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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Employment Law
Satisfied Customers: 111492
Experience:  20+ Years of Employment Law Experience
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We purchased the colleges health plan from Kansas University.

Customer Question

We purchased the colleges health plan from Kansas University. They offer United Health. We paid for the semester at t e end of June 2014 and it became effective July 1. This was just a continuation of the previous policy from them we buy each semester. He had a tonsilectomy at the beginning of August 2014 before going back to school. He went to Kansas and moved in but after a day he decided he wanted to transfer to SDSU. United Health has drug their feet and not acted on his claims for the tonsilectomy in any way. I'm not sure what steps to take. I realize that him not staying in school at Kansas would make that insurance ineffective at that point, but no one knew (even him) that he was going to end up at a different school when we purchased the insurance or when he had the tonsilectomy. The insurance card/letter said the coverage was in effect as of July 1. Can you advise me about what to do?
Submitted: 1 year ago.
Category: Employment Law
Expert:  Law Educator, Esq. replied 1 year ago.
Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.
If you had a insurance policy in effect at the time of the medical care, UHP is liable for paying for the care. So if the coverage was effective July 1, 2014 and the treatment occurred in August 2014, they are liable for paying for the care. If they refuse to pay, your first step is filing a complaint with the KS Insurance Commissioner, since they investigate claims against insurance companies. If the KS insurance commissioner cannot resolve the matter, you have a right to file suit against the insurer in KS for breach of contract and bad faith for hesitating to pay the claim on a policy that has been paid for and they accepted payment for in accordance with the terms of their policy.
I am afraid these are your options based on the information you have provided.