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coop439 | Pre-existing condition? |
I have been in turmoil with the temporary insurance company I purchased a policy from a year ago.
Last January, I had a pain in my side for about a week that wouldn't go away so I purchased a temporary insurance policy so I could go to the doctor (they said my pain was most likely a stomach virus). I was unemployed at that time. Well, I went to the doctor in the December prior to that January for pelvic pain. Turns out I had an ovarian cyst but it had gone away by the time I got an ultrasound on it.
Now this temporary insurance company is saying my condition was pre-existing even though one had nothing to do with the other and I had never been treated for the stomach virus. I've given them all the information to prove otherwise and they're not giving in. They said I can appeal their decision but what are my chances with that? HELP! |
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Fatdude427
 |
Insurance companies are evil. They just want people's money. They don't give a damn about people's lives.
I would appeal the decision. Hope for the best.
I have had bad things happen with insurance companies, too. It sucks. |
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Suzanne: YPA
 |
Read the definition of "pre-existing condition" in your policy. In all likelihood, it will include as a pre-existing condition any undiagnosed condition present before the effective date that produced symptoms that would have caused a "reasonably prudent person" to seek medical care.
You state within your question that you had the pain and realized you needed to seek medical care, so you purchased the policy. I'm sorry to be the bearer of bad news, but if the policy defines a pre-existing condition the way I've described, then the insurer is correct. With policy wording like this, appealing the denial wouldn't get you anywhere.
Yes, you could also contact your state's insurance commissioner's office. But they won't be able to ignore the plain wording of the policy, so they would have no choice but to uphold the insurer's determination -- leaving you in the same place you are now. So I recommend you begin to formulate a plan as to how you will pay for these services. |
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mbrcatz
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If you didn't disclose the other condition, when you filled out that application, then you lied.
Your best bet is still to appeal, and you can file a complaint with your state insurance department. The REAL issue is, you had something wrong with you, BEFORE you bought teh policy, "so you could see the doctor". People try to do this ALL THE TIME. Insurance companies are wise to it. You're probably not going to win, based on what you said here. |
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tswann77
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Another option is discount health benefits. You don't have the high cost of the monthly Ins rates, co-pays or deductables. The monthy rate is very reasonable for anyone to have. Plus all on-going health problems are accepted. You can go here to find out more about it: www.everyonebenefits.com/trodgers |
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G N A
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Shop around and find another insurance company. You still may find that the 'pre existing condition' may apply, but at least you will get better service than this.
Do it before anything else turns up because from what you have said, they want a medical history. |
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Anne R
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You went to the doctor in December of 2005 for pain and he ordered an ultrasound. You had the ultrasound and it was negative. Am I right so far?
You applied for insurance in January of 2006 but you didn't reveal on the application that you had seen the doctor in December 2005 and had an ultrasound. Even through the ultrasound was negative, you should have given that information to the insurance company. They may have increased your rates, denied you coverage, or it might not have effected your application at all and you wouldn't be having the problems you have having now.
I would appeal the denial. A negative ultrasound and a stomach virus are two different things but right now the claims representative doesn't have the advantage of the ultrasound report to make that determination.
Obtain a copy of the ultrasound report that shows it was negative. If this was done at a hospital, call the medical records department. Normally, they will ask you to sign a release. Ask your physician's office to you writing a letter explaining that you were recently seen for a stomach virus. Submit all that information with the original denial. Remember, there is a deadline in filing an appeal so read your Benefit Booklet and make sure you don't do all this work and then miss the deadline. Good luck. I hope you are feeling better. |
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