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Pre-existing Condition Clause

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Toogoofy317 non-obstructed hcm, AICD 11-01-02 and 10-6-05 Find out more about Toogoofy317
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  • Linda
    replied
    Now I must check this out also. We have one more wk to deal with this before the BD kicks our son off our policy. Linda

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  • mtlieb
    replied
    Mary,

    I wanted to wait until the 'HCMA' answered first since technically only staff and moderators are supposed to answer here. I've lived in many states and also dealt with Cobra in the past and i have been surprised how much the laws vary. I looked into Cobra in Montana when a project ended and assumed that if i paid the full premium out of my pocket the covereage would be the same as the insurance it was 'replacing'. Isn't that what Cobra is for, so you can continue your present coverage temporarily until you can get a new one? Boy was i wrong. It covered almost nothing.

    Jim

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  • Lisa Salberg
    replied
    You have to look at State law and Federal Law and read the policy to know for sure what your rights are - I can not give you a blanket 'Yes or No' with out looking at all of the information.

    Lisa

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  • Burton Borrok
    replied
    Well Pumpkin,
    I would suggest you first drag out the insurance policy that is now in force and read it slowly and carefully. Find out there definition of pre-existing conditions, and whether the transfer from the Cobra policy has any bearing.

    Next, check the law in regard to pre-existing conditions under both State and Federal guidelines, and the transferability from your old policy to the new one (I assume there are two insurance companies involved between Disney and the Hospital.)

    If, after reading the policy and checking the law covering such cases, you think you are right - go get an ACLU lawyer, or a Legal Aid lawyer, or the local Bar Association, or any legal society that may be available to you locally, and get their help in processing your claims. If on the other hand, it appears that the insurance company has the right to disallow your claims, see if the hospitals involved will waive any fees due. If not, all you can do is file for bankruptcy. The whole reason for the bankruptcy laws is to allow people with no other options to continue living a life outside of slavery.

    By the way, if appropriate, find out how long an insurance company can disallow claims based on pre-existing conditions. If memory serves, that may only be for six months before they must accept charges (or a year for senior citizens.) In any case you can IM or email me if you need me and I will try to help you as much as I can.
    Grandpa

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  • Toogoofy317
    started a topic Pre-existing Condition Clause

    Pre-existing Condition Clause

    When I left Disney to work at the hospital. I had no lapse in insurance coverage. Actually, I had both for two months just to make sure I was covered under the Cobra Act. Well come to find out the insurance company does not want to cover any of my medical bills for the past year. As you know thats a lot of visits and money. I sent them my certificate of portability about six months ago and again last week. Today I got a letter stating that all of my claims are denied due to my pre-existing condition.

    Is this legal? If it is I am financially ruined. What would be my next step?

    Mary S.

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