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Denied payment by insurance for so-called Pre-existing condition!

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needadvice2008

Junior Member
What is the name of your state? North Carolina

I took out a 6 mo policy temporary upon graduating from college in May. I was covered from June to December. In August, I went for a colposcopy related to pelvic pain at a gynecological clinic. In May, I was diagnosed to have Low-grade Squamous Ipithelial Lesions/dysplasia (LSIL). Though these cells often are a precursor to cervical cancer, it does not always lead to it. Nonetheless, in my original policy, it did say the squamous cells did not necessarily indicate a path towards cancer and that it was not considered pre-existing.

Well, my insurance is not willing to pay for any of the labs related to my new pains from the summer. They are claiming its a pre-existing condition. However, how can this be if the policy states that squamous cells are not considered pre-existing? On what grounds could I appeal this?

Also, if the insurance company claims that a pre-existing condition is one that I have been treated for in the past 12 months, could I technically go for treatment 13 mo's after my last appt and still be covered? Or could they use anything at all in my records as basis to deny me payment of any of my bills?

I'm very frustrated and am supposed to be monitored every 6 months. As a recent graduate, I cannot afford thousands of dollars in health bills each year due to a lack of coverage by my insurance company. I can only imagine what would happen if my condition did in fact progress into cancer.

Please advise! Thank you in advance!!
 


Betty

Senior Member
I can't tell you too much since I can't read your policy.

However, about all you can do is try an appeal. Most every ins. co. should has a clear appeals process that you must follow to the letter. You may only have a limited time from the date of the denial to get an appeal under way, possibly only 60 days. Depending on your company's procedure, you may have to start with a phone complaint, then move to a written appeal.

There are two methods of appeal in most states: internal and external. The internal appeal is to the insurer itself; an external appeal is to your state department of insurance. Usually you start with the internal (ins. co.) appeal. If your claim is still denied, you can have your case reviewed by your state dept. of ins. - they normally have experts to review these cases. If they rule in your favor, the ins. co. must pay the claim.
 

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