Health Insurance Problem. PLEASE help!

[monos26]

What is the name of your state? Indiana

Here's the problem. I was told my health insurance would cover a three day hospital stay. I asked over and over again, the benefits administrators, the hospital, the insurance people. Now neither insurance (I had two at the time), will cover the $3,000 in bills. I was admitted for being suicidal, and I asked repeatedly if I was to be covered. I made it clear that I would not stay in the hospital if I wasn't. Now, one insurance (Humana) is saying since I went in a day before my benefits went into effect that I will not be covered. The other insurance, American Fidelity, is the biggest problem. The insurance people at the hospital called to make sure and said that I had excellent benefits and that I would definitely be covered. Now, I find out that since I was treated for depression 12 months before getting coverage, that it is considered a pre-existing condition. I have two problems with this. One, it was emergency hospital treatment. According to everything on my card this should be covered. Even though it says "pre-existing conditions excluded" this was an emergency. Plus, I was not able to be released on my own after the first day. The other problem is this: there is a law that states that as long as you have continuous health insurance coverage, pre-existing conditions are waived. I called American Fidelity and they said that this law only applies to permanent health insurance, and not short-term, which is what I had. I am at a loss. I can't believe that I was careful enough to have 2 insurances and neither is paying for this. I paid these companies monthly for nothing. I am 22 and working at a very entry level job. I can't afford this. Please help and offer any advice possible!

 

[cbg]

Did they say, yes, this is a covered condition, or did they say, your hospital stay between xx/xx/02 and xx/xx/02 will be covered? There's a difference.

I cannot contrive of a set of circumstances in which Humana would owe for this hospitalization. Under no circumstances that I am aware of is an insurance company liable for something that transpires before the coverage is effective, any more than they are liable for something that happens after the policy is terminated.

With American Fidelity, it's going to depend on how the plan is worded. Unless your state has something very specific, I'm not aware of anything in the law that says an emergency situation is automatically covered. If the situation would not be covered in non-emergency situations, I don't believe they are automatically forced to cover it because it's an emergency.

You need to review the policy and see whether it says, pre-existing conditions excluded or, pre-existing conditions excluded except in emergencies.

You can always check with the state insurance commission to see if there are any state or local regulations that would help you.