What Do I Do When Health Provider Doesn’t Honor Contract?



I have joined one of the Health Care Insurance Group. As a member they gave me a Members Kit, which has the Exclusive provider Organization Contract. In that contract under Section 6.1.8.Screening for Prostrate Cancer; it states that the Insurance Company covers an Annual standard Diagnostic Examination not subjected to Co-payments or Deductibles when provided Participating Provider. I had my prostrate checked and when the bill came ; I not only have to pay half of the bill but also the Copayment also, which is over $11,000.00. I protested it but the review committee said I must pay. Ignoring, not honoring their very own rules.

Who can I go to, other than this insurance committee to look into this matter? Its like the fox watching the hen house. I pay my monthly dues, all of my prescriptions, and doctors visit fee $150.00 for every time I visited this year.

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