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luckyy721 | If I purchase insurance and require surgery 1 month later, is there a time gap that is needed? |
Does there need to be a time gap between the time period that I purchase the health insurance and the time that I get my eye surgery? Or is it considered an emergency and it will cover it?
Additional Details
I have not told the insurance company about it, but this is NOT a pre-existing condition. Pre-existing condition is defined in Texas as if you have previously seen a doctor about it and its has been diagnosed within the past 12 months. But I have not been to a doctor yet. And the doctor I am going to said that he will not classify it as a pre-existing condition or tell the insurance company about it. |
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sweetxgrace
 |
I would highly doubt it. Read EVERYTHING concerning your policy. More than likely your insurance will deny it, because it is a previously known condition. |
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mbrcatz
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If you know you need it now, and do not tell the insurance company, that's material misrepresentation. Do NOT try to play the lawyer based on hearsay from your friends & relatives. And if you ARE going to insist on playing the lawyer, good luck prosecuting the insurance company in court when they deny your claim and cancel your policy for material misrepresentation.
Believe me, if you have surgery within several months of starting a new policy, they are going to investigate pretty darned closely. Sure, your doctor might be willing to lie and commit insurance fraud which would get his license pulled, just for you . . . but if you're betting on that, well, I have some great land in the gulf I want to sell you. |
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Zarnev
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Did you have the condition that is requiring surgery prior to getting the policy? If so, did you tell the insurance company? If you had the condition and told the company they probably have a waiting period for that condition. The waiting period will depend upon your state laws and the insurance that you have. If you did not tell them they may cancel the policy and make you pay back anything they've paid out for you. If you did not have the condition then there is not any waiting period, although the insurance company may investigate to make sure you didn't have the condition. |
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jsfnita
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I would read over the policy carefully. Wait until whatever date you need to. If your state says it's not pre-existing unless you've seen a doctor then I wouldn't worry but their might be something in there about surgeries. |
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alcaholicdemon
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you better read the fine print.my husband just signed up for insurance and then had a total heart blockage,and was taken in hospital as an emergency,and because he didnt wait the 3 month time,they wont pay his coverage.now we have to pay tens of thousands of dollars,for his bill. and also he has no doctor to help him with his rehab or perscriptiions. |
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dimples_in_nj
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Texas is your friend as insurance carriers are unable to pend health insurance claims pursuant to state law. Also, the pre-existing condition limitation in that state is extremely in your favor.
Having worked for a carrier that does a lot of business in Texas I had a lot of exposure to this topic.
The eye episode would probably not be considered an emergency event as this is normally defined as treatment necessary within less then 23 hour period. Given your circumstances, I find a denial unlikely however; like all medical surgeries I would suggest a pre-determination by the carrier prior to services being rendered.
Texas has more insurance laws then people and an extremely unfavorable state for carriers to do business in. They merely pay the fines, pay the claims and formulate both into your premium.
FYI- You may want to confirm with your carrier that your contract state of your insurance is in fact Texas and if your company is self-funded. If not, you will not nearly have the same protection as your medical plan rules will not be dictated by Texas jurisdiction. |
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