Coverage for pre-existing conditions
originally posted: 11/22/2006 reposted: 2/18/2011 This post has not been recently reviewed or revised by the author and may be out of date. If you notice an error or are in doubt, please send a new question by email or ask for an update. Email asktony@tonynovak.com.
Q: I followed your advice about obtaining a short-term policy, and purchased one from Assurant Heath, underwritten by Time Insurance Company. A SUBSEQUENT CLAIM FOR A PREVIOUSLY UNDIAGNOSED AND UNTREATED BASAL SKIN CARCINOMA HAS BEEN DENIED AS A PRE-EXISTING CONDITION. You should be aware that the State Code of Maryland section 15-1301 defines a pre-existing condition in reference to a short-term health policy as "A condition that was present before the date of enrollment for coverage, whether or not any medical advice, diagnosis, care or treatment was recommended or received before that date". This language appears no where on the sales literature, or on the policy form itself. This is a huge loophole, which renders the policy worthless in this case. So now I have a $4000 bill to pay out of pocket, for which I thought I had coverage. We also have a diagnosed pre-existing condition, which makes getting individually underwritten for a future policy nearly impossible. You should be aware of and include such information before you recommend purchasing such a policy. Had I known this, and not been mislead by your definition of "pre-existing", I would never have purchased this type of policy. I plan on appealing the decision, but the law is against me.
A: Sorry to her about your poor experience but there are three important things to note here: 1) We have actively cautioned people to avoid Assurant Health for more than a year now, and 2) There is no implication that any commercial major medical health insurance policy available to individuals covers pre-existing medical conditions. This is true regardless of the length of the policy or the company issuing the coverage. If fact, almost every commercial individual health insurance policy clearly states that it does not cover pre-existing medical conditions. There are very few, if any, exceptions. 3) In a situation like yours, short term health insurance is recommended for the purpose of minimizing the waiting period until you do qualify for the pre-existing medical condition coverage under a group type coverage. Under HIPAA law, a group insurance plan may offer this coverage immediately to a person with a Certificate of Creditable Coverage from a prior short term medical insurance policy. Without the short term insurance policy, you could be faced with another six month waiting period even after the new coverage starts. It often makes more sense to enroll on a short term plan in order to meet the HIPAA continuity of coverage requirements and avoid a waiting period under the eventual coverage that you need for your medical condition. The popular article "Finding Health Insurance to Cover Pre-existing Medical Conditions" has been used by many to find the possible options but this article does not include any mention that a policy from Assurant Health would be a viable option. For the benefit of other readers in the future who might avoid a problem we will restate it loudly here: COMMERCIAL INDIVIDUAL MEDICAL INSURANCE DOES NOT COVER PRE-EXISTING MEDICAL CONDITIONS. The only possible "work around" solutions we can suggest are listed in the article linked below.
Summary
More resources:
Finding Health Insurance to Cover Pre-existing Medical Conditions