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Old 06-23-2015, 07:23 PM   #7
wretched34
Scoring Winger
 
Join Date: Apr 2009
Location: Lethbridge
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Not a lawyer, or an insurance claim agent, but have worked in HR for years, and have seen my fair share of queries like this regarding benefits, especially out of country medical.
Out of country is finicky at best, as you've noticed medical bills, especially from the states are very costly, and insurance companies always look for loopholes to get out of paying.
The biggest loophole is definitely "pre existing condition". this is likely where the denial came in, as they have evidence that she has been assessed for heart issues in the past, and likely at her doctors advice put that she did not have any heart issues on the application. It sounds like this is true, but again, insurance companies will deny at every opportunity, and make the insured put in the time and money to prove otherwise.
Having her Doctors on her side is definitely a good start, and hopefully with enough push back from her, and them, the insurance company will reassess. Otherwise it will need to turn legal.
Sorry I can't be of much help as far as actually pushing the claim through, and probably didn't shed much light on the situation, but I like the look of my own text.

Glad she is home and well now though!
Best of luck, hope you can get what is due, I hate insurance companies.
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