A Word About Pre-Existing Conditions

Can an insurance company exclude services for pre-existing conditions?

Then answer is both yes and no.

When you sign up with an Employer Group Health Plan (EGHP) during the initial enrollment period (usually the first 30 days of employment) then they take you the way you are, warts and all.  Your family members are also covered without restrictions as well.  If you enroll during this period, an insurance company cannot exclude any conditions from your coverage or care.

However, if you do not enroll within this initial coverage period, then the insurance company has the right to ask for either a health check up, or to review medical records (often times both) and can exclude any condition they think they may be held liable for.

Common pre-existing conditions are: chronic back problems, cancer, heart conditions, and carpal tunnel.  The list can be endless.

If you purchase a private policy, this rule does not apply.  With a private policy (including disability policies) they can exclude any condition they wish.  It would then be up to you if you choose to purchase the policy or not.  Other conditions within the polcy may be too restrictive, or may not provide the coverage that you need.

The lesson here is to ask questions, know your insurance coverages, your policy limitations and exclusions, and your rights. Understand what you are looking at, and what you are signing.  A policy is no good if it doesn't cover the things you need it to.  Otherwise you are just flushing money away.

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
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