0
This can be done in several ways. First, questions about health history are usually asked on applications for insurance, so it can be determined that way.
Thereafter, if a claim is submitted, the insurer often requests medical records to back up the claim. Diagnosis codes, medical history (self-reported and otherwise), and other aspects of the records may give the underwriter or adjuster reason to believe that there is a pre-existing condition. Whether there is or not can be a difficult call to make, dependent upon policy definitions, medical records, and explanations given by treating physicians and the insured.
Pre-existing condition denials of claims often provide fertile ground for coverage disputes.
Wiki User
∙ 13y ago
Add your answer:
Earn +20 pts
Does insurance cover foundation repairs?
It might and it might not. It depends on what scope of coverage you purchased and if it was a preexisting condition or not.Contact your insurer or your insurance agent for clarification of your coverage.
Is a genetic condition considered a preexisting condition?
Yes, if it was known prior to coverage. If you have had continuous insurance since the genetic condition was known and there was no lapse in coverage (or the lapse was short enough), care for that condition will be covered by your new insurer, per HIPAA.
Is a dislocated shoulder a preexisting condition?
If your shoulder commonly comes out of its socket, then it is a preexisting condition. If it is the first time you have dislocated your shoulder or if you have never dislocated your shoulder, then it is not a preexisting condition.
Does there have to be a diagnosis to be considered a preexisting condition?
According to my insurance company if you have seen a doctor about the condition it is preexisting.
Is having a heart cathetor test considered pre existing condition?
Tests, of any kind, are not included in the definition of preexisting condition. You have to be given a definitive diagnosis from that testing in order to have a preexisting condition. If by having a heart cath test, it was determined that you did not need to have one placed, then you do not have a preexisting condition. For example, you may have an MRI/CAT Scan and then a PET Scan to determine if you have cancer, but if they find you do not have cancer, then you are not diagnosed with a condition, therefore cannot considered preexisting. I should add that, generally if a Dr. wants to evaluate for a heart cath, then you currently have or have had issues with your heart in the past. This may be something like a high percentage blockage, irregular heart beat, thickening of the lining around your heart, etc. This would be considered a preexisting condition and future insurance companies may determine that any intervention needed on your heart would be preexisting. However, insurance companies usually have a preexisting time frame (generally 12 or 24 months) in which a condition is no longer consider preexisting. For example, if you were diagnosed with a heart condition 13 months ago and the insurance company you are planning on joining policy is a 12-month limit on pre-existing conditions, then you are in the clear and the preexisting condition clause does not apply to you.
Can A payer can cancel a patient policy or deny payment on a claim if the patient failed to disclose a preexisting condition?
Under federal health reform rules, an insurer can cancel a policy only for fraud on the application. Omitting a pre-existing condition might be considered fraud, especially if the condition is significant. The insurer could choose to continue the policy, but would have the right to deny claims for the pre-existing condition. If you had a 63-day gap in coverage, for example, the insurer could deny those claims for the first 12 months. After the 12 months ends, the insurer would have to start paying claims for all of your medical conditions.
Is prematurity considered a preexisting condition?
yes
Coding a condition as primary when the majority of the treatment is for a preexisting condition?
illegal
Would a complete knee replacement be preexisting condition?
Yes. In order to have a knee replacement done you must first have a significant amount of damage to the knee joint. That is your preexisting condition. The knee replacement itself was done to replace the damaged joint and may or may not be considered a preexisting condition.
Is preexisting the correct spelling?
"Preexisting" : a condition or state which preceded another. (sometimes appears hyphenated as 'pre-existing') A "preexisting condition" : A status for medical afflictions that were already affecting a patient before the beginning of the current (or future) medical coverage or treatment.
How do you use the word preexisting in a sentence?
She was denied insurance coverage because of her preexisting medical condition.
Why would life insurance company ask you to sign something telling them who your plan is with through your employer?
One of the factors that a life insurer is concerned with when issuing a policy is whether the applicant has a pre-existing condition (a condition that existed prior to the application for life insurance). It wishes to know this because, based upon the insurer's underwriting guidelines, it may want to, or have the right to, exclude coverage if death results from that condition. Therefore, the life insurer may want to examine the health insurer's records to determine if (1) answers on the two insurance applications were consistent; and/or (2) the health insurer paid claims for treatment of a condition that was not disclosed on the life insurance application.
