Health Insurance liability after cancellation?

[2manypets]

What is the name of your state? TN

I was in an auto accident on June 3rd. While I was re-cooping at home, my company changed insurance carriers. I'm still having treatment (PT, follow up appts, meds, ets.)
The new insurance came into effect on July 1st.

I'm now faced with large bills from my doctor and PT because my previous insurance is refusing to pay for anything after June 30th.

Is it true that the insurance company that the accident happened under is still liable for up to 6 months following?

[TIMMAAYY]

If it is a group insurance plan, your new insurance will have to start picking up the tab. It should be guarantee issue, and as long as you didn't have any lapse in your coverage for more than 63 days and were covered before for your injuries, and the new insurance offers similar coverage ( physical therapy, etc. ) your new insurance will be there just like your old one.

[cbg]

Is it true that the insurance company that the accident happened under is still liable for up to 6 months following?

No. It is not. They have no liability for anything after the last day their policy was in force; i.e. June 30.

I agree with Timmaayy (yes, it does happen occasionally) that as long as there was no gap in coverage of 63 days or longer between the end of the old policy and the beginning of the new policy that the new insurance will pay. However, to be ABSOLUTELY clear (though I know what Timmaayy is trying to say) the new policy is only responsible for paying what THEIR policy says. They have no legal responsibility to pay what the old policy would have paid, should there be a difference.

[Insurance Pro]

OK...let's get one thing straight. The "63-day" rule that is being referred to deals with HIPAA and portability of coverage (a small part of HIPAA), and has nothing at all to do with extension of benefits. The 63-day rule deals with changing plans (in your case; group-to-group) and the insurance company's ability to deny claims based on a pre-existing condition. For more info, Google HIPAAs "creditable coverage" rules.

Most states have what are referred to as "extension of benefits" laws that state (paraphrased) "a group carrier must continue benefits for any person insured under a plan and hospitalized on the date of termination, if the plan is terminated and immediately replaced by a group policy issued by another insurer, until the hospital confinement ends or the benefits are exhausted, whichever is earlier." That's takes care of hospital bills. In addition, most states have another set of laws referred to a "no-loss, no-gain" statutes that require that claims filed with the previous group carrier that have not been paid by the time new group carrier takes over the coverage are the responsibility of the new group carrier." This should take care of claims that have been filed by not yet paid by the previous group insurer. So, in a nutshell, in most states: Hospitalized when new plan kicks in? Old carrier must extend benefits. Claims filed with old carrier and not yet paid? Generally the responsibility of the new carrier. See your state for specifics!

[cbg]

And once again, you are misunderstanding.

The reference to the 63 day rule was to determine whether or not there was a gap in coverage that would possibly trigger pre-ex clauses. No one was trying to tie it to exentions of benefits.

Yes, if someone was in the hospital on the day the coverage changed the old carrier would be responsible for that bill. But new bills incurred after the change would be the responsibility of the new carrier. The old carrier is not going to be responsible for any bills incurred after the change in coverage. The hospital bill was incurred under the auspice of the old carrier. No one said differently.

You know, if you would consider the possibility that other people besides you have some knowledge, things might go a little easier here. I've been administrating benefits for 26 years, including 5 years working for a national insurance carrier. I'm not exactly talking out of my hat.

[Insurance Pro]

CBG, I admit (but only to a point) defeat. I apologize for missing the gist of the question in the first place, which was asking about if an insurer is still liable for the med bills for 6 months after the coverage has ceased. Simply put, they are not liable. Why would an insurer continue to pay bills for a contract in which they are receiving no premium? They won't. Simple as that.

As far as the HIPAA portability aspect is concerned, please keep in mind that HIPAA allows pre-x exclusions, even in group settings. HIPAA allows the carrier, for on-time enrollees in a group plan, a "6x12" exclulsionary period. It also allows, for late enrollees, a "6x18" pre-x exclusion. The employee must be given credit for time served under the old plan towards any waiting periods that will be in the new plan, assuming certain criteria are met. So, if there was a gap of more than 63 days between the end of the coverage on the old group plan and the new job that offers group benefits, no creditable coverage would be applied, and the employee could easily be subject to pre-x problems. On the other hand (for example), if the employee only had 8 months in the previous plan, the carrier, for on-time enrollees (depending on the state), could still impose a 4-month exclusionary period.

Finally, I do apologize for my somewhat "know it all" approach in my previous post. Normally, that isn't the way I do things. It was one of those days, I guess. It won't happen again!

[cbg]

Believe me, I know what HIPAA says with regards to pre-ex conditions. I've been working with HIPAA since it was passed into law. If I don't explain each and every factor of a law in trying to respond to a post, it's not because I don't know the details; it's because nothing in the post suggests that the missing factors are relevant and too much information can be confusing to the poster.

The extra details can always be raised if future information indicates it is relevant.

[TIMMAAYY]

That's why I always say "63 days". That's the minimum. If you go beyond that you might or might not have a problem. If you stay under it, you will always be fine. Keeps things simple.

[ajkroy]

I don't want to get in the middle, but I also have something to add: this is all moot if the providers that OP was using do not participate in the new insurance.

If it is just an issue of getting a referral or pre-auth, talk to the PCP about doing a retroactive one.

By the way, if this is an auto accident, was the person at fault without insurance?