Post-claims underwriting
How to save money: cancel a mother's insurance because she didn't disclose a minor condition before you have to pay for the son's heart surgery.
Four months after her first son, Jack, was born, Jessica Bath received a letter from her health insurance company, Blue Shield of California, saying she and Jack were no longer covered. Jack was born at Sierra Vista Regional Medical Center on April 8, 2003, with a hole in his heart. Bath was counting on Blue Shield to pay for a scheduled surgery to repair it....
Blue Shield claimed it was canceling the Morro Bay resident’s policy because she had a medical condition, which she failed to disclose when she applied for the insurance. She and her lawyer contend the condition was insignificant and did not have anything to do with her son’s heart problem.
2 comments:
I dunno, dude. I have mixed feelings about this. I feel for the family and the baby but the rules about medical disclosure are pretty cut-and-dried.
Although not a legal issue, it would be interesting to see what motivated Blue Cross to dig up the medical issue.
Here's one area unaddressed: Did she attempt to file a claim for a service or drug on the undisclosed issue? If that's the case, to me, it's a slam dunk win for the company.
If Blue Cross went to the ends of the Earth to investigate her to get out of paying for the surgery, then - while they can legally deny the claim - it would be a PR firestorm.
Agree?
Tentatively. It seems pretty clear from the evidence presented on her side that they went looking for a reason not to have to pay, but it's possible they came by it legitimately.
On the other hand, the rules about medical disclosure just suck in general anyhow. If I lost my job long enough for the ADD to be a pre-existing condition, how would I pay for the meds that enabled me to keep the job?
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