What will my health insurance company do regarding my coverage after I reported my preexisting condition?

Question

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http://answers.yahoo.com/question/?qid=20080523020104AAtB4FK

I reported to my health insurance company that I had a preexisting condition that wasn't adequately inquired by my writing agent, which is why it wasn't reported on the application. Now, I am waiting to talk to their underwriting dept until next week to resolve this situation. After looking over my application, I noticed that my agent didn't go over specific areas that are quite important. Generally, he indicated that I didn't have prior coverage, which is not true since I had group health coverage all my life. I can prove this with a CoCC, which wasn't reported on my application, so the insurance company doesn't know this. My general feeling is that my agent completed my application in a careless manner that might hinder my ability to receive care on my condition. Will underwriting exclude coverage on my condition despite this new info that wasn't reported by my agent? thanks for the input.

Answer 1

If you had less than a 63 day break in coverage, your previous coverage may be counted toward any pre-exisiting waiting period your new policy may have.

Your agent should have been more diligent in his efforts, but your speaking to them now will ensure that they have all the facts.

I personally completed an application for insurance and stated something from my medical history I believed to be true from memory and was hence excluded from my policy (as I knew it would be.) When copies of my medical records finally arrived and I could prove that I did not receive a certain drug, I forwarded the records to the underwriting dept and the exclusion was removed. My point  being--the info can change the outcome at any point during this process.

Answer 2

you should be okay. if you have supporting documentation showing you had valid coverage and you submit that with an explanation in writing, it should be fine. i would also report that agent to the insurance company (if they work direct for them) or the department of insurance (if they are independent).. sounds like they dont know how to do their job.

just to kinda support what i said above.. a lot of people arent aware of the pre exisiting waiting period/clause in their benefits.. several months and several denied claims later, they call and inquire about whats going on. the CSR explains to them , and the member says they have proof of prior creditable coverage. in my company, they will accept the proof, even months later. .. and will reprocess the affected claims.

so, with that said, i think you will be fine

Answer 3

i must know from which place you are .if from india get hold of todays HT . there is a report about supremes court judgement on the issue.pl go thru carefully.

Answer 4

If you are now applying for individual coverage, your CoCC won't help you out. The proof of prior coverage and no break in coverage for less than 63 days applies only if you are going for one group employer-sponsored plan to another group employers-sponsored plan.

If you are applying for group coverage, you wouldn't be filling out such a detailed health application so I'm assuming you are applying for individual coverage.

If you signed the application, you are responsible not the agent. The insurance company can cancel your coverage, apply a pre-existing condition limitation on the health problem they were not aware of when the application was originally considered, exclude the unreveal medical condition completely for the life of the policy and/or increase the premium. I hope this works out OK for you.

Answer 5

The company must have checked you out before issuing a policy.  There is something very wrong here.  You are not going to be covered for the pre ex or they will rate you up.  I am suspicious of the company and the agent needs to be reported to your state's Dept of Ins.  We don't need incompetent agents out there.  There are companies that will issue based only on the application.  When there is a claim, they will do post issue underwriting and look for fraud.

Check out the company at www.ripoffreport.com

Answer 6

more than likely refuse coverage or exclude coverage...