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Old 05-22-2010, 01:55 PM
 
1 posts, read 1,997 times
Reputation: 11

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For a little while in the fall, I was going to the doctors office with unexplained abdominal pain. I didn't have any insurance, and was paying out of pocket. I thought these were just urinary tract infections, because I had had one in august. but then they got worse..

So I signed up for my job's health insurance during the enrollment period (feb 2), so that the next time, I wouldn't have to pay so much. Urinary tract infections aren't pre-existing conditions, and insurance companies can't give you a hard time about them, right?

Well, later in the month, (Feb 19) I woke up in early in the morning, throwing up. I threw up about 9 times before the ER nurses could get some anti nausea meds in me, about 5 hours later. They ran a bunch of tests, x-rays, ultrasounds, and they found an ovarian cyst.

So they sent me home with some anti nausea pills and some tylenol with codene to help with the pain, and the names of a coupe of good gynecologysts in the area. I saw a gyno in march, she put me on birth control, and everything is fine and dandy.

Until April 1, when I got a questionnaire from my insurance company, asking about a visit to the doctor in December. I can't remember what the questionnaire asked, and it seemed innocent to me, because I skimmed over the letter and missed the words "pre-existing conditiong exclusion." It seemed to me like it was just asking if I had visited a doctor in December.

Well I filled it out, and 18 days later, I get a letter telling me that they wouldn't pay the hospital, x-ray or gyno bills because my policy included a clause on pre-existing conditions.

But I wasn't DIAGNOSED with this condition until after I was under their coverage!

Is that questionnaire I filled out going to screw me over?
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Old 05-22-2010, 02:57 PM
 
6,396 posts, read 14,205,725 times
Reputation: 10668
Call the insurance company to find out what exactly they are considering a pre-existing condition. You have a right to appeal their decision, especially if it is erroneous. Once you understand their reasons for denial, write an appeal explaining your position and including any documentation. Possibly someone either in hospital or GYN filled out paperwork incorrectly.
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Old 05-23-2010, 01:31 PM
 
26,590 posts, read 57,298,210 times
Reputation: 13098
You don't need a diagnosis, the symptoms were there, you had a pre-existing condition. They would have figured it out anyhow. Unless you have other coverage and then joined the company plan without a lapse, you won't be covered.

No one is trying to '*********," it's the way insurance works. Why didn't you take your employers insurance when it was first offered to you?
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Old 05-23-2010, 04:22 PM
 
6,396 posts, read 14,205,725 times
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You still have the right to appeal their decision. You should contact your doctor who could provide additional medical documentation. I appealed a claim and wrote to the hospital and admitting doctor. I was able to have the insurance reverse their decision and paid the claim. It might be worth your time.
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Old 05-23-2010, 04:26 PM
 
6,396 posts, read 14,205,725 times
Reputation: 10668
Quote:
Originally Posted by annerk View Post
.

No one is trying to '*********," it's the way insurance works. Why didn't you take your employers insurance when it was first offered to you?
Unfortunately MANY new employees don't take the insurance or long term disability when they are hired, probably because they don't want to spend the money. In the company I where I worked, I know of six people who didn't take Long Term Disability and they got sick and could have been paid 55% of their salary until they were of retirement age. Maybe they think they are invincible.
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Old 05-27-2010, 02:47 PM
 
301 posts, read 1,242,427 times
Reputation: 221
Yeah, so how's this private health insurance thing working for ya.......
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Old 05-27-2010, 05:36 PM
 
6,396 posts, read 14,205,725 times
Reputation: 10668
Quote:
Originally Posted by eastwestman View Post
Yeah, so how's this private health insurance thing working for ya.......
That's right, the Healthcare Reform is going to remove all that pre-existing condition requirements. Hmmmm, how much do you think THAT's going to cost you?
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Old 05-28-2010, 05:16 PM
 
Location: Fort Myers, FL
3 posts, read 4,360 times
Reputation: 10
you don't have a pre- existing condition because if you did go to the dr before for a possible uti, that is very different than having now a ovarium cyst, you should appeal this desicion and the insurance will have to paid it.
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