Pre-Existing Condition?

[alibild]

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

[averad]

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?

[alibild]

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.

[ecmst12]

If you can submit proof of continuous coverage since the last stone, that *should* take care of it.

[somarco]

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.

[ecmst12]

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