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  1. #1
    alibild is offline Junior Member
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    Mar 2006
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    Pre-Existing Condition?

    I'm currently writing an appeal to the health insurance company of Assurant, a short-term insurance policy as my husband is self-employed.

    For some reason, the pre-existing condition clause that says that as long as you're continually covered by insurance, the company cannot impose pre-existing conditions, doesn't apply to them.

    So, my question is, they have denied a kidney stone as a pre-existing condition as my husband had one within their 5-year clause. What leverage do I have to appeal that it is not a pre-existing condition? Is there anything I should cite? What wording would be beneficial? (So far I'm going with "this is a new event and was not a reoccurance", and am pointing out that this kidney stone was not in existance the last time he had one.)

    Thanks, alibild
  2. #2
    averad is offline Member
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    From my understanding they go based on the overall diagnosys not the specific stone.

    Here is what your story says:
    1) Husband wants a insurance policy
    2) He is self employed
    3) Has had kidney stones in the past 5 years.
    4) New policy added kidney stones as a pre existing condition.

    We Need some more history:
    1) Was you husband covered under another insurance policy? (if yes was it group coverage?)
    2) How long was he on the policy?
    3) What state are you in?
    Last edited by averad; 03-13-2006 at 07:07 PM.
  3. #3
    alibild is offline Junior Member
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    Mar 2006
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    We are in WA.
    1. we were covered under Assurant self insurance while this event happened.
    2. yes
    3. yes
    4. they won't cover because he had a kidney stone in the past 5 years.

    There has not been a time when we have not been insured.

    Thanks.
  4. #4
    ecmst12 is offline Senior Member
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    Feb 2006
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    Philadelphia, PA
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    If you can submit proof of continuous coverage since the last stone, that *should* take care of it.
  5. #5
    somarco is offline Member
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    Mar 2005
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    Atlanta
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    The kidney stone will never be covered under this plan.

    This is an individual, STM policy with a 5 year look-back for pre-ex. Continuous coverage is not an issue here since the policy is not HIPAA compliant.

    A STM policy is not a good substitute for a traditional major medical plan or even a small group policy.
  6. #6
    ecmst12 is offline Senior Member
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    Feb 2006
    Location
    Philadelphia, PA
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    Oh I'm sorry, I misunderstood the original post. I read it again and it DOES say that continuous coverage doesn't eliminate pre-existing. Oops

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