Tamer1982
Member
I’m in Texas and dealing with an issue with my health insurance company.
Before a procedure, I called the insurance company twice on the same day, and two different representatives both told me the procedures were 100% covered. Based on that, I went ahead with it. Later, I got a bill for about $600.
When I called back, they reviewed the case and actually admitted that their reps gave me wrong information. They said the calls are recorded, but they refuse to share those recordings with me. My policy does say I’m responsible for 20%, but I only did the procedure because I was told (twice) it would be fully covered.
I filed a complaint with the Texas Department of Insurance but didn’t get any resolution. Now I’m thinking about taking it to small claims court.
Do I have a real chance to win since they admitted their mistake, or will the written policy terms override everything no matter what?
Appreciate any advice from anyone familiar with Texas small claims or insurance law.
Before a procedure, I called the insurance company twice on the same day, and two different representatives both told me the procedures were 100% covered. Based on that, I went ahead with it. Later, I got a bill for about $600.
When I called back, they reviewed the case and actually admitted that their reps gave me wrong information. They said the calls are recorded, but they refuse to share those recordings with me. My policy does say I’m responsible for 20%, but I only did the procedure because I was told (twice) it would be fully covered.
I filed a complaint with the Texas Department of Insurance but didn’t get any resolution. Now I’m thinking about taking it to small claims court.
Do I have a real chance to win since they admitted their mistake, or will the written policy terms override everything no matter what?
Appreciate any advice from anyone familiar with Texas small claims or insurance law.