Can pregnancy complication be treated as pre-existing condition by insurance company?
I switched to my husband's insurance policy shortly after becoming pregnant because I plan to leave my job. I believe I have one prenatal appointment and one round of lab work covered by my old insurance.
I just received a statement from my current insurance provider stating that two lab visit will not be covered because they were for a pre-existing condition. These visits be for bloodwork to test my thyroid levels. I be diagnosed with hypothyroidism AFTER becoming pregnant, and had never have a problem before pregnancy. The diagnosis was base on my initial prenatal labwork ordered by my OB (which was covered by my old insurance). The condition have been treated solely by my OB.
The insurance paperwork stated that pregnancy is not considered a pre-existing condition. Does the same hold true for pregnancy complications? The charge for two lab visit is $500!! I have emailed the insurance company, but was wondering if I am correct surrounded by thinking these charges are unwarranted.
Answers:
Well, yes!
But the article is, did you have prior health coverage for 12 months, back switching? If you did, you need to get a "authorization of credible coverage" from the prior insurer, and then the new group policy can't exclude pre-existing conditions. That's probably the legitimate solution to this problem. Source(s): agent, 21+ years
Whether or not pregnancy is considered a pre-existing condition depends on your husbands insurance policy. You'd have to confer to the insurance company to find that out. Instead of waiting for them to e-mail you back, why don't you just bid the insurance company and get some answers? It'll be a lot quicker.
Hypothyroidism isn't going to be considered a "pregnancy complication" by the insurer. The fact that you didn't happen to seize diagnosed until after you were pregnant isn't going to make a difference.
There's a impartially standard list of what insurers are legally required to treat as "pregnancy complications" - those are the things that state mandate would require the insurer to cover. (Here's an example from the Idaho department of insurance...again, the list is fairly standard industry-wide. I'm freshly linking Idaho b/c it was the first state's rules I stumbled across to link: http://adm.idaho.gov/adminrules/rules/id… )
Your thyroid issue will be treated similar to any other medical issue - if you had enough continuous coverage prior to this policy starting point, then just provide the insurer beside that documentation. They should waive the pre-existing clause b/c of your creditable coverage. If you didn't have continuous insurance before starting this policy, you'll enjoy to pay for the thyroid treatment out of pocket. Sorry.
Edit to Add: Just to show you how generally standard the permitted insurance definition of "pregnancy complication" is, here's the link from the Colorado department of insurance. Note that the language is almost transposable to the link I provided above for Idaho. http://www.dora.state.co.us/insurance/re…
Vermont uses the exact same language to explain "pregnancy complications" : http://www.bishca.state.vt.us/InsurDiv/r… Source(s): 15 years working for health insurance companies and medical providers
Related Questions:
I just received a statement from my current insurance provider stating that two lab visit will not be covered because they were for a pre-existing condition. These visits be for bloodwork to test my thyroid levels. I be diagnosed with hypothyroidism AFTER becoming pregnant, and had never have a problem before pregnancy. The diagnosis was base on my initial prenatal labwork ordered by my OB (which was covered by my old insurance). The condition have been treated solely by my OB.
The insurance paperwork stated that pregnancy is not considered a pre-existing condition. Does the same hold true for pregnancy complications? The charge for two lab visit is $500!! I have emailed the insurance company, but was wondering if I am correct surrounded by thinking these charges are unwarranted.
Answers:
Well, yes!
But the article is, did you have prior health coverage for 12 months, back switching? If you did, you need to get a "authorization of credible coverage" from the prior insurer, and then the new group policy can't exclude pre-existing conditions. That's probably the legitimate solution to this problem. Source(s): agent, 21+ years
Whether or not pregnancy is considered a pre-existing condition depends on your husbands insurance policy. You'd have to confer to the insurance company to find that out. Instead of waiting for them to e-mail you back, why don't you just bid the insurance company and get some answers? It'll be a lot quicker.
Hypothyroidism isn't going to be considered a "pregnancy complication" by the insurer. The fact that you didn't happen to seize diagnosed until after you were pregnant isn't going to make a difference.
There's a impartially standard list of what insurers are legally required to treat as "pregnancy complications" - those are the things that state mandate would require the insurer to cover. (Here's an example from the Idaho department of insurance...again, the list is fairly standard industry-wide. I'm freshly linking Idaho b/c it was the first state's rules I stumbled across to link: http://adm.idaho.gov/adminrules/rules/id… )
Your thyroid issue will be treated similar to any other medical issue - if you had enough continuous coverage prior to this policy starting point, then just provide the insurer beside that documentation. They should waive the pre-existing clause b/c of your creditable coverage. If you didn't have continuous insurance before starting this policy, you'll enjoy to pay for the thyroid treatment out of pocket. Sorry.
Edit to Add: Just to show you how generally standard the permitted insurance definition of "pregnancy complication" is, here's the link from the Colorado department of insurance. Note that the language is almost transposable to the link I provided above for Idaho. http://www.dora.state.co.us/insurance/re…
Vermont uses the exact same language to explain "pregnancy complications" : http://www.bishca.state.vt.us/InsurDiv/r… Source(s): 15 years working for health insurance companies and medical providers
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