Pre-existing Condition Question

[difficult3]

What is the name of your state? Missouri

My fiance's son was taken to the hospital in 2003 with what turned out to be constipation. His coverage was a temporary policy that was renewed on a month to month basis. Because he had tests over several days...some ended up on one month's policy and some on the next.

They are deny the second month's claims because it was a pre-existing condition from the month before. Can they do that?

 

[pennylady]

What Dogs

It seems insurance companies will resort to anything to deny claims.

I would make them site 'title and verse' on the insurance policy as it pertains to pre-existing. Make them give you the exact page and paragraph. If it's CLEARLY defined in the policy as a basis of denial then they can do it. HOWEVER, if the language is left to interpretation you may have a case.

Another thought would be that if they like to play games that you can play games too. Beings a few days or weeks had passed from the initial onset of the symptoms.... did your son have the 'exact same' symptoms (ie condition) when the second month treatment / tests were provided or was it 'a little different'. Hospitals and doctors use literally thousands of different codes to describe procedures and diseases. If they will work with you (they should if they want to get paid) you might be able to call the ER stuff RED (bad pain, really sick) and the stuff a few days / weeks later MAROON (I've got gas). I'm not talking about fraud, NO NO DON"T DO THAT, just be sure it's coded correctly and the picture of his condition is correct. For example you said he was constipated. That can be month one diagnsis. If the 2nd month tests were done after he took a good healthy dump he wasn't constipated anymore. So maybe the second month diagnosis could be gas with an onset happening after he pooped. GET THE IDEA

GOOD LUCK