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Claim denied for pre-existing condition

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tayb

Junior Member
I am in the state of Texas.

I was unemployed from August 2010 to November 2010 and did not have insurance during that time. On February 11 2011 my new and current insurance with United Health Care kicked in and is still active.

In the middle of August 2011 I went to see a doctor for minor hand tremors. I am a computer engineer and I type almost all day at work. He told me it was probably just nothing but he would do a blood test just to be 100% safe. He prescribed me with nothing. A week later the test results came back and they were negative. He told me to just stretch my hands out and take walking breaks during the day. I want to stress here that the doctor said nothing was wrong.

Fast forward two months and in October of 2011 I receive a letter from the insurance company asking me to provide details of any doctors visits I've had in the past two years. The only "doctor" I have seen in the past two years was a CVS clinic when I had a sore throat. I faxed the document back to them.

In December I got a bill from the doctors office claiming that my insurance company has denied my claim as a pre-existing condition. I contacted the doctors office and asked them how this could be so as I was not diagnosed with anything and they referred me to my insurance company. I contacted my insurance company and they are refusing this claim because they said I was out of insurance coverage for more than 68 days.

My question is obvious but here it is just for clarity.

How can they deny my claim based on a pre-existing condition when the doctor did not diagnose me with anything? I've talked to tens of people at UHC and I've been nowhere. UHC tried to explain this to me by saying "the results of the visit don't matter, it's the diagnosis code that matters." I don't know what that means. Is the diagnosis code different from the actual diagnosis the doctor gave me? A pre-existing condition, as defined by the link below, is a "medical condition that occurred before a program of health benefits went into effect." Given that definition, and the fact that the doctor deemed my "problem" to be nothing but a natural side effect of typing, how can this be denied as a pre-existing condition?

Am I to also believe that any time I go to the doctor until February 11 2013 I'll be subject to this pre-existing condition bullsh**? It seems to me that if they can legally deny this claim they can legally deny just about any non-emergency claim.

Pre-existing condition - Wikipedia, the free encyclopedia
 


sandyclaus

Senior Member
Were you EVER seen previously for these same symptoms, whether or not a specific diagnosis was ever given?

Keep in mind that your medical history would be available to the insurance company to make this determination, so even years before, if you consulted with a doctor for the very same symptoms, that counts. If you were, then one could argue that it was a pre-existing condition, and the exclusion and denial of coverage could stand.
 

ecmst12

Senior Member
I don't see how they can consider it pre-existing if you truly have NEVER seen a doctor for any similar symptoms before.

You weren't diagnosed with nothing; there would be a diagnosis on the claim related to the symptoms you were complaining of.

Have you appealed the denial through the procedure laid out in your policy?
 

cbg

I'm a Northern Girl
Is your current insurance an employer sponsored group policy, or an individual policy? There's a reason I'm asking.
 

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