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I had Health insurance through Assurant with a maternity rider. They will not pay because of a "complication"?

I had a Major Medical plan through Assurant with a $5400 deductible. I had a separate maternity rider with a $2500 deductible. Everything went ok until the delivery. They paid for the prenatal care and that sort of thing, although I had to call them many times to get them to file claims under maternity instead of major medical. During delivery, forgive the details, my wife had a minor laceration which required a single stitch. It was nothing major, just one stitch. Assurant claims that it is a "complication" which means that it goes under major medical instead of maternity insurance. I could understand it if it was a c-section or something like that, but a stitch? Bottom line, the hospital charges were applied to major medical instead of maternity, thus, it was subject to the separate deductible which means I have to come out of pocket with another $5000. I have talked to Assurant several times and they have told me that the hospital needs to change their diagnosis code if I want them to pay it. After a year of going around with the hospital they say they are required by law to keep the diagnosis code that they have. They say, however, that a minor laceration is not really a "complication" and that it happens to most women during delivery. Can anyone tell me how to fight this with Assurant? I am so frustrated and would appreciate any help you can give. I would especially like to hear from Assurant agents as to whether this can be fought and won. Thanks in advance! Jeff

Public Comments

1. I think you need to file this complaint in writing with the state insurance commissioner.
2. health-quotes.isgreat.org - try this one. My sister had no problem with her insurance coverage while being pregnant.
3. What did the insurance broker you bought the policy through say? That's who you should be asking.