Is it possible for an insurance company to deny your claim because you have a primary and they can not be a secondary?
Conference the 2 claims reps together and let them Duke it out!
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That would be covered under the terms of your policy. In general that is what supplemental, (secondary) insurance is primarily for. Most "supplemental" plans pay the 20% that Medicare didn't pay only AFTER seeing an "explanation of benefits" statement--i.e. proof that Medicare paid their part. If M…edicare denies a service all together, the supplemental plan is often under no obligation to pay at all, as they are there to "supplement" Medicare, not take the place of it in cases of denial. This is especailly true if Medicare denies because the service was deemed "not medically necessary". So, in short, no. Medicare supplements often do not cover services if they are denied by the primary (Medicare). (MORE)
If your insurance company denies a claim can the state revoke your driver license just as if you were carrying NO insurance?
No, but if the reason that the insurance company denied the claim was because the insurance was not in force, then the license can be revoked for not having insurance, if that makes sense.
If you receive a speeding ticket is it your responsibility to notify the insurance company and if you do not can they deny future claims?
Your insurance company will be notified automatically via these shackles we have around us known as computers.
With Primary and Secondary Insurance your primary denied your claim because it was over a year is your secondary obligated to pay?
Answer . Yes, subject to the limits in their policy.. Answer . No. With most insurance policies, there is what is called a timely filing limitation. For my company; contracted providers have 6 months, and non-contracted providers have 12 months to submit the claim. If your primary insurance r…eceived the claim within timely filing, you may have the option of submitting the claim to your secondary with proof that it was filed in a timely manner. If that doesn't work you can always appeal the decision with the secondary or for that matter the primary insurance company.\n. \n. \nPolicy holders are not responsible for claims that deny for timely filing. (MORE)
Can Secondary Insurance not pay anything on claim if Medicare pays more on claim than they would if they were primary?
Yes, If medicare pays more than the secondary insurance allows for a charge, the secondary insurance pays nothing. The balance is written off to a contractual allowance that is agreed upon between the provider of service and the insurance company via contract.
What if an insurance claim is denied because the company found out that the applicant was HIV positive when they passed?
Answer . When they passed what? The question is probably, what if the application is denied, because of a medical problem? If that happens try another company.\n. \nDo you mean if the applicant lied on their application? Then see http://www.steveshorr.com/wrong.or.imcopmplet.info..htm\n. \n…For more info see www.SteveShorr.com/life.htm. (MORE)
What can you do if a death claim is denied because the company found out that the insured was HIV positive but the insured did not know?
Denial of Claim . Then you have a good argument to get the claim paid. For more info see http://www.steveshorr.com/wrong.or.imcopmplet.info..htm
There may be exceptions, but under most policies you are covered as long as your son had your permission to drive the car. At one time there was an amendment on my policy stating that my car was NOT covered if my daughter was driving (after several tickets and three at-fault accidents), but that wou…ld not be normal. If your company is investigating, that probably means they are trying to determine if there is any validity to the other party's claim. They would not have to look any further than the policy to determine that your coverage did not include the injury. (MORE)
In Virginia (and in most, if not all, states) there is an insurance bureau (http://www.scc.virginia.gov/division/boi/) to which you can file a complaint if you feel your claim was wrongly denied. Theoretically, they provide some regulation of the insurance industry and protect consumers to some exte…nt. (MORE)
What is the number of points you are allowed to have before insurance companies deny your claim for auto insurance?
%DETAILS%. Answer . The number of points have nothing to do with an insurance claim.\n. \nIf you are asking about a company refusing to give you auto insurance, it depends on your state and the individual insurance company. For example I have received reports of one company refusing to renew an…y driver with a 20mph over the limit ticket.. (MORE)
Can the insurance company of the driver at fault deny your claim because they can not get cooperation from the driver or owner of the car?
"I'm not a lawyer but I play one on the Web..." No they can't deny the claim, if their client has a legal liability. His lack of cooperation could delay getting it settled. You should ask for compensation for costs associated with those delays. Document them.
Answer . \nAs long as it is a covered expense by your secondary insurance and a claim has been filed with the primarty insurance then the answer is yes. The secondary insurance will only cover the expense according to your plan.
An auto insurance company can deny your claim if you haven't had your license for at least 18 months. or if the car has been sitting up (not running) for a while. they will need receipts from the repair man saying that the problem has just been fixed.
Answer . \nIf it is beyond the 1st two years, nothing short of dying while commiting a felony. They will deny the claim if the insured did not die! They will deny the claim until satisfactory proof of death. IS the policy over two years old? 4lifeguild.com
Secondary medical insurance is a second level of insurance coverage. Under most circumstances, the two policies are independent of each other. One policy may pay for a service while the other may not. The primary policy must pay first, then the secondary. The choice of which policy is primary or sec…ondary is established by a shared rule between insurance companies. It is not the policy holder's choice. Examples of Primary/Secondary coverage: A husband and wife both work and carry the medical insurance offered by their respective employers. The husband adds his wife to his policy. The wife adds her husband to her policy. Under most circumstances, the husband's plan would be his primary policy and his wife's plan would be his secondary policy. In like manner, the wife's plan would be her primary policy and her husband's plan would be her secondary policy. (MORE)
Can the secondary insurance provider deny a claim that was not filed with the primary insurance provider first?
\n. \n Answer \n. \nLet me tell you what happend to me. I hope that this helps. I used to be covered by two insurance companies. My primary insurance company was through the company that I worked with. My secondary was with the company that my husband works with. When a claim was filed with… my secondary insurance company they wanted to know how much my primary insurance company paid for and until then they would not pay anything. So I had to submit to my primary insurance company and once they paid some then the secondary would. I hope that this helped:)\n. \n . \n Yes.\n. \nA claim must always be made with the primary insurer first. (MORE)
Can your insurance company deny a claim if your registered address with the insurance company is in one city but you recently moved and live in another city?
Answer . \nYes, they can deny a claim. Check your policy for any reference to change of address or location. If you failed to meet the requirements (notification within a certain number of days of moving) they could consider you in violation of the policy and deny the claim.
Will a secondary insurance pay a portion or all of a prescription that a primary insurance will only pay part of because they will only pay for a lower dosage?
In most cases a secondary insurance would compensate coverage werethe primary insurance does not. Exceptions apply to theprescription drug type and coverage limitations.
GAP . No because GAP covers any GAP between what you owe on the car and the cars actual market value if the should your loan balance happen to exceed what your car is actually worth. If you owe $16,000 on a car but you owe 18,000, GAP would kick in and pay the remaining 2,000. You would still e…nd up with zero dollars, but you also don't have to worry about paying off a loan on a car you no longer own. (MORE)
The subscriber whose birthday comes first in the year is primary. The year is not considered. So a subscriber with a January 1 birthday is primary over the subscriber with a January 2 birthday. Hope this helps.
You could have two insurance companies pay the same medical bill or claim for a date of service through a process of subrogation where the first insurance company determined by the effective date of coverage will pay their portion of the bill and the second insurance company will pay the balance. Th…is process is called coordination of benefits. Secondary medical insurance is a second level of insurance coverage. Under most circumstances, the two policies are independent of each other. One policy may pay for a service while the other may not. The primary policy must pay first, then the secondary. The choice of which policy is primary or secondary is established by a shared rule between insurance companies. It is not the policy holder's choice. Examples of Primary/Secondary coverage: A husband and wife both work and carry the medical insurance offered by their respective employers. The husband adds his wife to his policy. The wife adds her husband to her policy. Under most circumstances, the husband's plan would be his primary policy and his wife's plan would be his secondary policy. In like manner, the wife's plan would be her primary policy and her husband's plan would be her secondary policy. Secondary insurance should not be confused with supplemental insurance. Supplemental policies usually abide by the primary insurance guidelines. If the primary allows the charge, the supplemental will allow the charge. Most supplemental policies cover the charges you would normally pay out of pocket. For example: A Medicare supplemental policy would cover the 20% coinsurance left over after Medicare pays 80% of the allowed amount. (MORE)
In most states an insurer has up to 60 days to accept or deny a claim. Save
You have had payments for claims recouped because the insurance company was secondary the primary insurance company is denying the claims recouped due to timely filing Is there anything you can do?
If your health insurance is thru your employer, have them contact their account rep. These issuse can be magicaly resolved when it is time to renew the company policy, if the rep is informed thast the company will seek another provider should it not be taken care of.
When you have a primary and secondary insurance will the co-pay from your primary insurance be paid by the secondary insurance?
I have insurance paid for by my employer (primary) and through my husband's employer (secondary). In my experience, I have never had to pay the copay required by my primary because it is covered by my secondary. When I first got married, 2 years ago, I still paid the copay, but the doctor's office w…ould always send me a check for the copay a month later because the secondary paid it. (MORE)
If a husband and wife both have dental insurance through their employers, the employee's insurance is primary when the employee is the patient, and it must pay it's benefits. The spouse's insurance is secondary, and will only pay once the primary insurance has paid. Depending on how the policy is wr…itten, sometimes the secondary insurance will pay any residual fees up to the annual maximum. Sometimes the secondary insurance only pays if their fee schedule allows higher fees than the primary insurance. This assumes that each spouse is named as a dependent on each other's policy. Ask the insurance coordinator at your dental office to what benefits are available between the two policies. (MORE)
Do long term care insurance companies pay benefits when the insured goes blind because of macular degeneration or do they deny the claim and say he can still do activities of daily living?
Any illness that may lead to vision impairment necessitates theneed for long-term care. Even people suffering from glaucoma whichmay lead to blindness may claim benefits for ltc, technically, onceyou are blind, you can no longer perform all of the activities ofdaily living on your own. Benefits trig…ger of long-term careinsurance usually start as soon as you need assistance performingADLs, then you can claim for benefits. It is always important tocheck the benefits trigger of your policy before making a claim (MORE)
In most states in the U.S. An insurer has up to 60 days in which toinvestigate a loss and accept or deny a claim
Family clinic accepted copay and claimed to be an in network provider. Insurance company denies claim because clinic IS NOT in the network. Can I dispute the bill for clinic's misrepresentation?
I did and finally, took about 3 months and finally it was PAID. I called the place several times and called Schalder Insurance and they finally paid it. Just be patient and keep records documented!
Can the insurance company deny a life insurance claim if the insured dies before they receive the application and premium?
Yes, the insurance company can deny a life insurance claim in the event of death before the company receives the application and premium. The question uses the word "insured" but at this stage in the process, the correct description would be "applicant" or "proposed insured". Life insurance protecti…on can be in-force before a policy is approved and issued by the company under certain circumstances. The usual rule is that coverage is effective upon the completion of three items: the application, the exam if required or the health questionnaire if exam is not required, and a check for at least the first month's premium. The application contains either a conditional receipt for temporary insurance (CR) or a temporary insurance agreement (TIA). Each life insurance company utilizes one or the other; more companies use the temporary life insurance agreement). There are specific terms in the TIA that must be complied with in order for the temporary insurance to be effective. It is possible for a claim to be paid by the insurance company if the applicant dies in the very short time frame between when he or she completed the application, provided the required health information, wrote a check for the first month's premium and satisfied the terms of the temporary insurance agreement but before the insurance company received these items. In this situation, the insurance company would review the claim and if all of the above items are satisfactory would pay the claim. Claims have been paid under these facts but note that the time frame between the applicant completing all the requirements and the insurance company receiving them would be very short, typically no more than a week or so. Unless all of these documents, along with the check, are in order the insurance company would not be liable for the claim. (MORE)
yes, they will treat it as if the primary was a different company. You pay two premiums. If they do not, contact the DOI.
Many health insurance policies have a maternity waiver. Meaning that pregnancy is not covered. ( Kind of a self inflicted injury type thing ) However, most companies will cover complications of pregnancy.
Is it required to make a primary dental insurance adjustment if the dentist is a preferred provider before submitting a claim to secondary insurance?
You wait until both claims are received then write off the lesser of the two amounts
If your insurance company denies the other persons claim can the other persons insurance deny your claim?
Perhaps the best answer is "yes and no". If your auto insurance company denied the claim of another party with whom you had a collision, it was either because you did not have liability coverage to protect you from the claim, or because your insurer, after investigating, did not believe that you wer…e at fault. If the other party had liability insurance, the insurer can deny your claim for the same reasons. If this happens, the other party is generally free to sue you, in which event you need to turn the suit papers over to the insurer so that it can defend you (if you had liability insurance). If you did not have liability coverage, you will have to defend the suit yourself. In all events, you have to act promptly, or else you may lose by default. When you (or the insurance company) respond to the lawsuit, if you have a claim against the other party arising from the same occurrence, it must be asserted as a "compulsory counterclaim". If it is not, you will lose the right to assert it as a separate suit. If the other party had liability insurance that covers your counterclaim, it will defend the counterclaim. The ultimate result will either be that the claim(s) are settled or resolved by the court after a trial on the merits. (MORE)
That is considered a road hazard but you should contact your insurance company to find out if anything can be done.
If a person has two Medical insurances and the primary denies due to preexisting will the secondary pay?
It depends on a few things. If your primary insurance is say less than 2 years old, they can deny claims to determine whether the condition is pre-existing. If you have had the secondary policy longer/ or the pre-x period has already been satisfied, then they may pay the claim as secondary. As long …as the treatment is indicated as covered benefits in the policy. These cases are common when both spouses have covered each other on their jobs. And/or when a child is covered under both parents policies. There could be a coordination of coverage issue with the latter. (MORE)
if it goes under payment account audit they will find out eventually and try to recoup whatever the overpayment was for that claim.
No, that wouldn't be a reason for claim denial. It may be a reason for them to investigate you for insurance fraud.
After you have received the Explanation Of Benefits (EOB) from your primary carrier if there is coordination of benefits. If the secondary insurance is an indemnity you do not need to wait.
It is usually written in an insurance policy if the policy is primary or secondary. If both policies have language that makes them secondary if other insurance is present then they may split the amount owed. State laws may change this.
Assuming that you have collision coverage, you are under no obligation to have your insurer pay for the repairs to your car. You are free to pay for the repairs yourself. If there was another vehicle involved, and you were at fault for the collision, other considerations exist. The other person inv…olved will likely want to assert a claim with your insurer to ensure that damages get covered. However, if you can reach an agreement to pay for the other party's damages yourself, you may be able to circumvent having a claim filed. (MORE)
Nothing prohibits an insurance company from denying a claim. An insurance policy is a legal contract binding on both parties. One party agrees to certain obligations such as telling the truth on the application for insurance and paying the premiums and the other party agrees to pay covered claims on… a timely basis. As long as the insured meets their obligations under the policy the insurance company will meet their obligations. (MORE)
Can an insurance company deny a claim if it has paid a claim three times for a roof to be fixed and it was not fixed And will the new insurance company fix a roof after being with them only 3 months?
Yes, they can deny the claim. If a loss payout was already issued by an insurance company, it was the insureds responsibility to make the repairs with the funds provided. The company is not required to pay the same claim twice. If the insured fails to make the repairs you can not seek those same …funds a second time. Also bear in mind the following 1. Your homeowners insurance policy is a term policy, usually a one year term. So your new insurance company would have no obligation to pay for claims for previous damage nor un-repaired damages that arose before the policy started. 2. Your Home insurance company also does not provide coverage for poor workmanship or quality on the part of your roofing contractor. This is why one should always hire a professional roofer and verify the the contractor has Insurance before allowing the work to proceed. If the roofer did a poor job resulting in failure of the roof or materials you will need to file claim against the contractors general liability completed operations insurance policy because the homeowners insurance company does not have to pay again for the same repairs. It is up to the homeowner to hire a qualified contractor. (MORE)
Yes, it can be and no it may not be. You did not give enough information for a determination. Usually, the primary carrier pays their maximum, then the secondary carrier pays some or all of the portion of the procedure that is left BUT not more than the claim itself or more than they would have pa…id if their contract was primary. Here are some reasons why it could be legitimate to deny your claim. You could have hit the limits of the secondary policy. There could be a provision in the secondary policy that it does not cover the procedure that you had or that says it does not pay anything if it is secondary. The latter is somewhat unusual but worth checking for. Did you ask the carrier why they denied it? If they do not point to a specific provision in your contract, ask them to. If they do not, your state Insurance Department should have a consumer representative that you can ask for help in determining whether it was legitimate for them to deny coverage. (MORE)
There are a few things you can do if you have a life insurance death claim that was denied. What you should not do is try to dispute the denial by yourself. Disputing death claims should be handled by a professional who has a lot of experience dealing with life insurance denials. So two options: 1. …Contact a local attorney who specializes in "bad faith claims" for life insurance. This person should have significant experience dealing with insurance companies. He/she will represent you in a legal dispute against the insurer and attempt to get your claim paid. You should expect to pay the attorney 30% of whatever you get from the insurer. 2. You can also contact The Center for Life Insurance Disputes. They offer an alternative to filing a lawsuit. Instead, they deal directly with the insurer in order to get your claim paid. Their service is usually about one-third the cost of an attorney and quicker because you don't have to wait for court dates and filing schedules. Answer You need an attorney if there are grounds to challenge reason for denial. (MORE)
The only step you have left is to sue the driver of the other vehicle. Keep in mind, it is your responsibility to prove that the other driver was at fault.
A claim can be denied for a number of reasons, but three examplesare" 1. The policy was not in force at the time of the loss. This canoccur if the policy never went into force (such as due to the firstpremium not having been paid), or because it lapsed becausesubsequent premiums were not paid. 2. …The terms of the policy did not cover the type of loss involved.Insurance policies are issued to provide protection for specifiedcategories of risks, If the loss did not fall within the ambit ofcoverage, it would be denied. Even if arguably within the scope ofcoverage, an exception or an exclusion to coverage, as stated inthe policy, may apply. 3. Misrepresentation of a material fact when applying for theinsurance. Insurers rely upon the truth of the answers given by theapplicant when issuing a policy. If a loss occurs and the insurerdiscovers that there had been a material misrepresentation of factwhen applying for the policy, coverage could be denied. Amisrepresentation is generally held to be material if, had atruthful answer been given to the question, the insurer would havenot issued the policy or, if it would have, only at a higherpremium. (MORE)
The 3 reasons why an insurance co. can deny an insurance claim are:- 1) Pre-existing disease not disclosed at the time of taking thehealth insurance policy. 2) No Intimation notice regarding admission to hospital/nursinghome submitted to the insurance co. or TPA immediately on admission of thepatien…t. 3) The papers submitted show that it relates to check-up and notfor treatment of the particular admissible disease as per policy. (MORE)
Being going for legal tussle, it's better to approach InsuranceOmbudsman under whose jurisdiction your Insurance Co. falls withall papers/documents. However, their verdict will be binding onboth you and your insurer.
If they denied that claim for cause, such as fraud, then there isnothing you can do. If they did not have cause, you can trycontacting the department of insurance in your state. That is ofcourse, as long as you had comphrensive coverage on the policy. Ifyou did not have coverage, they do not have to… pay for anything. (MORE)
Absolutely. Would you pay someone who owed you money. The no claims bonus is a gimmick anyway. Allstate advertises the refund of premium bonus if you don't have any claims. However, in order to get this bonus check you have to purchase an endorsement that costs you as much as the bonus could possibl…y be. (MORE)