over $8,000 this year and yet it is not paying one cent on my $12,214.82 bill. I have kept in touch with the company; the hospital and the doctors have done everything it has asked us to do in order to give all the info asked for and after 7 months of waiting - to be denied is not fair to me or the hospital."
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What Claimant Wants Hide
1. Payment due: Account #1108900357 Columbus Regional Hospital Nov 29, 2011 $12,214.82
2. Payment due: Account#93104 St Vincent Jennings Hospital Nov 19, 2011 $3,749.19
Cash total : $15,964.01
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Respondent's Counteroffer Hide
The claimant's settlement terms were rejected with the following explanation:
  • "Upon our review of this claim, it was determined that the claim was related to a pre-existing condition and therefore not a covered benefit within your plan.
    The policy states:
    "Pre-Existing Conditions" mean any medical condition or Sickness for which medical advice, care, diagnosis, treatment, consultation, or medication was recommended by or received from a Doctor within the 12 months immediately prior to a Covered Person's Effective Date of Coverage. This does not apply to congenital birth defects or anomalies of newborn infants, foster children and adopted children when you have paid the additional premium within 30 days of acquiring such dependent."

This claim will remain posted until resolved.

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  • Comment: by Visitor — Online mediator
  • On: 09-20-2013
  • If your Dr. states in writing that the medical that put in the hospital is not related to any pre-existing condition that you were treated for l2 months prior to the effective date of the insurance, you can hire an attorney to sue the company. Your chances of wining this case are good but only if your Dr. cooperates fully to the effecet that your claim is not related to any pre-existing conditions.
  • Comment: by Stuart Friedman — Online mediator
  • On: 09-06-2012
  • The AHCA will make problems like this nonexistent. But that doesn't kick in until 2014. But, only if Obama gets reelected. Imagine what it will be like if Ramney were elected. Then we're all screwed.

    Can I also suggest that you contact your insurance board in your state to help resolve the issue. And remember hospitals are businesses, so you can always negotiate with them as well.

    My heart goes out to you. Best of luck and I hope all turns out well.
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