Can pregnancy complication be treated as pre-existing condition by insurance company?

Question

I switched to my husband's insurance policy shortly after becoming pregnant because I plan to leave my job. I believe I had one prenatal appointment and one round of lab work covered by my old insurance.

I just received a statement from my current insurance provider stating that two lab visits will not be covered because they were for a pre-existing condition. These visits were for bloodwork to test my thyroid levels. I was diagnosed with hypothyroidism AFTER becoming pregnant, and had never had a problem before pregnancy. The diagnosis was based on my initial prenatal labwork ordered by my OB (which was covered by my old insurance). The condition has been treated solely by my OB.

The insurance paperwork stated that pregnancy is not considered a pre-existing condition. Does the same hold true for pregnancy complications? The charge for two lab visits is $500!! I have emailed the insurance company, but was wondering if I am correct in thinking these charges are unwarranted.

Answer 1

Well, yes!

But the thing is, did you have prior health coverage for 12 months, before switching?  If you did, you need to get a "certificate of credible coverage" from the prior insurer, and then the new group policy can't exclude pre-existing conditions.  That's probably the real solution to this problem.

Answer 2

Whether or not pregnancy is considered a pre-existing condition depends on your husbands insurance policy. You'd have to talk to the insurance company to find that out. Instead of waiting for them to e-mail you back, why don't you just call the insurance company and get some answers? It'll be a lot quicker.

Answer 3

Hypothyroidism isn't going to be considered a "pregnancy complication" by the insurer.  The fact that you didn't happen to get diagnosed until after you were pregnant isn't going to make a difference.

There's a fairly standard list of what insurers are legally required to treat as "pregnancy complications" - those are the things that state mandates would require the insurer to cover.  (Here's an example from the Idaho department of insurance...again, the list is fairly standard industry-wide.  I'm just linking Idaho b/c it was the first state's rules I stumbled across to link:  http://adm.idaho.gov/adminrules/rules/id... )

Your thyroid issue will be treated like any other medical issue - if you had enough continuous coverage prior to this policy beginning, then just provide the insurer with that documentation.  They should waive the pre-existing clause b/c of your creditable coverage.  If you didn't have continuous insurance before starting this policy, you'll have to pay for the thyroid treatment out of pocket.  Sorry.

Edit to Add:  Just to show you how generally standard the legal insurance definition of "pregnancy complication" is, here's the link from the Colorado department of insurance.  Note that the language is almost identical to the link I provided above for Idaho.  http://www.dora.state.co.us/insurance/re...

Vermont uses the exact same language to define "pregnancy complications" : http://www.bishca.state.vt.us/InsurDiv/r...