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What do u do if your insurance has a clause stating they WILL not pay for pre-existing conditions for a year? |
I was diagnosed with PCOS about 8 months ago. Ijust found out my insurance company has DENIED all the claims. They consider my "condition" to be pre-existing. What in the heck am I to do? I cannt afford to get off my meds. I have to wait a year until I am covered for this . Arghhhhhhhhhhhhhhhhh! I am very upset. I pay $100.00 a month for this insurance. Why???? Only your doctor can explain why your condition is considered pre-existing. Call your physician and ask if there are any programs that he/she is aware of to help with medical/prescription costs. You might also try the Department of Health and Human Services. If you were diagnosed eight months ago, you could just wait four more months, then get another diagnosis First of all, did you have the same insurer at the time of diagnosis? If yes, then the time you were diagnosed is when you became aware of the disease. That is like saying if you had a heart attack and were just diagnosed, you had preexisting coronary artery disease and they will not cover it. By that rational, they could deny you for any disease. However, if you and your doctor were aware that you had PCOS (whatever that is) at the time you signed up for the insurance, you are stuck with paying out of pocket for a year. If your job has a healthcare spending account plan, this will take money out of your paycheck, pretax, to pay for your uncovered expenses. You can appeal the denial of coverage to your insurer if the diagnosis was not made prior to their covering you. Have your diagnosing physican write a letter backing this up. You can also go to your state's insurance commission to appeal the issue. RN Unfortunately that is a pre-existing condition. How long have you had the insurance? Obviously you knew about the condition. If you applied recently, did you leave that off the application? Did the agent who sold it to you not explain that pre-existing conditions weren't covered for a year? If you coverage is new, did you have coverage prior to that time? If you have group ins thru work, and you have had continuous coverage, ask if that clause might be waived. First of all, did you have any lapse in coverage before coming to the insurance plan that you have now? If you did, you need to send your current insurance plan a "Certificate of Creditable Coverage" which by law, your prior plan has to send to you, showing the dates of coverage you had with them. This could take care of the pre-existing condition clause or at least some of it, depending on how long any gaps might have been. Also, was the PCOS diagnosed under your current plan, an older plan, or when you didn't have coverage? The pre-existing condition only comes into play if you were diagnosed, treated, or sought out treatment for a condition during a period of time before coming to your current plan. All of this is very important when determining who is going to pay for the claims. Contact your current plan's customer service department to find out how to get the pre-existing condition waived, or under what conditions it will be waived for. If you had previous coverage though, that will waive it. If you can't find your certificate from your previous plan, call them and have them send you out another one. Take control of your benefits just like you probably are of your PCOS. Good luck!! Dear RN, PCOS is polysystic ovary syndrome, I might add I hope you never have occasion to treat me. If your insurance has this as preexisting you are stuck. Chronic problems are usually like that. Meantime you will just have to hope you have few problems, wait out the year, that's a year insurance time, and pay for your meds. PS you have a genuine bargain at $100 for a month of insurance, for our family it is $750 and it won't even consider covering my husband, preexisting condition thing. |
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