Can TeamCare Deny a Pre-Existing Condition?
In June to avoid paying taxes on the health plan UPS switched to TeamCare, So now we have a new insurance policy. My wife had emergency surgery since then and now Teamcare is saying that because my wife had this surgery almost 5 years ago, they do not need to cover anything that they think is related to that surgery. Can they deny paying this emergency surgery claim?
Answer
Unions are exempt from some of the Affordable Care Act's rules. The idea that they are exempt from the pre-existing conditions clause doesn't sound right. The ACA means that you can't be discriminated against in regards to what you pay or what a plan will cover based on past medical history.
They shouldn't have to pay old claims, but they do have to pay new bills for pre-existing conditions.
Ask them to point you to the part of the law that says they are excluded from this, their policy, and your rejection letter. You should then at the very least send this to HealthCare.Gov and the Better Business Bureau.
Once you have the details, feel free to share your story with us.
Keep in mind, if you are choosing to stay on a grandfathered plan that doesn't cover preexisting conditions, you are making the choice. Anyone can go to the Marketplace and get a plan that covers preexisting conditions. If someone is offering you a grandfathered plan that can deny preexisting conditions, consider other coverage.
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I have insurance from SOS International through my employer. My employer is a non-US organization, but I am an American citizen. Can SOS International (a US company) deny pre-existing conditions in this case (i.e. is this a loophole)? My understanding is that if I got it directly through them (or through a US employer) denying pre-existing conditions would be illegal, but what about in this situation?