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HCC Medical Insurance Services / Denial of Insurance claim

1 San Diego, CA, United States

I have come to United States from India on a vacation. I had severe stomach ache on Saturday 6/27/15. As it was a weekend and there were no urgent care facilities open on that day I had to be rushed to emergency room because the pain was unbearable. Also I was diabetic and this called for immediate attention. In the emergency room, I was given pain killers to control pain. After diagnosis from blood, urine samples and CT scan it was concluded that the cause of pain was kidney stones and I was prescribed medication and discharged on the same day. Total bill from Sharp was around 13K !! HCC denial payment saying that emergency care services will not be covered if the patient was not admitted directly as in patient. I had a history of kidney stones when I was in India and I had undergone surgery in India on 2007 for kidney stones (supporting documents attached in this email) For the below reasons my case should be considered as “Acute onset of pre- existing condition” • My condition of kidney stone was preexisting and it occurred suddenly without any symptom ( I have attached the documents from the treatment that was done at India) • It is not chronic or congenital • I had to be treated within 24 hrs. as my pain was unbearable From the policy description of coverage I understand that there is a $75000 life time maximum coverage for acute onset of preexisting condition. I have filed an appeal with HCC against thier decision to deny payment . It has been over 6 months since the appeal was filed and i do not have a response from them yet . What should i do now ??

An
Jan 21, 2016

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