Insurance claims pre-exisiting condition

[kbradley]

I recieved a letter today from our provider. We have a short term interim policy (Blue Shield) and they are claiming that I have a pre-existing condition which was diagnosed sometime within the year before my current coverage began. The only time I went to a dr. within that year was for a mysterious scratch on my face that took a while before going away. Nothing was ever said about p nor were meds prescribed. Didn't even go to a derm. Has anyone ever had their provider make a ludicrous claim like this? If so, any advice is welcomed. Thanks. -kiki

[EdR]

Get a note from the doctor who examined the scratch, and have him write to Blue Shield (with a copy cc'd to you) stating that he did not diagnose psoriasis. If Blue Shield does not relent, file a complaint with your state's insurance commisioner or attorney general. If Blue Shield makes false statements, they will be called to the carpet and made to pay.

EdR

[flora_petal]

We used to have blue cross, it has gone down badly over the last 5 years or so. They deny everything they can, now. Look on the forms and get the Phone numbers and address. Call and protest the decision immediately. You have to do it now! Raise cane, get mad, I have had to do that several times. I was going to have sinus surgery (for blocked sinuses-they are deep within your head, right). They tried to deny it, said it was cosmetic surgery. I called and blue cross nurse did not know where your sinuses are. She said I was having cosmetic surgery on my nose!!!! I finally asked her to try to remember where the sinus cavities are. She said oh, yeah, they aren't on the outside, are they!!!! You have to protest quickly, before the dates run out. (sorry for venting, I am just tired of people taking advantage of sick people who pay their insurance) Good luck, flora

[kbradley]

Thanks for the advice EdR. I will take it to heart, especially since I live just across the Bay from you ;).

-kiki

[Zara]

k,
did you have some other health insurance continuously before you went on this interim policy? If you did, by federal law, I believe that they cannot deny you coverage for a pre-existing condition. (That's what HIPAA mandated.) If you had a break in coverage, I would check with your state's insurance department concerning what your rights are.

[Zara]

one other question..how the heck would they even know that you had been to a doctor for anything?? did you used to have Blue Cross insurance when you went to see the MD? If you had some other kind of insurance before, did you give them permission to contact that insurance company for info on you. If you didn't, that's a violation of your privacy rights, also not very smart of them. Or are they just claiming that because it's psoriasis it had to be 'pre-existing' since no one knows for sure how or when it starts.

Here is a link with some info that might help you:

US Department of Labor: HIPAA (http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html)