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Pre-existing condition 63 day rule- but it took them two months to turn me down!

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lijemo

Guest
(What is the name of your state? New Hampshire)

A health insurance company is not allowed to call a condition pre-existing and deny coverage unless you go for more than 63 days between insurance policies. However, what happens when an insurance company takes over two months to turn you down?

I signed up for an individual policy immediately on becoming unemployed in January, before my employer's policy ran out.
I spent two months assuming I was covered and just waiting for paperwork, because I am in good health. Then I got the rejection letter, and the 63 days are up.

Do I have any recourse?
 
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cbg

I'm a Northern Girl
HIPAA (which is the law that governs the 63-day rule you are talking about) only covers instances when you go from group policy to group policy. It does not cover when you go from group policy to individual policy. So the insurance would not have been restricted from implementing a pre-ex policy to begin with.

Why didn't you sign up for COBRA?
 
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lijemo

Guest
I didn't go with COBRA because I immediately signed up for an insurance policy that cost one third the amount (my former employer had good benefits, so COBRA would have been $600 a month). It never occured to me that I might be turned down- naieve, I know, but I'm in good health, and there is no *reasonable* reason to turn me down. Their reason was NOT reasonable, and in fact baffles me. (But since it seems to have been legal, that's not an issue for this forum)

If I had realized beign turned down was a real possibility, I would have gone with COBRA while I was waiting for the verdict. I didn't give the slightest worry about the 63 day thing, because I was signing up for a new policy two weeks before the old one ended! I thought I was really on top of things. Live and learn- next time I'll know :(

The policy that I was turned down for was through a self-employment organization, so I hadn't been thinking of it as an 'individual' policy, since it was at 'group' rates.

So, if all the laws protecting customers from the insurance companies apply only to employer-provided plans, what does a self-employed person do to protect oneself? Is it possible to get in on a 'group' policy when you are self-employed?

It seems I'm considered high-risk and uninsurable for reasons that baffle me :confused: , considering that I'm in good health and don't smoke. But it looks like I'll be getting insurance through my state's high-risk pool- but because the first company took so long to let me know, I'm hitting the pre-existing condition thing. (I know the 63 days does apply to the state insurance, because they told me). I'm trying to figure out if there's any way for me to gain an "extension" on the 63 days, seeing as I spent the entire grace period assuming that I was insured.
 
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cbg

I'm a Northern Girl
My state allows for a one-person group for self-employed people, but all states don't. You'll have to check with your state insurance commission to find out if your state allows for that. Several years ago I could have told you since when I worked for the insurance carrier New Hampshire was part of my territory, but that was long enough ago so that they could easily have changed the rules since then.

It's too late now, but for the future, it's always wisest to go ahead and sign up for COBRA unless you already have the issued policy in your hand. Since you have 60 days to make the COBRA election and 45 days from the day you elect it to send in your first payment you don't run too much of a risk of double-paying.
 
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lijemo

Guest
Yup, next time I'll know. I didn't research it more carefully in January, because I didn't realize there was anything more to research- the sales guy signed me up for the health insurance, and I thought that was that- I didn't know a young, healthy, non-smoker had any reason to worry about being turned down. Live and learn :(

I'll sign up for the state insurance, but also look into the "group of one" thing, so I can start the pre-existing waiting peoriod asap, if it applies in NH.

I do have to take a maintenence medication every month for an old issue that is otherwise dealt with- I think that's the real reason they turned me down, because the policy had a perscription plan and the perscriptions are so #$%* expensive... (They probably also think the old issue somehow makes me more likely to have future health problems, even though there is no evidence of this)

It's criminal what medicine costs :mad:. catastrphic health insurance + mothly perscriptions = more $ than I currently pay in rent! Now that I won't have perscription coverage, I'm having to move out of my apartment and in with a friend so I can still cover the @%#! drug costs every month...

But looking on the bright side, at least I have that option. The insuance insustry has done a lot more damage than this to a lot of people, so the reform crusades should probably start with more serious problems than what I'm experiencing.

Thanks for the info :)
 

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