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Insurance Complaints

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Complaint 0 of 0 in "Pre-existing Conditions"

Insurance Carrier: Bluecross Bluechoice
State: Maryland

Consumer Complaint:

I basically was on an individual health insurance policy with BlueCross BlueChoice in a HMO plan for more than a year with my wife. While applying, we did not mention anything as a pre existing condition on the paperwork as it was more than 5 years that my wife had problems with anorexia and by law, we were, I guess, authorized not to mention it. On my side, I do not have any pre existing conditions. Last winter, my wife was hospitalized for a while because of anorexia issues and stroke problems. When we submitted the claims, BlueCross paid their part, but the underwriter reviewed the case and decided to drop my wife out of the insurance plan where I am still. She said we lied on the application regarding the pre- existing condition of my wife. I personally do not think we did. Also, they took the decision without even consulting us. Now, my wife does not have health insurance and is declined by all the other insurance companies. What should we do?

Insurance Expert Answer:

As the laws governing what health insurers and HMO plans can and cannot do when underwriting an application for coverage vary considerably from state to state, and it would take an expert in your state's laws to be able to give you a definitive answer, other that provide some general guidance, we are not going to be able to assist you with this matter. The problem you have presented is just one more illustration as to why our nation needs, more than ever, a national health insurance plan providing basic medical coverage for all, to replace or supplement the largely employer based system we have now. The first general suggestion we can make is to join a group that enables you to have coverage without any underwriting for yourself or your dependents. Individual plans are almost always underwritten, and the plans aim to weed out those applications that their experience demonstrates have a greater than average likelihood to produce what would be a major claim, even if the chance of a claim is still small. Here, at least they paid the claim. We've seen lots of cases where the insurer attempted to retroactively rescind coverage and deny the claim. Second, contact your state insurance department (or the other regulator of the health plan in question) and seek its assistance. Third, do what you can to help bring about a national health insurance plan, We need one.