I just got a new medical insurance plan and the letter they sent me stated that I would have a waiting period of 12 months for any pre existing condition. I called them up and both their automated system and customer service rep said I had no waiting period. I had medical insurance up to 4 days before the new policy kicked in. The new insurance company said that as long as the gap of un-insurance was less than 63 days, their would be no waiting period. I decided to go ahead and ask the new insurer to send me a letter stating that their was no waiting period and ask the old insured to send me a letter stating that I was insured (Certificate of Creditable Coverage). I have two questions: 1 Is the 63 days a national law, a state law, or a company policy? 2 Has anyone ever had a problem with being denied coverage for a pre existing condition due to not getting a letter confirming that their is no weighting period?
If you get a 'certificate of credible coverage' from the prior insurance company then you should be OK with the new one. I work as a medical claims examiner and I've never seen a claim come thru and deny for pre-x BUT that is determined by insurance companies. They all have different policies. If you have a pre-existing flag on your acct and they deny for that then you will be denied if a claim comes thru with the diagnosis that is considered pre-exisiting. So, get that letter to them ASAP and that should be filed and the flag should be lifted. And keep a COPY of that credible coverage for your records just in case them decide to deny for pre-existing.
If you get a 'certificate of credible coverage' from the prior insurance company then you should be OK with the new one. I work as a medical claims examiner and I've never seen a claim come thru and deny for pre-x BUT that is determined by insurance companies. They all have different policies. If you have a pre-existing flag on your acct and they deny for that then you will be denied if a claim comes thru with the diagnosis that is considered pre-exisiting. So, get that letter to them ASAP and that should be filed and the flag should be lifted. And keep a COPY of that credible coverage for your records just in case they decide to deny for pre-existing.
Hkolln Thanks. sirrowan I think you are right for group plans. This is an individual medical only plan.
1) In 1997, the Health Insurance Portability and Accountability Act (HIPAA) became law and says that workers with existing health insurance will be covered under a new plan WITHOUT PRE-EXISTING CONDITIONS. The employee has 62 days after continuation ends to apply. On the 63rd day, creditable coverage cannot be used. 2) Yes - You could be denied without the letter of creditable coverage. However, if you need the letter they damn well better send you one. hth
I believe that the COBRA and Health Portability laws only cover group plans. The only other coverage where no waiting period is mandated is in medigap policies. When you purchased your new plan, was there a rollover provision in the application,or did the policy state that if you gave the pol.# and name of your existing plan that there would be no waiting period other than that which was already in your existing plan. Why did you change?You say it is individual, but did you purchase it through a group?
Why Chat This is the provision in the application: "Finally, I understand that coverage is not provided for a pre-existing condition within the first 12 months after my effective date, unless I receive credit towards some or all of this waiting period." I changed because I am working for myself now. I was on cobra before. The plan is not through a group. The plan is Blue Advantage from BlueCross BlueShield of North Carolina.
No. I am in great health. I just feel if I am going to pay for something, I want the full benefits of what I am paying for.
Excuse me for being so blunt, but what you are doing is silly. If you don't have a pre-existing condition, it does not apply to you. Many of the notices like the one you got are simply compliance disclosures, and if they don't apply to you, there's no need to pursue it. There's even no need to send in the paperwork for the pre-existing credit. Why waste your time like this? Just like fighting, LOL?
If you came off COBRA the preexisting condition waiting period is waived. If you CHANGE private policies, you will have a new full 12 month waiting period. Since you are completely covered, and wish to "get what you paid for" Develop a serious life threatening illness and get your money's worth.
Thanx Breeze, That's why I asked. Before I gave the long winded version answer to the questions I wanted to know if it even mattered. LOL
Thank guys for your answers and support. I got both letters today. One from my prior insurance company and one from my current insurance company.
