Aa
Aa
A
A
A
Close
Avatar universal

ADA and Health Insurance

If drug treatment is covered by your health insurance- can it be denied as a "pre-existing condition" if you were getting treatment and paying out of pocket before you got the insurance??? Anybody know? Someone told my son that because of ADA it cannot be denied. Anybody know?
2 Responses
Sort by: Helpful Oldest Newest
Avatar universal
I think I found an answer to my question on the COBRA web site:
"Pre-existing conditionsSome health insurance companies cut their costs by invoking something called a "pre-existing condition" clause. The notion of a pre-existing condition makes sense when you're talking about car insurance: your windshield was cracked before you bought your coverage, so you can't expect the insurance company to replace it once your policy is in force.

But it's a more sensitive issue when you're talking about someone's health. Got diabetes? Your current benefit plan may pay for your insulin and doctor visits. But if you change jobs, your new health plan can call your diabetes a preexisting condition and refuse to treat it. Now, you're paying for all of your diabetes treatment yourself, plus the regular out-of-pocket expenses for other medical treatments.

HIPAA limits the instances in which a company can exclude payment for preexisting conditions. This is where it gets tricky:

The definition: A pre-existing condition is something for which you've been treated or diagnosed in the last six months.

The time limit: A health insurance company can still refuse to pay for a pre-existing condition, but only for 12 months. Late enrollees in group health plans may have to wait up to 18 months for coverage of preexisting conditions.

Credit for time served: If you've been continuously covered under another plan, your new health plan must give you credit for time served. So if you move from one company to another and you've already been denied coverage for a pre-existing condition for 12 months, the new health plan must cover your condition. Likewise, if you've been waiting out a pre-existing-condition clause for eight months, the new health plan can deny you coverage for that preexisting condition only for four months - a total of 12 months.

Continuous coverage: In order to keep your coverage continuous, you cannot let it lapse for more than 62 days. That's where COBRA comes in. If you leave one company before starting with another, or if your new company's benefits don't kick in for three months, you should buy COBRA coverage to keep your coverage continuous. Otherwise, you'll be back at square one with the 12-month waiting period.

Five types of coverage: There are five types of coverage that may carry an additional waiting period: prescriptions, vision, dental, mental health, and substance abuse treatment. "If the health plan wants to, they can look back at prior coverage to see if you had those services," says Karen Pollitz, a health policy researcher at Georgetown. "If you didn't, then they can apply a separate pre-ex on those coverages." Aside from those five, your new health plan will have to cover you regardless of what your coverage was under the old plan."

The last paragraph is confusing, any help with interpretation here?

Helpful - 0
Avatar universal
MY HEART ,which was ripped out, fiddled with and slapped back in, GOES OUT TO YOU!!! I think?                  DIVIDED WE STAND
Helpful - 0
Have an Answer?

You are reading content posted in the Addiction: Social Community

Top Addiction Answerers
495284 tn?1333894042
City of Dominatrix, MN
3060903 tn?1398565123
Other
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
Is treating glaucoma with marijuana all hype, or can hemp actually help?
If you think marijuana has no ill effects on your health, this article from Missouri Medicine may make you think again.
Julia Aharonov, DO, reveals the quickest way to beat drug withdrawal.
Tricks to help you quit for good.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.