curiousgeorgette
New member
advice was given, then....? How can an insurance company providing a geoup plan have a pre existing condition clause of 24 months prior to inception of the plan, that if one received care, diagnosis, treatment, advice, etc., AND states that if a condition manifested itself within 24 months prior to inception of the plan that a "reasonably prudent person" would have sought care.. If HIPAA expressly states that they are only allowed a look back of 6 months and specifically states that if care, treatment or diagnosis was not provided within the 6 months prior to enrolling in the plan that they are prohibited from excluding it as a pre existing condition?
HIPAA also expressly states that pregnancy cannot be considered a pre existing condition, but my Employer's group coverage- BCBS Blue Options- benefit booklet specifically states that pregnancy IS considered a pre existing condition and that new enrollees with no creditable coverage are subject to a 12 month wait period on pre existing conditions- which are considered to be anything which manifested itself within 24 months prior to inception of the plan, which a reasonably prudent person would seek care for, or if treatment, diagnosis, etc was given within 24 months of inception of the plan.
How can they LEGALLY do this if HIPAA says 6 month look back, and pre existing only is applicable if care was given, diagnosis given, etc within 6 months prior to inception.....????!!!
HIPAA also expressly states that pregnancy cannot be considered a pre existing condition, but my Employer's group coverage- BCBS Blue Options- benefit booklet specifically states that pregnancy IS considered a pre existing condition and that new enrollees with no creditable coverage are subject to a 12 month wait period on pre existing conditions- which are considered to be anything which manifested itself within 24 months prior to inception of the plan, which a reasonably prudent person would seek care for, or if treatment, diagnosis, etc was given within 24 months of inception of the plan.
How can they LEGALLY do this if HIPAA says 6 month look back, and pre existing only is applicable if care was given, diagnosis given, etc within 6 months prior to inception.....????!!!