Case Studies  

Three Insurances with No Coverage

   Mr. J.K. lost his job January 1st and did not elect to take his COBRA benefit.  He went six months before his wife was able to include him on her plan. She then changed jobs in January and elected for COBRA on her 1st job and put J.K. on her new plan. J.K. went to work in September and was put on his new company's plan. He was covered by THREE Plans.  In November he had a cardiac event and had emergency bypass surgery with multiple complications.  The total cost for his medical care exceeded $55,000.  All of the insurance companies refused to pay. Why? They claimed a pre-existing condition and no continuous coverage because of the six month lapse.

  LCI was hired to advocate for Mr. J.K. The first step was to reduce the number of carriers to avoid the finger pointing.  This immediately saved the client $1,200 a month in costs. We then went to each physician to document that he did not have a pre-existing illness.  The company still refused to pay.  J.K. was fraught with anxiety because he was going to lose his house.  This resulted in new cardiac symptoms.  We requested an outside medical review and worked with the client and the physicians to document the medical history in detail; utilizing the information provided the medical reviewer approved the claim.  The advocacy fees for this case were less than $2,000 which was money well spent.  The lesson is do not let your insurance lapse.  Pre-existing clauses put your wealth at risk.  Without lapses the insurance company can not use a pre-existing clause to deny payment. back. . .