Is there a way to get around pre-exsisting conditions with ins. gap???

[mum4jenn]

We had a gap in our insurance coverage. I have a few pre-existing conditions. Is there any way to get around this? If I go to a different doctor and get "re-diagnosed" will that work?

 

[GoodFairies]

Unfortunately there isn't. That is why it is never recommended to have a lapse in insurance. Some carriers will cover it again once a certain period of time has passed; you will have to check with your carrier to find out what that period is? How long did you allow your insurance to lapse? That may also affect the answer.

 

[golfgal]

Well the only way I know is to get on a group policy.

 

[The Mystery Machine]

We had a gap in our insurance coverage. I have a few pre-existing conditions. Is there any way to get around this? If I go to a different doctor and get "re-diagnosed" will that work?

No.

You have to get on a policy that does not have preexisting conditions in their policy.

And what you are talking about is insurance fraud, btw.

 

[golfgal]

No.

You have to get on a policy that does not have preexisting conditions in their policy.

And what you are talking about is insurance fraud, btw.

It isn't insurance fraud if she gets a second opinion

 

[The Mystery Machine]

It isn't insurance fraud if she gets a second opinion

This is not a second opinion.

She is talking about getting around her policy and if she is successful that is insurance fraud, in which they will deny coverage and then force her to retro pay which usually lands people in bankruptcy.

I am just informing her of the consequences because people have been denied coverage even when they are not trying to get around the system and then forced them to pay.

 

[golfgal]

This is not a second opinion.

She is talking about getting around her policy and if she is successful that is insurance fraud, in which they will deny coverage and then force her to retro pay which usually lands people in bankruptcy.

I am just informing her of the consequences because people have been denied coverage even when they are not trying to get around the system and then forced them to pay.

Not if she was misdiagnosed to begin with. Yes, if the dr fraudulently "rediagnoses" her then he can be charged with insurance fraud. If she doesn't think her current diagnosis is correct and seeks a second opinion and has documentation and tests to show the first diagnosis is incorrect, it isn't fraud. On top of which, depending on what the condition is, they may not even put a pre-existing condition clause into the contract to begin with. Also, there is a time limit on how long they can deny coverage for a pre existing condition so even with that on there you are better off having the limited coverage then no coverage.

 

[The Mystery Machine]

Not if she was misdiagnosed to begin with. Yes, if the dr fraudulently "rediagnoses" her then he can be charged with insurance fraud. If she doesn't think her current diagnosis is correct and seeks a second opinion and has documentation and tests to show the first diagnosis is incorrect, it isn't fraud. On top of which, depending on what the condition is, they may not even put a pre-existing condition clause into the contract to begin with. Also, there is a time limit on how long they can deny coverage for a pre existing condition so even with that on there you are better off having the limited coverage then no coverage.

It will all depend on the language of her policy. I would just hate for her to pretend she does not have a problem and then gets tests, meds, etc. and then the insurance company comes back and says we won't cover that and now you have to pay full price.

So delve into your policy OP.

 

[mickeyboat]

Not if she was misdiagnosed to begin with. Yes, if the dr fraudulently "rediagnoses" her then he can be charged with insurance fraud. If she doesn't think her current diagnosis is correct and seeks a second opinion and has documentation and tests to show the first diagnosis is incorrect, it isn't fraud. On top of which, depending on what the condition is, they may not even put a pre-existing condition clause into the contract to begin with. Also, there is a time limit on how long they can deny coverage for a pre existing condition so even with that on there you are better off having the limited coverage then no coverage.

I would tread lightly on this one. It is my understanding that if you received medical advice, care, diagnosis or treatment within the 6 months prior to enrollment in a new plan, you can be subject to pre-existing conditions waiting periods. It doesn't just depend on diagnosis.

 

[golfgal]

It will all depend on the language of her policy. I would just hate for her to pretend she does not have a problem and then gets tests, meds, etc. and then the insurance company comes back and says we won't cover that and now you have to pay full price.

So delve into your policy OP.

When she applies for a policy they will request medical records from her doctors and make the determination from that. Now, if she doesn't disclose that information, that would be fraud.

 

[The Mystery Machine]

When she applies for a policy they will request medical records from her doctors and make the determination from that. Now, if she doesn't disclose that information, that would be fraud.

Yes, that is true.

I am just saying that insurance companies today are using the "fraud clause" severely these days. And you have to be careful.

 

[wdwfan16]

Not if she was misdiagnosed to begin with. Yes, if the dr fraudulently "rediagnoses" her then he can be charged with insurance fraud. If she doesn't think her current diagnosis is correct and seeks a second opinion and has documentation and tests to show the first diagnosis is incorrect, it isn't fraud. On top of which, depending on what the condition is, they may not even put a pre-existing condition clause into the contract to begin with. Also, there is a time limit on how long they can deny coverage for a pre existing condition so even with that on there you are better off having the limited coverage then no coverage.

The OP did not say she thinks she does not have the condition but she was trying to find a way to get around the diagnosis so it would be covered by insurance.

 

[Allison]

Not if she was misdiagnosed to begin with. Yes, if the dr fraudulently "rediagnoses" her then he can be charged with insurance fraud. If she doesn't think her current diagnosis is correct and seeks a second opinion and has documentation and tests to show the first diagnosis is incorrect, it isn't fraud. On top of which, depending on what the condition is, they may not even put a pre-existing condition clause into the contract to begin with. Also, there is a time limit on how long they can deny coverage for a pre existing condition so even with that on there you are better off having the limited coverage then no coverage.

Being misdiagnosed has nothing to do with what the OP said though so what does that have do with it?

 

[golfgal]

Being misdiagnosed has nothing to do with what the OP said though so what does that have do with it?

The op didn't give us enough information to tell us what she meant one way or another, people her just jumped to the conclusion she was trying to commit insurance fraud vs trying to figure out a way to get insurance.

 

[mickeyboat]

We had a gap in our insurance coverage. I have a few pre-existing conditions. Is there any way to get around this? If I go to a different doctor and get "re-diagnosed" will that work?

So the answer to your question is no. If you have had treatment, care, advice or diagnosis in the last 6 months, and have had a 63 day or more gap in coverage, and you get a policy with pre-existing condition provisions, you will have a waiting period of up to 12 months for treatment of that condition.

Check out this link.

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

 

[Allison]

The op didn't give us enough information to tell us what she meant one way or another, people her just jumped to the conclusion she was trying to commit insurance fraud vs trying to figure out a way to get insurance.

You are right, she is trying to figure out a way to get insurance and "get around" the exisiting condition problem. That has nothing to do with a misdiagnosis.

 

[The Mystery Machine]

You are right, she is trying to figure out a way to get insurance. That has nothing to do with a misdiagnosis.

If she is trying to find insurance then that is different. I would suggest to her that she look at policies very closely and hopefully she can find one that is well suited to her.

 

[Keli]

The prexisting clause on my current insurance is 12 months. I know because I had to get my previous insurance co to send info to my current insurance co to avoid that clause.
I guess after 12 months they'd have covered all conditions, even the prexisting ones.

 

[Allison]

If she is trying to find insurance then that is different. I would suggest to her that she look at policies very closely and hopefully she can find one that is well suited to her.

I should clarify what I meant, they appear to be trying to get insurance and find a way "to get around" the previous diagnosis.

 

[bgirldeb]

Well the only way I know is to get on a group policy.

This is what I was thinking...