need advice Doctor-Patient Privacy & Insurance

[tbaileysmith]

What is the name of your state? Georgia
My husband and I recently moved from Canada to the USA and have had Heath Insurance all our lives - which in Canada is not privatized, but rather government insurance. This is comprehensive coverage - everything is covered except cosmetic surgery or unnecessary elective surgery.
Now myhusband is working here in georgia for a large corporation with new health benefits. However the provider has refused to pay for my doctors visits claiming that "possible previous medical condition". They claimed that they will not recognize our health insurance in Canada as legitimate previous health insurance. Once we contacted them, they said they would cover us if I hadn't seen a doctor for the last three months for the same medical problem and they sent me a letter asking for a list of every doctor or hospital visit I've had over the past three months, including medications prescribed etc. Isn't this illegal? Do they have a right to my confidential medical information or any information that pertains to things that occurred prior to my husband's husband and new health insurance benefits? Any help would be great.
PS: We were never told prior to moving that the health insurance could be denied to us and was promised to be full coverage for our family.

[cbg]

No, this is not illegal.

In the US, an insurance carrier may deny coverage based on pre-existing conditions, but only within a limited time frame. To that end, they are permitted to know what conditions you have been treated for within that time frame, which is actually 12 months. (Evidently they have a policy of only going back three months, which is good for you.)

Had they recognized your Canadian coverage as "creditable" they would have automatically picked up any conditions at all without denying any for pre-ex, as long as you had been covered for 12 months or more. But they are not obligated under US law to consider foreign coverage creditable.

This is actually quite standard and a US citizen who did not have previous creditable coverage would be held to the same restrictions.

[purple2]

Originally Posted by tbaileysmith

Isn't this illegal? Do they have a right to my confidential medical information

Unless specifically prohibited in the state of Georgia, exchange of patient information for the purposes of payment is allowed without patient authorization. However, your spouse probably did sign an authorization when he enrolled in the insurance plan.