Help - Pre-Existing Condition

[RobinWyman75]

What is the name of your state (only U.S. law)? MA

I know this has been covered, but just to confirm.

My new insurance company is "investigating" claims that were paid out for an endoscopy procedure that I recently had. They are looking to see if this is a pre-existing condition. Which it is! I had insurance by my previous employer and a new company took over and their insurance is from a different insurance company. I was with the prior employer for 4 years with the same coverage. There has been no gap in coverage from one insurance plan to the other. So my understanding is that this new company must not deny any claim based on a pre-existing condition due to a federal law, is this correct? And I would assume that the new insurance is just going through the procedure of investigating, but in the end will not be able to use the pre-existing clause as a reason not to pay. I do remember getting a letter from my previous insurance co providing details of length of coverage...should I send this to my new insurance or just wait until they ask? I ask this because the insurance company 1st paid the claim, but now are rejecting and reversing the payment. Should I be expecting a letter asking for proof of prior coverage??

Thanks for help
JRWhat is the name of your state (only U.S. law)?

[seniorjudge]

Don't wait. Make sure you are covered.

[cbg]

Yes, you should expect a letter requiring proof of other coverage.

It is quite common for such an investigation to take place. Just because they are investigating doesn't mean they're going to try to get out of paying.

As long as you were covered for at least 12 months before starting the new plan and as long as there was no gap (or a gap of less than 63 days) between the two plans, then under Federal HIPAA they cannot deny a claim because it is pre-existing.

Honestly, the insurance companies are the bad guys both coming and going. If they investigate, they're trying to get out of paying. If they don't investigate, they're irresponsibly driving up costs by not making sure the claims are legitimate.

And no, I do not work for an insurance carrier.

[momm2500]

Just send in a copy of the credibility of prior coverage to them. You should also check with your employer since this is a take-over (aquisition) that there might be already something in writing that prevents the insurance company from investigating pre-existing. The employer could call the insurance company for you.

[cbg]

I have been through a number of acquisitions on both sides of the desk and I have NEVER seen a clause that prohibited a carrier from investigating pre-ex's.

[ecmst12]

Find your creditable coverage letter, and call your insurance company to ask where you should send it.