Time Period For Insurer to "Investigate" Pre-Existing Condition

Denise1959

I haven't even gotten over the initial blow of my diagnoses, and now I have to play the waiting game for the insurer to verify that I was NOT a pre-existing condition.   (Policy acquired 2 months b/f I even had a routine mammogram).    How long does it usually take for them to "investigate."    This is BC/BS of Alabama.   Are there any laws that govern the time they have.   My concern is that my treatment may be delayed while I'm waiting on BC/BS to discover I'm not pre-existing.   I even called them and offered my assistance (i.e., give them prescription records, dates/names of medical visit w/in 2 years b/f my diagnoses, which were 2 & totally unrelated), but they refused.    

tealorca11

Hi There-

I wish I could give you a definitive answer. This sounds horrible! I am actually worried about this myself as I go through checking out breast cancer and skin cancer symptoms and figuring things out. I hope someone on the boards has some knowledge about this situation and can give you some help. In the meantime, hang in there. It seems so unfair with how insurance companies operate, and I can only imagine how "the waiting game" is just making things harder for you.

NNBBFL

There is an affordable insurance program called PCIP (Pre-existing Condition Insurance Program) that you may want to look into. Just google PCIP and you should find their website.

Chickadee

In most states I think it's called Insurance Commissioner. You provide no info so google your state govt and you can do a search.

Mardibra

Also, I think it may depend upon whether you are covered by an individual policy or a group policy.

GointoCarolina

 I currently have an HMO and have been thinking of changing insurance as the doctors I want to do my recon are out of network for the HMO.I called BC/BS to ask if there would be a problem in coverage for an illness I had prior.I was told as long as I had had insurance coverage with no lapse I could change insurers and everything was covered.Maybe have your doctor write them a letter stating the urgency of starting treatment.

Shrek4

0

peggy_j

Yes, call your state health insurance commissioner (or whatever it's called). I called the one in CA and the guy I spoke to was very knowledgeable and helpful. Can't believe your'e going something like this right now. Sending you good vibes that this gets straightened out ASAP!

Wabbit

Truth ... they are going through everything they can find with a fine tooth comb trying to find some excuse to call you pre-existing so they don't have to pay.

Good news is that it does not sound like there is anything there for them to find.  I agree that they need to have a fire lit under their behinds to make a decision and let you get on with your treatment.  Perhaps your doctor can call and put some pressure on them also?

This sucks ... hope you get it all worked out soonest. 

peggy_j

FWIW, didn't the Affordable Health Care Act of 2010 make it harder (or illegal?) for them to rescind policies? I remember reading an article that here in CA some of the big health insurance companies changed their policies after the law was passed but a couple months before it officially went into effect. Maybe this is different because the OP's policy is so new (or if her state offers less help for consumers).

tninalabama

I also have BC/BS Alabama. The major problem that I have encountered was when I was going from one policy to another (job change). It took several months to get straightened out. I still have some doctors offices that file the old numbers, (ugh). Otherwise they are usually very professional. Check with your doctor to be sure they are sending the correct info. Best of luck!!