Request to send medical history

[horitsu]

I live in the state of Ohio.
I received treatment while covered by new a insurance policy. For this claim I received a letter stating that this treatment may be for a preexisting condition, and that in order to process the claim, I have to sign a release for my medical records 6 months prior to enrollment.
It was not for a pre-existing condition, but I am not comfortable signing my medical records over to the ins. company when I was not covered by them at that time. What options do I have?
If I produce a signed statement from my physician stating that the treatment was not for a pre-existing condition, do State laws typically support my actions?
Thanks.

 

[cbg]

Not in my experience. But then, I don't have a lot of experience in Ohio.

Although HIPAA has put substantial limits on what can and cannot be considered pre-existing, it has not eliminated the concept entirely. If you are subject to pre-ex checks, the company does have the right to this information.

When you started with this new insurance, had you been covered previously right up to the change, or was there a gap in coverage? If a gap, how long? Was the old insurance group or individual? The new? These answers will help me form an opinion as to whether you actually are subject to pre-ex or not.

If it turns out that you are, my suggestion would be that you call the Ohio state insurance commission and get an opinion as to whether you would be supportive in your decline to provide such records. But as I said, in my experience in other states you would not be supported by the state in this action.

 

[horitsu]

Thank you for your reply.
In answer to your questions:
I was covered by group insurance up to the point of my new policy enrollment, so there should not be any gap in coverage.
The new insurance in group as well (both policies provided by my employers - job change).
I will look forward to your ideas.
Thanks again!

 

[cbg]

If you had no gap in coverage, and went from group insurance to group insurance, you should not be subject to pre-ex checks. (Oops, I forgot to ask, how long had you been covered with no gap?) When you changed jobs, you should have received a Certificate of Coverage that spelled out the exact dates that you had been covered. This might have come from either your former employer, or from your old insurance carrier; they share joint responsibility for that. If you did not receive one, or if you did and have lost it (quite possible - a lot of people do) call your former employer and ask for one. Then send a copy to the new insurance carrier. That should wipe out the whole problem.

Caveat, based on my forgetting to ask how long you had been covered: If you have had continuous coverage for less than one year, you still may be subject to a short pre-ex period. Example; you had continuous coverage for eight months, you can be subject to pre-ex for four months. But this is all your past employment put together; if you were at your former employer for six months, but the employer before that for eight months, and there was never a gap in coverage, you've had fourteen months coverage, which means you've had more than a year, which means no pre-ex, even though your last coverage was less than a year. See how it works? (If the twelve months continuous coverage does cover more than one employer, though, you will need to send the new insurance carrier a Certificate of Coverage for each one.)

A gap in coverage is defined by law as 63 days or more. So if you had no coverage for, say, 30 days, that's not a gap in coverage.

Under no circumstances that I am aware of can any condition be considered pre-ex for longer than one year. This is Federal law we've been talking about. State law CANNOT make it longer than this; it can make it shorter, although I don't know if Ohio does.

If this has totally confused you, let me know.

 

[horitsu]

Your advice has been extremely helpful. It sounds like I should be okay. I will probably have to get the coverage documentation again from my previous employer, but it doesn't sound like I have any gaps.
Thanks so much for your help!