NC man gets insurance claim runaround waiting for his money; ABC11 Troubleshooter gets him results

Diane Wilson Image
Wednesday, May 1, 2024
Insurance runaround for NC man waiting for his money
The man had surgery and previously paid out of pocket for benefits in case he was hospitalized. When it came time to take advantage of those benefits, that's where he hit roadblocks.

KNIGHTDALE, N.C. (WTVD) -- A Knightdale man says he is fed up waiting for his money.

James Marable previously had surgery and paid out of pocket for benefits in case he was hospitalized. When it came time to take advantage of those benefits that's where he hit roadblocks.

"They said, they mailed out a check for a certain amount on January 22. I never received that check in the mail whatsoever," he said.

Marable said the first problem with the insurance payment is that he never received the check from the third party handling his claim.

The second issue is a mathematical error on the paperwork that explains the approved coverage. If you add up the coverage approved on the statement, it says $800 for daily in-hospital benefits and $400 for daily recuperation, that's $1200 not $1,000 which is stated on the paperwork.

Marable said he called the company listed on the letter ESIS to try and resolve the two issues.

"They said, well, they did a wire transfer that was about a month ago, but I never received it," he said.

Marable said he continued to call to get his money.

"This is my own private insurance that I pay every month for. I had surgery and, you know, my bills are piling up and what can I do? All I can do is just sit and wait," he told ABC11 Troubleshooter Diane Wilson.

Wilson reached out to ESIS, and they never responded. However, Marable did get a $200 check, but the $1,000 was still missing. That's when Wilson reached out again to ESIS and Marable and filed a complaint with the NC Department of Insurance.

In a letter, the insurance company Marable contracts with said they weren't aware he didn't get the $1,000 and overnighted him a check.

Marable says he has the full amount he's owed and is happy.

In the letter to the NC Department of Insurance, the company where Marable had the insurance apologized for the confusion and frustration.

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