Recission of Health Insurance
Can you help me? I had my insurance cancelled and I don’t know what to do. My insurance company claims that they cancelled me because they say I lied on my application, but I didn’t. I have only had the insurance for 6 months and now they want to make me pay for all the claims they had to pay. What can I do?
If your health insurance coverage has been rescinded for omission or falsification of information you provided on your application, you should have received prior correspondence from your insurance company that informed you of these allegations. This correspondence should have provided you with the exact details of their accusation and an opportunity for you to respond with an explanation as to why the information was omitted from your application. Did your insurance company follow this procedure? Have the returned to you all of the premiums that you have paid during your 6 months of coverage?
They sent me letters about that and I did respond. I sent them a detailed letter and told them that I did not know about the problem. I don’t really want to get into details about what they are claiming. I got a letter back about 3 weeks ago that told me they would review my reply and let me know what they decide. Next thing I know, I get a letter from them telling me I don’t have insurance. They did say that I will get a check for the premiums I paid, but I have not gotten it yet. I just got the letter yesterday.
Comment by Diane — November 30, 2006 @ 9:51 am
It sounds like your insurance company took the proper legal steps in rescinding your health insurance. We are unable to say if their claim was justified. This is a fairly rare occurence, and when it does happen, the insurance company has proof that you must have been aware of the omission or falsification. This proof should have been provided to you. If you feel that you have been wronged, you may either make another plea with your insurance company, or contact an attorney that specialized in insurance law. An attorney will review all correspondence and provide you with a professional opinion if the recission was justified and legal.
Comment by admin — November 30, 2006 @ 9:58 am
OK, but what do I do now to get health insurance? I already called another insurance company and told them the situation and they said because of that they won’t approve me for insurance.
Comment by Diane — December 5, 2006 @ 5:42 am
You will need to find health insurance that is guaranteed issue. This is usually available through an employer-sponsored group health plan, a HIPAA plan, or your states high-risk pool. Since you have been uninsured for several months, you are not HIPAA qualified, so that leaves group insurance or the state high-risk health pool. You will need to check with your state on the qualifications for their risk pool. Many states will not accept a person into the risk pool if their previous medical insurance was cancelled due to fraud. If that is the case, you are left with the option of obtaining coverage through a group health plan. This would require you to find employment with a company that offers group health insurance. Keep in mind that even if you join a group health plan, you will probably incur waiting periods on enrollment eligibility, and once you are enrolled on the plan, they will likely be exclusionary periods on treatment of your pre-existing conditions.
Comment by admin — December 5, 2006 @ 6:12 am
Carefully study the letter from the insurance company. Carefully study the application and the questions you responded to when you applied for the coverage. Was there a misrepresentation? Is it obvious? Or just the imagination of the claims examiner? What state do you live in? Google SHERNOFF for additional information.
Comment by Terence Kelley — February 14, 2007 @ 6:49 am
I was recently denied through two appeals with Aetna Health Insurance coverage for my jaw surgeries. They did approve the joint surgery that I had on 5/6/08, but did not have the remainder of the jaw surgeries. The reason for the jaw surgeries was I have an underdeveloped upper and lower jaw (hypoplasia), non-union of jawbone, relapse from jaw surgery back in 2005, misaligned jaws, decreased airway at 4mm (11mm is normal), limited ROM at 5 to 15mm, (40mm is considered normal), pain, headaches, etc. The reason for the denial is Aetna stated they considered the surgery cosmetic. My doctor reevaluated my models and stated that I have a 4mm Transverse deficiency which falls under Aetna’s guidelines to cover the surgery. My primary doctor and surgeon wrote letters to Aetna and stated that even though I passed a required sleep apnea study, my sleeping heart rate was increased along with I had difficulty falling asleep and woke up three times during the night which are all symtoms of obstructed airway. My health plan at work is self insured so even though under VA state laws my surgery has to be covered it is exempt because of being self insured. What advice do you have from here? I am trying to get my HR to step in and require the insurance to pay since we have over 6 doctors warranting the medical necissity of this surgery.
Comment by Karen — June 12, 2008 @ 10:56 am
I was out of school for a time and didn’t cancel my insurance. Now they have cancelled me and I am worried if I am in trouble? What about claims they have paid? I am worried.
Comment by Dawn — December 30, 2008 @ 11:22 am
Health Insurance providers can and will rescind an insurance policy unilaterally. Most of the times it comes down to omissions on the application form, voluntary or not. In most cases this happens when a claim is made and the insurance company decides to investigate the claim. In the large majority of cases the recission is for valid reasons, such as the applicant forgetting (or deliberately omitting) cardiovascular history or other similar health problems. Though more and more insurance companies are walking a fine line between being cautious and punishing innocent consumers. A good argument for this, is that recissions often happens when there is an expensive claim to be paid.
Large claims are the biggest costs for insurance companies, but it is worth to remember that an unfair elimination of an insurance policy. Fighting back trough the legal system can be the only option if you feel you have been treated unfairly or it is at least always a possibility to get conversations started with your insurance company.
Comment by Scott — June 9, 2009 @ 12:30 pm