In 2011 I went to office of health insurer to enroll in PPO on the spot so I had to take costly guaranteed-enrollment plan. I asked if they had cheaper medically-underwritten plans. Sales agent said no. I asked again if they had plans like that I could apply for for the future. Again, no. So I enrolled in costly PPO. Last year I found out agent was wrong (company's website is no help, so it took a while.) I am healthy so I applied for the underwritten plan. I was denied based on diagnosis codes on doctor bills for things I didn't have. I appealed and won but it took months to gather my records for the appeal, during which time I was still paying $850/mo. when I qualified for $440 plan. Can I recover overpayments due to wrong advice by sales agent, or for during appeal period? Cont'd
What irks me is that I overpaid for 2 years due to being given wrong advice by their agent regarding available plans, and then when I finally learned the truth and applied for underwritten coverage, they turned me down based on non-existent things that it should have been clear to them that I didn't have because there was no treatment ever given. They'd have known about it if I had anything serious because they were my insurance company. E.g., I went to a cardio because I was having palpitations that turned out to be benign and the doc's office somehow put "atrial fib" as a diagnosis code on my bill. Believe me, there was no possibility of mistaking these occasional palpitations for a-fib. And wouldn't I have been treated for it? I feel like I'm owed a set-off for overpayment due to bad advice & during the appeal period since I should rightfully have been accepted into the plan.