Our insurance company refuses to pay my hospitalization amounting to several thousand dollars for a Coronary artery bypass graft(2X). It claims that I have a pre existing condition of coronary artery disease which the doctor discovered in a treadmill test done in May 2009. I have a continuous group insurance coverage with Select Health beginning August 2008 as a teacher, the insurance taking effect after 90 days. I moved to another school in August 2008 the same month when my insurance coverage from the former school ended/terminated. In October 2008 my wife had me covered from her group insurance company; The insurance took effect 90 days thereafter. On February 19,2009, I was operated on. Has the insurance the right to refuse payment of my hospital bills? My wife faithfully pays the premium on the insurance every 15 days from salary deduction.
Answer by moderator — June 9, 2009 @ 2:53 pm No CommentsNo comments yet. Leave a comment |
|
There are a couple of reasons that might explain why your insurance company is denying your recent hospitalization. They are either within the rights of the law to do so, or they are not aware of your prior insurance coverage and are imposing pre-existing condition waiting periods because of this. Any lapse in coverage of more than 60 days can cause waiting periods to apply on your new coverage. According to your listed dates of coverage, if we are reading these correctly, you have had continuous coverage for 10 months. Did you have insurance prior to the coverage that began in August of 2008? The length of time you have had prior coverage (without a 60 day lapse) will be applied to any waiting period. If they pre-existing condition waiting period on your policy is 1 year, which is common, then the length of prior coverage as of February 2009 was not sufficient to meet the this waiting period. We suspect that this is the reason, but highly suggest you ask your current insurance company for a detailed explanation. We are a little confused by the timeline, as you mention that you had a treadmill test in May 2009, but your bypass was in February 2009. Do you mean 2008 or earlier for the treadmill test?
