Can Somebody Tell Me What This Means?

[Eeyores Butterfly]

My new insurance started today and I received a letter in the mail stating:

...You have not received credit to reduce the member's Pre-Existing Condition Exclusion period. The Pre-Existing Exclusion period will end 12 months from the Pre-Existing begin date shown above.

If this member has had other healthcare coverage during the last twelve months, you may forward either a copy of Certification of Coverage or documentation regarding this coverage to the address noted above...

So what exactly does that mean? I have diabetes and have had coverage, in fact, my other coverage is active until the end of the year. I have an appointment next week and I'm scared this means they won't cover it! Is that what this is saying? How do I get this certificate of coverage and how long will it take for this to go away? Their customer service line is already closed, but I will be calling them tomorrow during my plan time. I really don't want to have to reschedule my appointment since I was supposed to have one in August but couldn't go because my old insurance won't cover anybody within a 50 mile radius of where I live.

If anybody who has gone through this can give me an idea of exactly what this means and what to expect, I would appreciate it. Thanks!

 

[golfgal]

It means that they don't have proof you had prior insurance. Send them the information about your previous policy and you will be fine. Is this an individual policy you took out? Also, often policies have a "rural medicine" clause that states if you don't have a preferred provider within x miles they will cover you at preferred provider cost to anyone you see.

 

[Eeyores Butterfly]

It's not an individual policy. It's through the school district I am employed for. Does this mean that I need to reschedule my appointment next week? That's what I'm most worried about. I've been waiting so long, and God only knows how much longer it will be if I have to reschedule.

 

[honugirl]

You need to send them some sort of proof that you were covered under your old insurance until you got your new insurance. If they don't get it before next week, you can pay OOP and then get a superbill from the doctor's office and send it to the insurance company once they get it sorted out and you should be able to get reimbursed for it. Good luck!

 

[laurie31]

No, you don't need to reschedule. You can easily get this taken care of during business hours tomorrow.

Just send (or fax) them the Certification of Coverage. It's pretty standard when you switch insurance companies. Was your old insurance through your employer? If so, call your HR people for the form, or you might be able to just fax the new insurance a copy of your card; if your policy is active until the end of the year, that might be sufficient. Otherwise, call your old insurance and get them to fax the form to the new insurance.

 

[golfgal]

It's not an individual policy. It's through the school district I am employed for. Does this mean that I need to reschedule my appointment next week? That's what I'm most worried about. I've been waiting so long, and God only knows how much longer it will be if I have to reschedule.

Was your previous policy through the school too? Your name might have been missed on the census they sent over. If you had an individual policy or a policy with a different employer you will have to send that information over. I would call them an double check what they need but once you produce proof they should cover your appointment (they may deny it until the paperwork is cleared). I would give them a quick call in the morning and then fax over what they need.

 

[Nancy]

I take these calls all the time! Just call the insurance and tell them you need the certificate, they can either mail it to you or fax it. Usually it is sent automatically when the policy terms...but most people ignore things that come from insurance and don't even realize they got it. You do not need to cancel...even if you did not send in the certificate when the claim came in it would deny and then you would get a letter stating the claim denied and it would ask for the information at that time to reconsider. Sometimes the cert comes from the employer..but the insurance company will let you know if it does.

 

[Eeyores Butterfly]

Because I was a student, I am still insured through my father's work and the policy doesn't terminate until the end of the year. Would they be able to fax it to the new insurance company directly, because I most definitely do not have it.

 

[golfgal]

Because I was a student, I am still insured through my father's work and the policy doesn't terminate until the end of the year. Would they be able to fax it to the new insurance company directly, because I most definitely do not have it.

Call your new insurance tomorrow and ask if your current insurance card is enough along with an explanation of where the coverage is from. If they want the certificate call the HR department of your Dad's work and ask them to fax it over. Tell them you need it sent by the end of the day and hopefully they will get it over quickly.

 

[golfgal]

I should add to that your Dad should be able to have you removed from his coverage-mainly not pay for you any longer-now that you have your own coverage. That is considered a life event and it is acceptable to make that change outside of the open enrollment period.