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Insurance questions

hoagiemom's picture
hoagiemom
Posts: 87
Joined: Feb 2007

I don't know if anyone has any advice on insurance but I really have to vent. I went to my GP Dr in Oct and told them that I had seen blood in my stool so she scheduled me for a colonoscopy. In Nov I saw that Dr with my insurance and we scheduled the colonoscopy in Jan. Well my husband changed jobs and we switched to his insurance In Dec.because it was cheaper. So in Jan I got my colonoscopy and they found my polyp and scheduled my surgery for Feb 5th and then found out I had cancer on Feb 15th. Well now my husband's insurance is refusing payment and will not pay for any of my treatments because they are saying it was pre exsisting case. How could it be pre exsisting when we didn't know until Feb 15th. I'm so frustrated we have $15,000.00 worth of bills and I start chemo on Monday. Do you think they could really refuse making payments? Has anyone had any other problems with insurance? I was so ready to start fighting this disease and now I also have to worry about how I'm going to pay for it. I just feel like my whole world has been put upside down since Jan and now I have one more thing to worry about. My husband says not to worry it will work out but it is just so frustrating. Believe me if I knew what my outcome was I would've kept my insurance. Thanks for letting me vent.

Michelle

hopefulone
Posts: 1048
Joined: Jan 2007

File a written appeal as quickly as possible , and and find out what your state insurance law is regarding pre-existing conditions for health insurance . I believe, since you were diagnosed after you started the insurance with new company, it wouldn't be seen as "pre-existing'. The key is that you were dx after starting the insurance. The symptoms you had prior , could have been a number of other things. Point that out in your appeal. The National Coalition for Cancer Survivorship (NCCS) points out that cancer survivors have a pre-existing condition from the time of diagnosis through the remainder of their life, since a cancer survivor usually needs to see a physician at least once a year for a checkup. I'm willing to bet they wind up having to cover claims. Good Luck and God Bless.

Betsydoglover's picture
Betsydoglover
Posts: 1254
Joined: Jul 2005

Here's a good link from Department of Labor.

In general under HIPPA if you were previously covered by health insurance and you didn't have a coverage gap of more than 63 days, the new insurance can't impose a pre-existing condition period.

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

Good luck,
Betsy

MCarr's picture
MCarr
Posts: 20
Joined: Feb 2007

My understanding and experience says that Betsy is right. 'Pre-existing' conditions don't matter as long as you don't have a gap in insurance. Some States may be different, but I know that is the case in most. Companies change insurance coverage all of the time so tons of people would have pre-existing conditions.

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