Pregnant At Time of Application
Now, for the issue with the agent providing you with poor advice, and basically advising you to lie on your application. You may have a legal claim against that agent, but it won’t change the fact that you will be uninsured. Licensed health insurance agents are required to have liability insurance for instances such as these, but the insurance company will not be liable for their actions. You should contact an attorney to discuss this case. Perhaps the liability insurance of this agent will cover the medical costs associated with your pregnancy. But, there are two problems here, it is your word against his, and you were just as responsible for falsifying the application. In addition to contacting an attorney, you should also file a complaint with your state Department of Insurance. They may open an investigation, and if they determine your claim to be true, may cancel the license of this agent. Agents that advise people to falsify their application, and assure them that there is no risk in doing so, are doing a great disservice to this industry and they should be penalized. 2 CommentsLeave a comment |
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I have a big problem and I hope you can help me. About 5 months ago, I bought health insurance because I had a feeling that I might be pregnant. I had not taken a pregnancy test, so I was not 100% sure about it. I told the insurance agent why I needed the health insurance and that I thought I might be pregnant. He told me that if I had not been to a doctor for this, the insurance company would have no way of knowing, since I did not know for sure myself. Well, I was right, I was three weeks pregnant. Last month I had a prenatal exam with my doctor. Now, I get a notice from the insurance company telling me that since I was pregnant when I applied for the coverage, and did not put it on my application, they are not paying for any medical claims related to my pregnancy. How can they prove that I was pregnant? What can I do about it? Doesn’t the insurance company have to cover it because the agent told me it was OK? Isn’t he a representative of the insurance company and so the insurance company is liable for what he told me.
OK, let’s address one question at a time. Determining that you were pregnant at the time you completed your application is easy enough. Your medical records provided through your physician will indicate an estimate delivery date, and therefore an estimated date of conception. Whenever a person applies for health insurance, and soon after shows positive for pregnancy, this sends up a major red flag with the insurance company. They will request medical records, look at the date of conception and compare that to the date of your application. The fact is, whether you were 100% certain or not, you were pregnant when you completed your application. The insurance company has the right to deny this claim. In fact, they will probably even cancel your policy for non-disclosure of important medical information, which they view as fraud. All premiums that you have paid to date will be returned, but you will be left without insurance for yourself and your newborn child.
If the agent was told, then this knowledge should have flowed to the insurance carrier. The carrier must investigate your allegation that the agent knew. As the carrier investigates ALL incidents of agent misconduct, they will have a history of the complaints about the agent’s behavior in the past. If he had many complaints in past 30 months, that will add to your allegation. If many of the applications he has written have resulted in rescission, that, too, will add to your allegation. A lawyer can define AGENCY law . If you tell the insurance agent something, that knowledge flows to the carrier. They are estopped from using a policy defense stating “we did not know you were pregnant”. Tell the company. They will be obligated to investigate. Then complain to the Dept of Insurance. They license both the company AND the agent.
LESSON LEARNED: Obtain Insurance coverage before you need it. Do not misrepresent facts.
Comment by Terence Kelley — February 14, 2007 @ 6:29 am
What can I do when I am pregnant and don’t have any health insurance? I am over 6 weeks pregnant now and I only found out last week. So, I don’t have any health insurance unfortunately. I do have a job but my employer does not offer any group healthcare, I know.. I should find another job, but that’s not so easy where I live. I have way to many expenses and bills and I can’t afford the doctor bills. I am not sure about Medicaid, how does it work? I have heard that you will be visited by a lot of people to check up on you. I don’t really like that. Can Medicaid just help with paying the doctor fees?
Comment by Angela — June 25, 2009 @ 12:32 am