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Re: [IP] Coverage for pump education classes-what does it cost?

On 27 Jun 00, at 21:47, Samantha C. Rohwer wrote:

> On Tue, 27 Jun 2000, Michael wrote:
> > Don't worry yourself about it, just get a written denial, and file an
> > appeal. Let them know in plain but polite terms that they can pay the
> > bill or you will be happy to sue them for breech of contract -- this is
> > not a denial of benefits issue, but a matter of contract law. You can
> > probably even take the matter to small claims court if you wish.

> This is good advise, but you have to be careful with it.  In the state of
> AZ you cannot sue your HMO.  You have to sign a contract when you first
> sign up that says this.  All you can do is keep filing the               
> complaint here!

Those states where you cannot sue your HMO, Texas for one  :>( , 
an effective phrase to use with the insurance company is "Bad 
Faith claims practice."  You may not have the help of the courts 
but the Insurance Commissioners office will look harshly upon any 
company that can be accused of "bad faith" practices.  Mention 
the Commissioners office in your conversation also and see if they 
don't change their attitude.  You also might look to see if the state 
Insurance Dept. has an Ombudsmans office.


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