I have health insurance provided by my employer through a TPA service provider. Recently I had to undergo surgery for torn ankle ligaments. I have submitted all requisite documents and my claim has been approved. About 10% of my claim amount which includes Consultaion Charges, Medical Imaging & Misc. charges have been termed “Non-Payable”, the reasons for which I have not been disclosed.
I wish to seek advise from fellow members on this forum as to whether it is possible for me to seek clarification from the TPA on the same by law. Also if they choose to not reimburse me for my Imaging films (MRI) can I ask them to return the films back to me?
Thanking you