by Guest » Tue Sep 04, 2012 07:54 pm
Hi all, I am in the US state of Georgia.
Quick question, I needed some temp insurance to hold me and family over for a month before starting new job, so I called Blue Cross Blue Shield and got the process started. My main concern is if my wife having an emergency issue with her hernia, we plan on getting surgery after I get insurance with my new job. I forgot to mention her hernia stuff with BCBS and I'm a little afraid to in case they deny her (although I will call back BCBS as last resort).
But question is, as it stands now if an emergency situation did occur, would they typically cover her emergency surgery? Or would they look really hard to find previous doctor visits about this hernia problem so they could deny claim (she did have one with a general surgeon)?
Thanks for any help,
J
Quick question, I needed some temp insurance to hold me and family over for a month before starting new job, so I called Blue Cross Blue Shield and got the process started. My main concern is if my wife having an emergency issue with her hernia, we plan on getting surgery after I get insurance with my new job. I forgot to mention her hernia stuff with BCBS and I'm a little afraid to in case they deny her (although I will call back BCBS as last resort).
But question is, as it stands now if an emergency situation did occur, would they typically cover her emergency surgery? Or would they look really hard to find previous doctor visits about this hernia problem so they could deny claim (she did have one with a general surgeon)?
Thanks for any help,
J
Posted: Wed Sep 05, 2012 12:34 am Post Subject:
But question is, as it stands now if an emergency situation did occur, would they typically cover her emergency surgery? Or would they look really hard to find previous doctor visits about this hernia problem so they could deny claim (she did have one with a general surgeon)?
You're concern is valid, and you are talking about a PREEXISTING CONDITION. Coverage for preexisting conditions may or may not be included in your policy. It depends on whether BCBS in Georgia is already implementing that aspect of Obamacare (I doubt it).
It may also be excluded for the same reason under a new employer's health plan -- unless you have HIPAA creditable coverage from your previous employer.
If you recently left employment where you were covered by health insurance, why did you not elect COBRA continuation? There would be no question about coverage in that case. If you left your former employer within the last 59 days, you have one day left to elect and pay for COBRA continuation.
Posted: Wed Oct 03, 2012 01:06 am Post Subject:
Your "forgetting" to mention your wife's preexisting conditions could easily be interpreted as (1) a material misrepresentation, and potentially (2) fraud.
In health insurance, "fraud is forever." In other words, if the insurer can prove that you obtained the policy fraudulently (and omission of a material fact can be construed as concealment in the application for insurance, which can lead to an investigation of fraud) then coverage under the policy is suspect.
A "material misrepresentation" is this: Had the insurer known the CORRECT information, would that (correct) info have adversely affected the issuance of the policy? In other words, if the insurance company knew of her preexisting conditions, would that information altered the way the insurer would have issued the policy? If so, the misrepresentation is considered "material to the insurer's decision to issue" and could void the policy and coverage.
InsTeacher 8)
Posted: Wed Oct 03, 2012 11:18 am Post Subject:
Material misrepresentation, to be clear, is a false statement concerning a fact that a party has the right to know in order to make an informed decision -- yes or no -- about a proposed contract. If the correct information would change their mind, it is material information.
In order to get to "fraud" there must also be an "intent to deceive or gain an advantage" by making the material misrepresentation.
Misrepresentation is not a crime, but it can void a contract. Fraud voids a contract, and is also a crime.
Posted: Sat Nov 17, 2012 09:30 am Post Subject:
Yeah, my swamp cooler leaked and ruined the ceiling in our hall and a bedroom. We didn't realize it was leaking until we noticed the ceiling was beginning to bow. The ceiling caved the next day. It was covered by our Homeowners insurance. But like Len says this was more of a sudden damage thing which occurred once we turned on the cooler in the spring.
Posted: Mon Nov 19, 2012 10:06 pm Post Subject:
If your wife has been told that she needs surgery no plan is going to take her.
What if something happened to speed the need for surgery up or the new job doesn't work out?
Then that insurance company is stuck with the surgery bill.
No company is going to want to take on that liability.
If you do find a plan it will be super duper expensive and probably not affordable to someone who is not working.
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