ConsumerWatch: Timing Key To Insurance Policy Claims

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(CBS)

(CBS)

SAN FRANCISCO (CBS 5) – One ConsumerWatch viewer found that out the hard way that insurance providers can be strict about when their coverage is in effect.

This past New Year’s Eve, Chris Nygren started to feel chest pains and was rushed to the hospital where he underwent heart surgery. Luckily for Nygren, he had recently purchased a $10,000 supplemental Critical Care Insurance policy from Allstate that he thought would cover his procedure.

“Sitting in the back of your head, you’re going like ‘this is gonna cost an arm and a leg. I just hope I have enough insurance to cover all this,’” he said.

His primary insurance policy left him on the hook for several thousand dollars out of the $167,000 bill he had racked up during his hospital stay. However, his extra Allstate insurance did not come to the rescue.

“The insurance started literally 12:01, January 1…I went in on December 31, 7PM,” he said.

Those five hours, as Nygren would realize, would have a huge impact. Even though he purchased the policy back in October, he said that because he was admitted to the hospital five hours before his policy kicked in, everything that occurred that night was considered “pre-existing” and would not be covered.

Nygren tried to appeal the denial but was denied not once, but twice.

“It’s hard not to feel like you’re the David and they’re the Goliath,” he said.

That’s when Nygren decided to contact ConsumerWatch. After a ConsumerWatch producer contacted Allstate, Nygren said he was contacted by higher-level representatives from AllState and promised a payout.

Less than two weeks after ConsumerWatch intervened, Nygren received a check in the mail for $10,000.

“Really, a three, four hour window could make a huge difference to somebody,” Nygren said.

Allstate told ConsumerWatch that it was determined to do the right thing as soon as they were made aware of Nygren’s case.

(Copyright 2011 by CBS SF. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.)

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