My wife started a new job as a schoolteacher last August. She visited the doctor a few months after that to address a blood pressure concern. Now the insurance company is refusing to pay for that visit, because the company's policy is not to pay for preexisting conditions until the person has been employed for 6 months, and at the time of the visit, it had only been 5.5 months. Is this right? What recourse do we have? Thanks!
2007-03-23 03:28:45 · 8 answers · asked by M W 1 in Business & Finance ➔ Insurance
Was this a pre-existing condition before she was employed? In other words, did she know she had a blood pressure problem before the insurance went into effect?
If she had had a blood pressure problem prior to going to work there and taking out insurance, then they absolutely can deny coverage for a pre-existing condition. Some policies won't cover a pre-existing condition for a year. It varies depending on what the employer contracted for.
If she just got the blood pressure problem though, then it's not pre-existing. It's a new condition and I would fight it on that basis.
2007-03-23 03:49:46 · answer #1 · answered by Faye H 6 · 3⤊ 0⤋
All companies and carriers view pre-ex different. Also, depends on your state.
Generally speaking a pre-existing condition would be something she was treated for prior to her effective date. If the time period is six months then they would look back in her history 6 months.
Now, if she had other insurance prior to the new school insurance and didn't have a gap of 62 days then she can get a Certificate of Prior Coverage Form as proof and send it to the new carrier. They "should" credit those months toward the pre-ex waiting period.
All this is subject to your particular plans policy benefits, limitations, and exclusions
Being that your wife is on a school plan...their rules might be different than typical group health plans. Maybe ask them for something in writing to better understand what coverage you have and your limitations and exlusions. There should be a pre-existing condition section
2007-03-23 05:30:03 · answer #2 · answered by Jasmine 5 · 1⤊ 0⤋
Most insurance companies do not cover any type of preexisting condition for the first 12 months of coverage, so 6 months is pretty good. As the first poster said, you can try to get your doctor to wrangle it for you, but if they won't bite, there's not really anything you can do. Like I said, 6 months is pretty good compared to the customary 12.
2007-03-23 03:39:18 · answer #3 · answered by Anonymous · 1⤊ 0⤋
If you did not have medical insurance prior, then the pre-existing clause is legit. Only 6 months is good actually, most are 1 year to 18 months. However, if you had continuous insurance for the length of the pre-existing period. (you had medical coverage for the 6 months prior to her starting the new position) then the pre-exisiting clause is null and void under COBRA-HIPPA regulations.
COBRA laws were put into effect for this reason. It allows people to continue their insurance as well as void pre-exisiting clauses
2007-03-23 03:37:04 · answer #4 · answered by Mom of 2 4 · 0⤊ 0⤋
you dont have to see a dr for the condition before the policy started in order for it to be pre-existing. if the symptoms were there prior to. for example a person had insurance for 3 months never saw dr for heel pain but stated heel pain for 6 months that falls under pre-existing.
2007-03-26 13:59:27 · answer #5 · answered by Anonymous · 0⤊ 0⤋
if your spouse had non-end, creditable (and there's a key notice) coverage with decrease than a sixty 3-day hollow (and a minimum of twelve months of coverage) then she will't be denied coverage for her pre-cutting-edge subject. although, there's a danger that her previous coverage isn't seen creditable coverage. working example, if she had what's many times observed as an "open enrollment" coverage, this would not count quantity in direction of gratifying the creditable coverage standards. she will would desire to acquire a replica of evidence of previous coverage from her former coverage corporation and positioned up it to the present corporation. they'll respond in writing -- in case you don't comprehend the reaction, call them on the instant. The longer it is going on, the greater of a multitude it incredibly is going to be.
2016-10-01 09:09:10 · answer #6 · answered by ? 4 · 0⤊ 0⤋
Your doctor should be able to hande that with the insurance company, speak with someone at the doctors office, preferably someone who does billing, explain what has happened, they know the verbage to use with the insurance company to get it taken care of.
2007-03-23 03:35:40 · answer #7 · answered by Hot Coco Puff 7 · 0⤊ 1⤋
if she had coverage prior to this and there is no issue in her records about this.. your doc can help you with this
2007-03-24 19:21:55 · answer #8 · answered by larsgirl 4 · 0⤊ 0⤋