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Insurance co. mistakingly paying

I have a permanent rider on my insurance policy for anything to do with my breast because I failed to check the appropriate box concerning a diagnostic test 10 years ago when I made my application. I was diagnosed with breast cancer this past January and as far as I understood my insurance company was not supposed to pay a dime towards this. As it turns out they have been paying for everything except for the initial consultation and a few lab bills. I was told in the beginning that this would not be a covered expense because of the existing permanent rider attached to my policy. I know that they have made a mistake and in time will probably realize it. In the meantime this has caused me to not qualify for the breast cancer program through Medicaid because you can't have private health insurance and Medicaid so I'm afraid to say anything now for fear that no one will pay for my mastectomy and breast reconstruction. I am paying $567.00 monthly for my health insurance and I feel that they have been unfair to do this to me. I simply forgot about a diagnostic test I had done 10 years ago and checked the wrong box and they want to say that I have misrepresented myself and they are treating this as a pre-existing condition. What am I supposed to do? If I tell them and they want to recover the claims they have paid to the hospital (I also had a lumpectomy first) and then Medicaid doesn't pay either because of the Insurance involvement I'll be screwed. I need to know if the Insurance Company can go after their money from the hospital and if they don't get it can they come after me?
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replied August 1st, 2008
Insurance payments
Yes they can and will go after the hospital and then the hospital will go after you.
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replied October 7th, 2008
Community Volunteer
Call your insurance company first and get clarification on your policy, document who you spoke to, time, date, etc.... If you are told that your policy does cover these expenses, ask that they send this to you as you have 'misplaced' your benefit package.

However if they do not cover and have been paying all along they will be requesting their money back from the hospital and the hospital, inturn, will look to you for payment.

I would begin this right away as if they are paying in error you can go ahead and begin the paperwork with Medicaid as Medicaid has a time frame.

~Zig
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