Another Issue I have been Dealing With

As some of you may remember last year I had serious trouble with my feet/ankles that required numerous visits to my GP and a foot specialist. I lost about a 4-6 weeks worth of wages due to not being able to work, spent money on Rx's, etc.. To make a long story short, my BLEEPING (now former) insurance company is refusing to pay for the custom molded orthotics that they pre-approved.

This battle has been ongoing since September, the HR department at my job has been attempting to help, but we think that the insurance company's attitude is f*** you since we no longer use them as our insurer. My problem now, this bill of $259 is going to into collections by the end of the month.

[Please note: I never would have gotten these orthotics had I known there would be personal cost other than our co-pay. At the time I was seriously considering bankruptcy and I did not want to add more debt. That is why I got pre-approval, to know what I would have to pay.]

The service provider for my orthotics have been helpful, and informed me that if I could make a $25 payment they would be able to keep it out of collections. Now I have to scrape together the money to do so and hope I can get reimbursed.

So my new question(s): can I sue my former insurance provider to compel them to pay? or, can I sue in small claims court to get my money back if I pay the orthotics company?

I do have "evidence" to show they are required to pay. I can show that there was a coding error on insurance company's part, as orthotic company has shown/documented that they coded it properly when they submitted bill to insurer. Also, my policy states that orthotics are "paid 100% after $15 co-pay". I can also show that insurance company has been mis-leading, repeatedly stating that this bill was paid after it was brought to their attention--FALSE!! My employer can show that there is a pattern of "lies" as I am not the only person having this problem.

So now I need to investigate my 2 questions and decide what direction to go. The above problems is partly why my employer dumped this company. They were/are horrible.

Will keep y'all posted on how this turns out. I just hope our new insurance company is better!!