Claim Denied For a Preexisting Condition?


First here is some background information…

I have been receiving methadone maintenance treatment for opiate addiction non stop for 6 years. when i first began receiving treatment i had insurance through my employer and they covered it.

In August 2013 I was let go due to company restructuring and lost my insurance. In November 2013 I found a new job and started receiving insurance in December of 2013 through my new employer.

My insurance plan covers substance abuse treatment.

I had insurance through my employer with Humana beginning Dec 2013 through Dec 31 2014.(Beginning Jan 2015 my employer changed insurance providers)

I go to a methadone clinic for opiate addiction. They do not accept insurance so I pay cash at a rate of $110 per week. I filed a claim with my insurance provider to receive reimbursement for the substance abuse treatment i received, and they denied my claim for treatment for the dates starting jan 2014 through October 2014 because they said it is a pre existing condition, and said that I had to wait 1 year before I could be covered for this.

They said because I had a gap in insurance coverage longer than 63 days when I lost my previous job that they would not cover it. I have been treated for this condition ongoing for 6 years never a gap in treatment.

My question is, I thought with the new laws that there were no more ore existing condition exclusions? Can they legally deny my claim because its a pre existing condition?

Thank you for your help. I hope I provided enough information

Leave a comment

We'll never share your email with anyone else.

1 2 3 4 5

This site uses Akismet to reduce spam. Learn how your comment data is processed.

I was in a car crash the other was giveing a ticket. The insurance co. Refuse payment because I was dienos with a problum .the doctors don’t know if it was my back or my hip. Now I get in this car crash and three days later I can’t walk and the resart of this crash i had to have my right hip repaced and from that the life had to be replaced. Please help

Reply

Are you aware that health insurance companies do not send out bill’s for renewal so that you have a coverage gap and therefore they will not pay for pre-existing conditions because of the loop-hole? These insurance companies and the loop-holes really need investigated…..please!
My insurance expired 1-day before I noticed it (at my Dr’s. office) so now they will not pay for my Thyroid testing because it is now falls into the ‘gap’.

Reply
ObamaCareFacts is a free informational site. It's privately owned, and is not owned, operated, or endorsed by the US federal government or state governments. Our contributors have over a decade of experience writing about health insurance. However, we do not offer professional official legal, tax, or medical advice. See: Legal Information and Cookie Policy. For more on our company, learn About ObamaCareFacts.com or Contact us.