Strange Insurance Question

Dlynn · March 31, 2005

Hello all,

My insurance company called me today after my Dr submitted all paperwork and asked for a HIPPA statement from my old job. I have been on my new job now for 8 months now.

I am researching HIPPA, and was wondering why would my insurance co need this info. I have found out that HIPPA tells what your medical history is.

My main question is has any other bandsters had this requested and if so, what was the outcome?

Thank You

Dlynn

Alexandra · March 31, 2005

Dlynn, the HIPAA form your carrier is asking for is only to establish that you had coverage for a certain period of time prior to coming on their plan. That will tell them whether they can apply a pre-existing condition exclusion on you. (I believe the regulation is that if you had coverage for a period of 18 months prior to starting this plan, they CANNOT impose a pre-existing condition exclusion on you. If you had no coverage or coverage for a shorter period, they might be able to. But even if they do, it can't be longer than 12 months in most cases.)

The form you get when you request a HIPAA form from your prior carrier or employer gives no more information than your name, ID number, and the beginning and ending dates of your coverage.

Not to worry--it's not anything invasive of your privacy and a perfectly legitimate request. Good luck!

Dlynn · March 31, 2005

Alexandra,

Thanks for the quick reply as I got nervous as to why they needed this info, not knowing what they were for anyway.

I did have insurance prior to my current job, there was a 5 month lapse in insurance thats it.

This site is awesome for information.

Thanks a million

Dlynn

Alexandra · March 31, 2005

Be prepared for the possibility of an exclusion if you had a lapse in coverage, Dlynn. If you had a lapse of five months immediately before taking this current coverage, you may very well have a pre-ex imposed. If that happens and you're denied for this reason, just find out how long the pre-ex is, and try again at that time. Don't lose heart!

Dlynn · March 31, 2005

Alexandra,

This is our pre existing statement, so I believe I should be ok according to the below.

Any condition for which the insured has received medical treatment or diagnosis during the three months prior to his/her effective date of insurance will be deemed pre-existing, and the plan will not cover claims on that particular condition during the first 12 months of coverage.