Denied Health Care.

I aim to make this a photography and film based blog, but every now and then it is sprinkled with other bits of information on my mind. This has nothing to do with media, but I found it and think it maybe of interest to some people.

Did you know that most of the time that insurance compay CANNOT deny you coverage? There are specific statuates dealing pre-existing conditions and the insurance companies simply ignore them because it’s easier to deny coverage, hope people can’t afford to fight it or just don’t know any better. Below are some specific guidelines governing pre-existing conditions. Even people with serious illnesses are covered a good portion of the time. The insurance companies have done the math and figured out that if they deny coverage, it will take several years and a great deal of attorney’s fees to recover that money. If you are covered by group insurance (and most people are) ERISA also affects this. If the insurance company doesn’t pay, there are NO PENALTIES. The worst that can happen to them is that they eventually have to pay the claim but often they don’t have to pay the plaintiffs attorney’s fees. That means the insurance company still wins.

42 USC § 300gg sets a max pre-ex period of 12 months, but that 12 months is reduced by any prior coverage. So if you have more than 12 months of continuous prior coverage, no preexisting exclusion applies.

42 U.S.C.A. § 300gg

United States Code Annotated Currentness
Title 42. The Public Health and Welfare
Chapter 6A. Public Health Service (Refs & Annos)
Subchapter XXV. Requirements Relating to Health Insurance Coverage (Refs & Annos)
View the full text of all sections at this level Part A. Group Market Reforms
View the full text of all sections at this level Subpart 1. Portability, Access, and Renewability Requirements
Current Selection§ 300gg. Increased portability through limitation on preexisting condition exclusions

(a) Limitation on preexisting condition exclusion period; crediting for periods of previous coverage

Subject to subsection (d) of this section, a group health plan, and a health insurance issuer offering group health insurance coverage, may, with respect to a participant or beneficiary, impose a preexisting condition exclusion only if–

(1) such exclusion relates to a condition (whether physical or mental), regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on the enrollment date;

(2) such exclusion extends for a period of not more than 12 months (or 18 months in the case of a late enrollee) after the enrollment date; and

(3) the period of any such preexisting condition exclusion is reduced by the aggregate of the periods of creditable coverage (if any, as defined in subsection (c)(1) of this section) applicable to the participant or beneficiary as of the enrollment date.

The more people know about this, the more they can demand accountability from the insurance companies. They cash your premium checks then refuse to offer the service you are paying for.

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2 thoughts on “Denied Health Care.

  1. Tnelson says:

    Hey, I found your blog while searching on Google your post looks very interesting for me. I will add a backlink and bookmark your site. Keep up the good work!

  2. RobD says:

    There is obviously a lot to know about this. There are some good points here. 🙂

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