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Laura B
AIG Critical Illness insurance - claim denied due to pre-existing condition?
Hi,
My husband's kidney function recently got down to 12% and now he has ESRD - End Stage Renal disease. This requires him to be on hemo-dialysis. He has Critical Illness insurance through his employer that is supposed to pay him $20,000 for a critical illness like stroke, heart attack, cancer, and organ failure. So, we filed a claim and it was almost immediately denied. The denial letter said that the reason for denial was that this was a pre-existing condition. I called them because this was obviously a mistake, because his kidneys had never failed before.
This is what I was told: The kidney failure was due to diabetes and the diabetes is a pre-existing condition because it was diagnosed in June of 2012. I read the policy and it was very confusing and not clear. I can appeal but I don't know what to do or what to say. They basically said I'd have to find a doctor that says that his kidney failure was not caused by diabetes.
We are so frustrated and so disheartened by this. Any help or advice would be greatly appreciated. We have pre-paid legal and they weren't very helpful. Has this happened to anyone else? Is there any recourse? His employer's HR department weren't much help either. They never bothered to explain this could happen. Why not disclose this plainly before letting their employees sign up for such a plan? We've been paying high premiums thinking we were covered, but I bet ANY critical illness he has will be linked back to diabetes and not be covered. *sigh*
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It's just like all of the child tax credits. Those of us who don't have kids (that need to go to school) we have to pay all kinds of taxes, for the government just to take that money and give to those who (either by choice or by accident) happen to have kids.
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Your thoughts?
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