Long story short, my family switched insurance in May… I thought everything was fine. I’ve been to a few different doctors for a few things since the switch, no biggie… those claims were paid with no trouble. I’ve been filling Rx’s since May with no trouble (nearly $3k worth at this point).
I saw my endo and eye doctor two weeks ago… and now my insurance won’t pay for those visits because they were for a “pre-existing” condition! I called my isurance last week because I got a letter in the mail, requesting my previous insurance info before they would pay the claim… okay, fine, I gave that to them, they said everything would be fine, and asked specifcally if they needed a certificate of coverage from my old insurance and they said NO. At the same time, I had them correct the spelling of my duaghter’s name since it was wrong on our insurance cards. They said everything would be taken care of, and it would take 24-48 hours to get updated in their system… okay, no biggie. I got another letter 2 days later for another claim, and I called back, just to make sure, and again, I’m told that it should be cleared up in 24-48 hours, and they’re not sure why it wasn’t updated. MMmmmkay, that’s a little weird, but I know things happen. My daughter’s name WAS fixed though… which really makes me wonder. They never said ANYTHING about having any pre-existing limitation on my policy… didn’t even suggest it.
I’m trying to get back on a pump too, and my animas rep told me that my insurance told him Friday that I have a pre-exisiting condition limitation in effect until 12/31!! What?! I was not uninsured when I went on this new insurance… I moved from one group plan to another, I thought they could NOT do this? I fully disclosed everything on our insurance application, including that I was diabetic along with my prior insurance information… so they should have already HAD that. I was never notified in any capacity that there would be a problem… I had no reason to suspect there would be. Why would they offer this information up to my pump rep, and NOT tell me?!
I called up my insurance again yesterday, and they simply told me it hadn’t been updated yet… again. That’s call #3. I see that another claim (for labwork) also went through yesterday, and it’s also listed as “pending review”. What the heck?! According to the first person I spoke with it should have already been taken care of!
I don’t have a spare $862.89 to just shell out if my insurance isn’t paying these… especially since I really had NO indication that they wouldn’t or shouldn’t, and I am so ticked off! Not to mention there will be another claim going through soon for the appointment i just had with my CDE on Wednesday… ugh… just ugh
I know the feeling Sarah. I worked for a life insurance company before so I read the fine prints of the contract. My insurance company did not cover much during the first year… In fact most (if not all) illnesses I had was not covered. I declared that I have diabetes and asthma upon application. And both were not covered since they said its a pre existing condition (one year contestability period). Ok then, I said. ThenI just found out that most of the illnesses I had was also not covered, why? They claimed that these illnesses are “predisposing factors”, or illnesses that are brought about by pre existing ilnesses or that I am more “prone” to having it. Geez… how on earth can I know that? The only ones covered are injuries brought about or are accidental by nature. The second year they finally covered the pre existing ilnesses.with the exeption of ALL medications and equipmnets if classified as “out patient”. They covered all check ups, laboratories and confinements. Thank God! Considering they jacked up my premiums by 90% and required a medical certification from my doctor that my diabetes is “controlled”. Oh well…UGH!
really? how long have you been on that “plan”? was there a span of time where you had no coverage? If not, what they doing is illegal. there are ramifications to this, as will force the employer to redo their contract, however the insurance company DID know this was illegal. It has been for years. they’ll keep it up until someone complains.
I think that your old insurance was required to send you a certificate of coverage–we chagned in May too–was supposed to be a “seemless” transition–well you can guess the rest of that story–but the previous insurer sent a certificate of coverage and I at least had no problem with pre-exisiting conditions (Asthma, diabetes, kidneys-not diabetes related, thryoid…etc)
As long as you have had no lapse thy are not supposed to be able to calim a pre-existing conditioin
We were on cobra for 18 months before this switch, so I think that counts as credible coverage
I have been uninsured in the past, but not for quite some time now.
I always assumed that with group insurance, they couldn’t do this… except that it seems it isn’t true. They can’t deny you medical coverage, but it is in the fine print that they CAN impose limitations. We signed the form stating it, I just didn’t read it very closely, becuase I was being assured by DH’s employer that it was going to be fine
Tell then that you are going to report them to the insurance commissioner of you state. Ask them is this a form of discrimination. Ask them you want the name of the person would ha denied your claims, in case that your lawyer wants to bring that person to court.
Sometimes you just have to lay hard ball…Threats go along way!
GOOD LUCK
It’s called a certificate of credible coverage - as long as no lapses or less than 60 days shouldn’t have a a pre-ex problems. It standard operating procedures now days . You get it from your prior carrier
