What is a letter of creditable coverage and why does every insurance company want one before they cover you?

Question

What's the deal with these things anyway?

Answer 1

The letter of creditable coverage lets the new insurance company know if you have had recent insurance coverage and it comes from your past insurance company.. The main reason they want one is because of pre-existing conditions. If you've had insurance you've probably been treated for those conditions and are in better health. Your new insurance will then waive much if not all of the waiting period for coverage of those conditions. If you've not had coverage that means the insurance companies are taking a bigger chance on you because your medical history is unknown. They will then impose the full waiting period for any condition you had prior to the effective date of the policy.

Answer 2

To reiterate what the others have said, a letter of creditable coverage is similar to your HIPAA certificate. It shows that you have had previous insurance coverage, which saves you from having to met pre-existing condition time periods.

Some companies will add you to the coverage before you provide your COCC or HIPAA, understanding that it can take some time to get it from previous insurance, just let them know that you're still waiting on it. Medical claims may be pended for this information, however, so turn it in as soon as you get it.

If you had coverage, but not a full 12 months, that's okay. Give your new insurance that COCC. It will help cut down the pre-x period. If you had coverage through multiple employers in that 12 month period, and you did not have more than 63 days between coverages (and that's actual time, not qualifying time) then you can use all of your COCC's together, to make up 12 months of coverage. Make sense?

The 63 day rule means 63 days between instances-if you start a new job 60 days after your coverage ended with your previous employer, but your coverage doesn't start for a month, you're still okay.

Also, an employer and insurer must accept anything you can provide that shows what kind of coverage you had and that you actually had it, including check stubs showing the deduction, with something to back it up to show how long you've had coverage, or a letter from your previous employer, or even a copy of your enrollment form. If you need something, call your employer and ask for it.

Answer 3

A letter of creditable coverage is a statement from an insurance company stating that they have covered you in the past.

The idea here is this: a new employee signs up for company insurance. The insurance company wants a waiting period of six months or so before they'll start covering you - but a letter from your previous insurance company shows you've already been insured and there is no need for the waiting period.

The 'creditable' coverage is the period you were already insured - a period the new insurance company would normally make you wait before they'd cover you.

Answer 4

Letter Of Creditable Coverage

Answer 5

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RE:
What is a letter of creditable coverage and why does every insurance company want one before they cover you?
What's the deal with these things anyway?

Answer 6

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It is up to the patient to understand their medical coverage, and to know what is covered and what isn't. As a courtesy, the doctor can verify your medical benefits with the insurance company, but they're certainly not required to do so. You wouldn't buy a car without knowing the price - why would you accept medical treatment without knowing how much it was going to cost you? Someone above me wrote that you should pay the doctor $25 a month and they can't sue you if they accept payment. That's not entirely true. They don't have to accept your payment at all, in which case they can take you to court and get a judgment against you and start garnishing your wages. Just because they accept a $25/mo payment from you doesn't mean that at some point they won't demand payment in full. You need to talk to the doctor's office and work out an acceptable payment arrangement with them.

Answer 7

Ok I believe you got one of those crummy plans they advertise on tv that is cheap and they only pay "X" amount for everything so basically you end up paying 80% for everything. They probably brag that they cover well visits which is good since they maybe around $100 or less per visit, but as you see, when you get outside treatment like a specialist, go to the ER, get zapped with huge bills since they cover so little. Call an agent and see if you qualify for a "real" insurance plan. But'''''due to this procedure and if you have any other conditions you may find yourself un-insurable. That is the reason for talking to an agent, they will know. Granted all doctor's office ask for your insurance and make a copy for their records, but unless you ask them or you call 1st, most will not verify if something is covered or not, or if you get on the hook for the bill. In reality, the doctor did give you a "hint" that you would be on the hook, when he stated that its not fully covered by your insurance, but stating that should not be a problem. (not a problem when you are stuck for $2,400?) It would be great if all doctor offices would call 1st and verify, but that most likely would be unrealistic. Say someone has Blue Cross which is a huge company. They have maybe 100 different plans out there with different deductibles, co-pays. Some plans may cover something whereas another may exclude. The other argument is that in many offices they have 2 people handling billing due to so many companies out there and fighting them for payment etc. For the meantime. I suggest you call the doctors office and see if you can negotiate the bill and get on a monthly payment plan. The next time, most likely before anything is done, you will be on the phone prior or ask the amount charged and then tell them to verify before its done and too late. good luck

Answer 8

Not every company wants such a letter. I have never been asked for one.