Alexandria T asked:


I went in for an urgent care visit back in October bc I had a UTI. My insurance co refuses to pay the bill, stating that its a pre-existing condition. I.e., I had one less than a year ago and was prescribed antibiotics for it.

However, an infection IS NOT pre-existing unless it is chronic. Furthermore, the UTI in October is technically a NEW infection, as the previous one was treated and “cured” with antibiotics. Hence, the infection cannot be termed pre-existing as it is neither the same infection from before (though yes, the same type - both UTIs) nor is it a chronic condition.

Is there anything I can do to appeal aside from sending a doctor’s note in my favor? I cannot afford to seek out a lawyer for this unfortunately. What can I seek on my own? Any legal cases I can review? Any other documents or letters I could write to help my case?

Thank you in advance

Leo

3 Responses to “Insurance denied claims, stating pre-existing condition. But it’s NOT! How do I appeal/fight back?”

1. curtisports2 on January 29th, 2010 12:40 pm

   Emma

   Were cultures taken? If they were, and the strains of either virus or bacteria that caused it are not the same each time, there is your proof that it is not a preexisting condition. Talk to your doctor.

2. Jan on January 31st, 2010 6:13 am

   Luana

   First thing to do is call your insurance company and argue the point. If that doesn’t work, ask your human resources manager at your work to call the insurance company and argue the point. That usually works.

3. belgrademitch on February 3rd, 2010 4:21 pm

   Carin

   unfortunately there is not much that you will be able to do. They set the rules and if you fight it they have more money so they will win.