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warmwardbound | What can I do if my insurance company is rescinding my past health insurance coverage? |
When I sent in my application for my health insurance, I forgot to note that I have obstructive sleep apnea. Stupid mistake, but I hadn't had insurance since I was 20 years old and paid of my OSA treatments out of pocket nearly two years ago. I had an expensive hospital bill in September for a completely unrelated illness. When my insurer pulled my medical history, they saw the OSA and sent a letter with reimbursement for premiums and said that my coverage was null and void. I feel that they should cover the bill since the illness was unrelated.
Additional Details
Also, I've began working for a company that offers group insurance through the same insurer that rescinded my policy! I didn't even have a lapse of coverage. I didn't purposefully omit the OSA. |
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mbrcatz
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Well, that's a pretty big disorder to forget about. "Oops, I forgot I'm a type 1 diabetic", kinda thing.
Sorry. It's YOUR mistake, not theirs.
Get on that group policy, and wait out your 18 month exclusionary period.
Meanwhile, you can always file a complaint with your state insurance commissioner - but the company is going to cite "material misrepresentation" which is true. They NEVER would have given you ANY coverage if you had disclosed the OSA. So the commish is likely going to uphold their denial and cancellation. |
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r2mm
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Anything less than full and truthful disclosure on an insurance application can be cause for the policy to be rescinded. They asked for full medical history, not what was paid with insurance. It doesn't matter if the current illness was unrelated to the undisclosed condition. |
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halfthebottle
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You falsified information, so of COURSE they shouldn't pay! Apply that premium check to your newest batch of medical bills and consider yourself lucky you got that back! Good luck getting insurance now... |
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sarah314
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Unfortunately, there's nothing you can do. (Sure, you can try to file a complaint w/your state's insurance commissioner, but you aren't going to win.)
It doesn't matter if September's hospital bill was related to your sleep apnea or not. Your policy became null and void entirely the minute that your insurer discovered that you didn't disclose your medical history on your policy.
BTW - its not just September's bill that won't be covered. Its *any* service (doctor's visit, prescriptions, etc.) that you've had since the policy went into effect. The insurance company will retract payments from any medical providers or pharmacies and will let them know that your policy is void. So, if you've had any other services done, don't be surprised to start getting collections notices from providers. (Even if you thought the bills were taken care of already...with your policy being made void, the insurer will take all of the money back on claims that had already been paid out for you.)
Situations like this are exactly why I always emphasize to people to not leave *anything* off your health insurance applications...you end up creating a big mess.
Like I said, you can try filing a complaint w/the state insurance department, but don't be optimistic about your chances. The insurance company has pretty substantial documentation for why they voided your policy.
As far as your group benefits go...group insurance policies are completely different from individual. Your medical history doesn't matter when signing up for a group policy. But when it comes to applying for an individual policy, your medical history is relevant. (Its the basis for getting approved or not for a policy, and also the basis for your premium level.) Omitting something from the application, whether it was intentional or not, is a *big* issue. As you're unfortunately learning now. |
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Joe
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You failed to identify a pre-existing condition and that is reason enough for the insurance company to refuse to pay a claim.
Many insurance companies have clauses in their policies that if you fail to disclose an existing (or past) medical condition AND if you have a medical claim within a certain period of time (can be up to five years), they have the right to refuse further coverage.
You don't mention how long you had the policy prior to having the expensive medical bill. Remember that insurance companies are in the business of making money for themselves and their shareholders. |
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Wendy S
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Mistakes like this happen all the time. Even though this wasn't deliberate, the insurance company does have the right to rescind coverage if you fail to disclose something that would have had them either decline to issue you coverage, or if they might have offered you coverage but at a higher rate.
Try calling the agent who wrote the policy for you, or the company itself if you had no agent. Sometimes you can get it turned around if your agent can convince them that the information wasn't purposely withheld, and they may be willing to issue you a policy at a higher rate.
It's not likely, but it is possible.
You can also negotiate with the hospital to give you a much lower bill rate.
It may be a good idea for everyone to keep a record somewhere of all of your doctors visits - what happened and when. That way you can just print it up and attach it to any application for health insurance.
Best of luck to you! |
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Rusty Shackelford
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Sorry, but you can't do anything. Insurance companies use specific language in their contracts to protect themselves from having to pay claims in any way they can. In this case, I'm sure you unintentionally, but nonetheless, violated the terms of the contract and have no grounds for recourse. |
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JaredBalis
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Yeah, if you had listed that in the beginning, they would have denied coverage. All they are doing is making things right on their end. If they diplicated that situation and covered everyone's ailments that werent listed, they would probably go out of business.
Jared Balis
http://www.utahinsurance.org
http://www.myinsurancequotes.net |
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DMEdwards
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All individual insurance has a 3-month probationary period. If you took out insurance, then immediately had an expensive procedure performed, that is like waving a red flag in front of a bull!!!
The problem is not the pre-existing condition. The problem is you used your insurance in a somewhat stupid way. Now, your insurance company is looking for a way to get rid of you, because they perceive you as a negative on their books.
Let's not forget, these insurance companies are in this to make money...they aren't necessarily interested in covering your medical expenses.
If you feel you have been treated unfairly, file a complaint with your state Department of Insurance.
Otherwise, let's learn the following lessons:
1) When you take out an individual policy, obtain a copy of your medical history FIRST. You can get this by going to the Medical Information Bureau at: http://www.mib.com/html/request_your_record.html
2) Report to the prospective insurer what is on the MIB. They know anyway. The rest of the disclosure process is up to you.
3) Make SMART decisions on how to use your insurance. Frankly, I don't believe in full disclosure if there are some conditions for which my insurer will NEVER pay for. And I DON'T use my insurance for every expense...only for emergencies.
4) And most of all, the 3-month probationary period is CRITICIAL. DON'T get any expensive treatments done in that timeframe!!
When you are on individual insurance, it DOES NOT work like group insurance. Group insurance does not take into account pre-existing conditions, whereas pre-existing conditions are practically God on individual plans.
And by the way - you CAN get insured again. Please see my site to get advice on how. |
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Ivanka F
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There is nothing that you can do about the poilcy being rescinded. I do take issue with the agent that told you that money paid will be taken back from the doctors. That is not at all true. The money paid will be held from any refund you are due. You will be entitled to every dime you paid on this policy; minus any claims paid by the company. LVHEALTHINS.COM has many companies that will insure persons with sleep apnea. Feel free to visit the site that helped me through this same situation. The illness was not sleep apnea but http://www.lvhealthins.com |
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