Mid-West National Life Insurance Company of Tennessee Denided 55,000 medical claim for hospital bill the business that doesnt give a dam North Richland Texas

Let me guess...Cynthia does not know anything about health insurance and is one of those people who does not read a policy and gets mad when the company pays what they are supposed to pay? I have Mid-West and everything is paid exactly as stipulated by my contract. I had a pre-existing condition, listed it on my application, and a year after taking out the coverage, had to have a procedure relating to the condition and they paid it just as they said they would in my policy...this person may have had an exclusion for their pre-existing in their policy (IN BOLD PRINT). Or they lied on the application. 55,000 in bills is frustrating to say the least, but an attorney will have to prove that Mid-West did not follow their side of the contract, which, by the way, they do read. Good Luck!

first of all, I hope you are in better health and doing well, but, I agree more info is needed. when did you take out the policy, did you have prior coverage, is this a pre-existing condition ??? 11 days for an irregular heartbeat? was it irregular all 11 days or just the first day with 10 days of follow up observation? more info needed. if your treatment was medically necessary, covered by your plan, and you meet the pre-existing condition clause, and they are still denying the claim, then I guess since you have a lawyer let your lawyer handle it. however, I've seen claims denied for totally stupid reasons, wrong birthdate, filing with the wrong insurance company, so many stupid reasons to name. I've had so many people come in my office in a wreck over something trivial that I take care of in one phone call. but it has ruined this person's entire weekend because they are at their wits end and they got "a letter" on Friday denying the claim. (i'm in HR for a co. and deal with ben., not emp. with any insur. co). call them and find out what the problem is, it could be simply an administrative issue, and you could save attorney fees to boot. good luck.

Michael, just ignore Cynthia. She is clueless. Sounds like someone who has a way of thinking very similar to the person who originally posted this. They must be like a good majority of people on here who don't read their fine print, don't do any research and go flying blind into an agreement or contract without reading a thing.

Cynthia, the insurance company is not going to pay for a pre-existing condition. Since common sense is not for everyone, this needs to be explained to you. I feel really sorry for the person who posted this. It is truly awful to have to be hospitalized for so long, experience the trauma of having something wrong with you, and then have to pay $55k to take care of it. I was hospitalized once for 5 days and the total bills came to over $40k. I didn't have to pay a penny out of pocket because it was from a car accident that someone else caused but if it wasn't then I would have had to pay 20% out of pocket. Does that mean I'm getting ripped off because the insurance co. wouldn't pay the whole amount? No and I knew that when I got the plan. I actually DID MY RESEARCH. I had to get different insurance a year later and I had the common sense to give all of my hospital records pertaining to the injuries I had to the new insurance company so I would not have any issues later. Guess what? I had to go back for more rounds of physical therapy once I got the different insurance (let's keep in mind now that I now have a PRE-EXISTING CONDITION) and they covered it. They probably would not have if I had not disclosed the accident info. Don't mess with the insurance companies. If you don't do it by the book, you will not be covered!! Simple as that.

Michael, just ignore Cynthia. She is clueless. Sounds like someone who has a way of thinking very similar to the person who originally posted this. They must be like a good majority of people on here who don't read their fine print, don't do any research and go flying blind into an agreement or contract without reading a thing.

Cynthia, the insurance company is not going to pay for a pre-existing condition. Since common sense is not for everyone, this needs to be explained to you. I feel really sorry for the person who posted this. It is truly awful to have to be hospitalized for so long, experience the trauma of having something wrong with you, and then have to pay $55k to take care of it. I was hospitalized once for 5 days and the total bills came to over $40k. I didn't have to pay a penny out of pocket because it was from a car accident that someone else caused but if it wasn't then I would have had to pay 20% out of pocket. Does that mean I'm getting ripped off because the insurance co. wouldn't pay the whole amount? No and I knew that when I got the plan. I actually DID MY RESEARCH. I had to get different insurance a year later and I had the common sense to give all of my hospital records pertaining to the injuries I had to the new insurance company so I would not have any issues later. Guess what? I had to go back for more rounds of physical therapy once I got the different insurance (let's keep in mind now that I now have a PRE-EXISTING CONDITION) and they covered it. They probably would not have if I had not disclosed the accident info. Don't mess with the insurance companies. If you don't do it by the book, you will not be covered!! Simple as that.

Michael, just ignore Cynthia. She is clueless. Sounds like someone who has a way of thinking very similar to the person who originally posted this. They must be like a good majority of people on here who don't read their fine print, don't do any research and go flying blind into an agreement or contract without reading a thing.

Cynthia, the insurance company is not going to pay for a pre-existing condition. Since common sense is not for everyone, this needs to be explained to you. I feel really sorry for the person who posted this. It is truly awful to have to be hospitalized for so long, experience the trauma of having something wrong with you, and then have to pay $55k to take care of it. I was hospitalized once for 5 days and the total bills came to over $40k. I didn't have to pay a penny out of pocket because it was from a car accident that someone else caused but if it wasn't then I would have had to pay 20% out of pocket. Does that mean I'm getting ripped off because the insurance co. wouldn't pay the whole amount? No and I knew that when I got the plan. I actually DID MY RESEARCH. I had to get different insurance a year later and I had the common sense to give all of my hospital records pertaining to the injuries I had to the new insurance company so I would not have any issues later. Guess what? I had to go back for more rounds of physical therapy once I got the different insurance (let's keep in mind now that I now have a PRE-EXISTING CONDITION) and they covered it. They probably would not have if I had not disclosed the accident info. Don't mess with the insurance companies. If you don't do it by the book, you will not be covered!! Simple as that.

Cynthia,

So you think I am deficient. Your entitled to your opinion as I am. Listen with all do respect, I said in one of my comments, that there is no perfect insurance company. If there was we would all be on it. However, since there is no perfect insurance company, there will always be products that people buy that do not add up to their standards. Everyone's expectations are far beyond what products provide and do. This is in any case. People want the best things in life but at the same time they want to pay nothing for it. When there is something that becomes affordable but does not give the person everything they want, they are the ones that sit around waiting to see if the product or service drops the ball, so they can point the finger and never take the blame for making a decision that didn't ever meet their needs.

You were quick to say the client was right and I was wrong. How can you do so with out hearing two sides of the story. How do you know that the client wasn't honest on the application, lied about a pre-existing condition, didn't take the time to understand what his policy covers and does not cover, etc?

Maybe Mid-West didn't pay the claim because they said "oh we don't want to pay the claim becuase we just do not feel like it" do you really believe this is what insurance companys do? There are laws that they have to abide by and if they do not they are not allowed to be in business.

Since you know everything,can you provide me with cases you read that the client won the dispute and the insurance company was found guilty? If so please let me know. I would love to see.

So know tell me why I am wrong in this case and the other cases you read about? Use valid information to give me a good enough awnser.

If Mid-West National Life is so bad why are we the largest INDIVIDUAL insurance company in the country? Why do we insure more people then any other individual insurance company in the country. Why do I have happy clients that have made claims small and large? You know why Cynthia? It's because I explain things with integrity, I review policies with people, They learn as I educated them. Now if there bad apples out there misrepresenting the product then that is a different story. However you can not say Mid-West is horriable when a bad apple out there made them look horriable. Do you agree?


Why do people like you take the time to compalain and point out negatives rather then compliment and point out positives? Are you misrable and have nothing better do with your time?

I look forward to seeing the information you can provide that proves I do not know what I am talking about and that all of these complainers on this site are right and I am not.

What is your profession again Cynthia? I think it is something that doesn't take to much brain power to do. Have a nice day!

Michael,
I keep seeing you posting your little rants and bashings at people whom have been burned by this company, and I just have to ask: Are you deficient? Are you so blinded by greed that you see nothing wrong with the treatment this company dishes out to innocent victims? Do they pay you extra to come in here and make derogatory comments about their clients after they have been bent over by this group?

If you are just deficient, well, I suppose that you might be forgiven for your ignorance. If it isn't that, however, maybe it is just that you like seeing people squatted on. Regardless, you really are pretty much...well, this is a family board, and I'm trying to not make personal attacks, so I'll not go there.

Get a little bit of common sense working for a minute and READ what is being complained about. If your company is so wonderful, the complaints wouldn't continue pouring in about them. And they sure as certain wouldn't have class-action lawsuits going after them. If there were no merit to the complaints, a lawyer would not take the case. Obviously, that isn't what happened. A lot of lawyers took the case. Enough that a class action suit was filed.

Again, bust out some common sense for a minute and see what your company is doing to their customers, and just try to imagine that it is your own family going through this. Not such a nice picture, is it?

In situations like these the finger is always pointed at the insurance company. The client never assumes responsability for the action.

When an insurance company sends out a contract to a client after being applyed for it is the clients responsibility to read through that contract within the first 10 day of recieving it to examine it for any exclusions, waivers, rate ups, etc. This is something most people do not do because of laziness.

I can probably guess one or two things has happened. This individual didn't disclose that he had heart issues prior to applying for the insurance and their is the possiablility that the insurance company isssued the policy with out knowing about the pre-existing condition. But all insurance companies are protected by what is called a two year contestability clause which protects the insurance company from paying any cliams if the applicant didn't diclose a pre-existing when he applyed for the plan.

The other thing that possiably may have happened is that he did diclose the pre-existing condition but never read his contract to see if there were any waivers or exclusions on his heart. And when he went in to get this procedure done he thought it would be paid for and now he is supprised because they didn't pay the claim.

People have to understand one thing insurance companies are regulated by the state they do business in. And when the insurance company leaves brochures with the client and sends them a contract when accepeted the insurance company can say they are not going to pay a claim because they just do not want to. So of course this individual no has to pay the claim and of course he his furious and the first thing he wants to do his hire a lawyer to sue. Just like every one else in this country who has been sue happy.

Also has this person contacted the claims department to see what the reason for not paying the claim was. He will probably find out a lot more than he thinks.

Save your money on the lawyer you will need it to pay your claims.

Had to retain a lawyer.....He is handling it

Was your claim on a pre-existing condition. Have you had problems with your heart or blood pressure prior to signing with the company that you may or may not have disclosed in your agreement? I am just wondering because I recently started working for this company and I would like to know if there is a legitimate reason behind your accusation.

Our company has been given an excellent rating by A.M. Best.(The largest insurance rating company in the US). Please let me know about this. It may change things for me.