how can a health insurance company do something like this? very confused on this?

Question

I had a visit two months before I was forced to changed coverage(I was coming off my parents insurance to an individual policy) to a chiropractor's office. The reason for my visit was that I was feeling sort of stiff and that I wanted to see how I'd feel after that. When I obtained my new policy I had an exclusion on it for any outpatient back treament of any kind: due to ongoing back problems.
When I called the plan up(golden rule by united healthcare plan 100) they led me to believe it was a misunderstanding and that I should have the doctor send in the information to them for review. Turns out they reviewed the information and the only thing they changed is now I am not "excluded for life" but will be reviewed a year after my policy is in effect to see if I am eligible for these benefits. When I called them up again customer service told me in simple words that if I had gone to any doctor recently any such possible symptoms and conditions would be excluded for at least a year.

It did not matter I had a preventive healthcare type visit and NOT an ongoing condition of any kind. This lady also let me know in no small terms that their underwriting department can decide whatever they want based on this guideline as long as it quote" financially protects the company from excessive claims." What the heck is up with that?
That means that if I would of gone to a doctor and said I maybe had say.. a head cold I would be excluded for life for any benefits if getting a cold? Or had I been at a doctor to see about a pain in my knee I would of been excluded for life if I ever developed any knee condition?
I believe they want way too overboard in my case and they made an incorrect decision. Problem is . what can I do?

Also with these exclusion added they changed my rate up from the time I applied by over 20% because I am now a standard instead of a preffered customer by their definition. They also said that if I go to the chiropractor even once a year even if I went to ask a question I will automatically be declined when I come up for review that once a year time.

Answer 1

Insurance companies don't like to insure bad drivers, bad hearts, people with terminal diseases, or people with chronic physical conditions. There's no making of money in that. These companies are not for public service, but for your protection in case of an unforseen condition or accident. In your case, your back problem will not make them money. Good luck and I sincerley hope your back repairs itself, as I've hurt my back badly, but now is fine. The best way to help your back is to keep moving and don't let the muscles shrink or get weak in spots.

Answer 2

The only thing you can do, is go find a new insurance policy. HOWEVER, the new company is likely to exclude it as well. Pretty well guaranteed, actually. And don't hope that all of a sudden, stuff will be covered in a year.

People who use chiropractors, tend to use them a lot. And when something goes wrong, you need a lot of "adjustments" to make it right again.

You went to a chiro. There is an "undiagnosed" preexisting condition - the stiffness. A PRIVATE policy is allowed to exclude whatever they want. A GROUP policy - like through YOUR employer, can only exclude stuff for 18 months. So.

Get a job with group health coverage, and switch over.

Answer 3

This is the reason a lot of the population of this country did not want this law passed in the first place. This law is supposed to make an insurance company accept you as a client regardless of any illness you may have, and cover you for everything as long as you pay the premiums. Something in this law is supposed to make insurance more affordable, exactly how it is to do that I am not sure. In practice this will in time make insurance premiums go even higher or make the insurance companies go bankrupt. You can not operate a private company in the red the way the country is running in the red. In time the insurance companies will fold and the goverenment will decide when you stop getting healthcare.

Answer 4

As I understand it, individual policies can exclude almost anything you have been treated for. The only policies that don't are group to group and that is only if you have had no break in coverage. A one year exclusion for a back problem is at least a liveable exclusion.

Answer 5

You can try appealing. But, considering that your doctor already sent in your medical documentation for review, odds are that the appeal won't go in your favor. (Unless there's more medical documentation that the insurer hasn't received yet.)

What you're describing sounds pretty standard for an individual policy. You might not encounter the same issues on an employer group policy though - if you have any opportunity to get covered on an employer group policy, I'd try to go that route.

Answer 6

Hmmmm...kinda confused.......

Pre-existing conditions are carte blance denied for anybody anywhere if you were, at any time prior to the inception of your policy, UNINSURED.

Soooooo - what you've written about what the insurance company is correct...if you WERE NOTinsured previously.

If you WERE insured previously, you can get a letter from your prior insurance carrier to present to your new insurance carrier to PROVE you had insurance.

If ANY time elapsed between when you were insured and then UNINSURED...then yea - they have you between a rock and a hard place. I don't know of ANY insurance that will provide coverage for a previous pre-existing condition if you were previously UN-insured.

Good luck to you.

~jifr!

Answer 7

Read the January 08 Consumer Reports magazine.The article on the status of Heath Insurance is very informative. If you are not one of the 60% with group health insurance you should pray that you don't get a serious illness.

Answer 8

"customer service told me in simple words that if I had gone to any doctor recently any such possible symptoms and conditions would be excluded for at least a year."

in most states, this is normal underwriting action. get used to it.

Answer 9

They want to exclude any existing problem. They are in it for the money not your benefit. Be glad you don't have a heart condition.

Answer 10

It is pre excluding conditions Really sucks if you have a major illness the only way really around is if you join via an open enrollment at which time any pre existing conditions are generally accepted