Lost health care/ new plan.Can I be denied reconstruct

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Lost health care/ new plan.Can I be denied reconstruct

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  • Debe772
    Debe772 Member Posts: 11
    edited September 2015

    please help. My husband's company recently did not pay the premium on our health care. I am still in need of another reconstruction. We should have insurance back on October 1, but unsure if it will be a group health care or individual plans his comany pays for. It's a small company. My question is, can I be denied?will I still fall under the protective coverage for reconstruction after mastectomy? I am soo sick over this

  • rainnyc
    rainnyc Member Posts: 1,289
    edited September 2015

    Debe, I'm not an expert, but I believe that reconstruction is covered under the ACA, so all insurers have to offer it under the law. So you will have your reconstruction covered. Where it could get sticky is if the new insurer (if in fact you have a new insurer rather than the one you had previously) resets your deductible/out of pocket to zero. I think you will have to see whether you have a new insurance company or the one you had previously, and then ask the question. There also is a provision under the law for those who have to switch insurance while dealing with a serious illness--I believe you have the right to be grandfathered under your old health plan for 60 days. Good luck! Let us know what happens.

  • susan_02143
    susan_02143 Member Posts: 7,209
    edited September 2015

    In the United States, there are no longer any pre-existing condition clauses. This was a major change that was initiated as part of the Affordable Care Act. The deductible will no doubt restart, but you should be covered. Good luck!

  • vlnrph
    vlnrph Member Posts: 1,632
    edited September 2015

    Even prior to ACA, when a plan allowed for mastectomy, it had to provide reconstruction benefits and not try to deny by classifying it as elective cosmetic surgery. We can thank our foremothers for that law.

    The 60 day interval may not apply if there was a break in coverage, however it sounds like the employer was the party that neglected their responsibility. They're probably too small to have a human relations or personnel department to help resolve this. Did you call the insurance company to ask about immediate reinstatement?

    Find out whether there is any policy you qualify for right now. Something catastrophic (car accident, etc) could happen next week. It's not a good idea to be "going bare" even when it's not your fault!

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