pre exsisting conditions

[Neddie]

What is the law in Utah regarding pre exsisting conditions? I was treated twice by a family practice doctor with prescritption medication for depression in the 6 months prior to my new insurace policy taking effect. Now the company says they will not pay for any office visits related to depression? Is this legal? I have paid $500 premiums for 6 months and this is the first thing I have ever submitted to them! They are also requesting me to release my medical records to them. Is this a good idea?

 

[Donna32669]

Pre Existing Conditions

Neddie, you don't indicate if this is a group or individual policy. In either case you should have received a policy to review, and it will explain in detail what Pre Existing conditions are excluded, and which may be covered after a specified time. You may want to check the State of Utah website for Dept of Insurance. However, if the exclusion is in the policy and you accepted it when applying I would think it is legal, and it is not uncommon.

 

[cbg]

Pre-existing clauses are legal in all states.

Under HIPAA, which is Federal law, the maximum length of time a condition can be considered pre-ex is 12 months. A state may make that limit shorter, but no longer; contact the Utah division of insurance to determine it your state has a different schedule.

As to whether you are covered under HIPAA, we would need to know if this is an individual or group policy; whether you had been covered under other insurance previous to this policy; if so, whether there had been a gap in coverage and if so for how long, how long you were covered under the previous policy and if the previous policy was group or individual. Without the answer to all of these questions, it is impossible to say if what you are being told is correct or not.

 

[Neddie]

This is a group policy, yes i was covered by a group policy before this although there was a 1 month gap in coverage. I had been covered by the previous plan for 3 1/2 years. I had only had 1 office visit previous to the disputed visit for post partum depression. There is a part in the insurance handbook about preexsisting conditions that says that it wont cover them but it has no specific information about what types of diagnosis. It says that if i had been seen for a condition 6 months previous to the start of coverage that it is considered pre exsisting. Please someone answer about releasing my medical records, is that a good idea or not. we wll be changing insurance again in a few months and I don't want this to follow me forever! Thanks.

 

[cbg]

If you were covered previously by a group policy and there was only a one month gap in coverage, you should be covered under HIPAA and pre-ex should not be a factor. You need to go back to your previous employer or your previous carrier (they have joint responsibility) and ask for a HIPAA certificate which will show all the time you were covered with them. When you receive this certificate, send a copy to your new carrier. That should take care of the problem