Below is a copy of a letter I submitted to my employer and to my health insurance provider as a benefit of my employment. As you can see I was terminated with a retroactive date and this has caused problems with medical claims. I need legal advice about this situation.Donna J Matthias*****
Cherry Hill, NJ 08003
Jan. 14, 2016
Highmark Blue Cross & Blue Shield of Delaware
PO Box 1991
Wilmington, DE###-##-####RE: Member ID XHP122253381001
I am disputing unpaid claims to three medical providers for 3 medical visits in the month of August 2015. The claims are for Advantage Sleep Centers, Eye Physicians and Dr. Daniel Ragone. The reason for my dispute
is simple. I was insured by Highmark through my employer, Horizon Services, and was out on disability due to a stroke. My health insurance was terminated retroactively to the date, August 1st , 2015 however I was never informed until August 24th, 2015 As proof of this I have new insurance cards that were issued to me on Aug 18th, 2015. Enclosed you will see copies of these cards. Since termination
of my medical insurance was retroactive the liability for any medical costs incurred between August 1st and August 25th, falls on Highmark and Horizon Services. It would have been impossible for me to know I was not being covered and have evidence of coverage as shown by the enclosed insurance cards (copy of them.)
Advantage Sleep Associates - date of Service 8/2/2015- Amount of Service - $999.00 all for Highmark, $0.00 copay
Eye Physicians - date of Service 8/13/2015- Amount of Service - $220.00, $180.00 for Highmark, $40.00 for my copay (copay paid).
Dr. Daniel Ragone - date of Service 8/24/2015- Amount of Service - $120.00 , $80.00 for Highmark, $40.00 for my copay (copay paid).
I have enclosed a copy of the newly issued insurance cards showing my proof of insurance at the time of these visits. Please review this and please make payments to the providers and update me with a written statement of the payments. This issue will end up in litigation if the claims are not paid. I have clear evidence of insurance and proof for retroactive termination of health insurance.
Thank you for your time and attention to this matter.
Donna J Matthias
Cc: Horizon Services, Advantage Sleep Associates, Eye Physicians and Dr. Daniel RagoneThank you very much for your assistance, if you need copies of the enclosures mentioned in the letter I can send them also.