Okay I will give a little background first. Ds is 2 1/2 years old. He has had several medical issues in the last year and a half. Eye surgery, throat surgery, and a history of seizures. He just had an MRI that revealed white matter in one of the ventricles in his head that could be causing the seizures. About 6 months ago DH changed jobs and we got new insurance. I just got the first EOB today. I know many more will follow, but our insurance is denying coverage for anything pre-existing. That is about 99% of his bills. I know for fact I didnt see this clause when we chose the policy. I read it 20 times to check for stuff like this. What do I do now? This could really sink our financial battle ship quick. I dont think he will qualify for state coverage either because our income is too high. He really might as well not have coverage if this is the way it will be. I will be calling them in the morning also to try and appeal.

Have your husband talk with the HR department at work too. They could be some help.

Have your husband talk with the HR department at work too. They could be some help.

I will. I hope they can but I think that is where the problem started. I got the policy info from the HR manager and I suspect it wasnt completely correct. I have had a hard time getting in touch with her and Dhs company has even thought about finding someone else because she is hard to deal with. Well she has messed with the wrong Mama now!:hero:

Try calling the insurance provider directly. Customer service SHOULD be helpful. If they can't answer your questions regarding the claim denial, ask for a supervisor. It has been a few years since I was in HR, but in Oregon if there was no lapse in insurance coverage the condition had to be covered. (That may have been a Federal Law.)

Very often claims are processed incorrectly. Never take a denial as a certain thing. Question the determination, ask for a review if they say it was processed correctly. Be politely persistent. Good Luck!!

I wish you luck, I agree with Robin. It shouldn't matter that the insurance switched as long as you went from one coverage directly into another. I'd fight the insurance company all the way on this!

I worked for a health insurance company in the past and I agree that you should contact the insurance company directly. I would go past the peons and keep moving up the management chain at the insurance company until I reached someone really knowledgeable. GET READY FOR A FIGHT!!!:fuming:

I do not have any advice, but wanted to let you know that I'll be thinking of you and your family.

I'll be thinking of you too. The other posts make really good points about not seeing anything as totally and permenatly denied. I would also check into your state's medical assistance. There are different rules for adults vs. children in the state where we live. Even if you have health insurance here the state's insurance does cover part of your premiums and co-pays if you qualify. Best of everything to you: coverage and good health!

My understanding is that if you did not have a lapse in coverage you cannot be denied for what is considered pre-existing. Double check with HR but this is why I have always been told to never let it lapse.

Do you still have copies of the papers you read and signed? If so you can look through and if there isn't a clause and you didn't sign off on it and they are trying to throw it in now since your child is sick then thats wrong morally and in the law.

If there wasn't a laspe in coverage they can't deny you (if it is group insurance such as with a company). I have a heart condition and I will end up needing a transplant one day. This is something I have researched and know for sure. Contact your state department if they don't resovle it ASAP.

GOOD LUCK!!

If there wasn't a laspe in coverage they can't deny you (if it is group insurance such as with a company). I have a heart condition and I will end up needing a transplant one day. This is something I have researched and know for sure. Contact your state department if they don't resovle it ASAP.

GOOD LUCK!!

Yeah, as long as the gap in coverage was no more than a certain amount (I'm thinking 60 days?) you should be covered. As Plan B, check into your state's insurance option--there should be an insurance pool for those considered "uninsurable", no matter what your income. Sorry you're going through this!

Very often claims are processed incorrectly. Never take a denial as a certain thing. Question the determination, ask for a review if they say it was processed correctly. Be politely persistent. Good Luck!!
Amen I work in a Physicians billing dept and we are ALWAYS getting claims in that the insurance didn't process correctly whether it be a contracting issue, meeting the deductible issue or as in your case pre-existing issue.
I would definaltey make sure the dr's you are going to are contracted with the insurance...if they are and still won't pay see if they can still process the claim for the contractual discount if they are contracted.

If there was no lapse in coverage when switching insurance, they have to cover you. You'll need to prove that you had prior coverage, so contact your old insurance company and have them fax or mail your proof of prior coverage. You'll need to present that to the new company, then there should be no problem. It's a bit of a hassle, and it seems like we go through it every single time we get new insurance.

Like all the others said, I would definitely follow-up with the insurance company.

You don't say if your son has been diagnosed with epilepsy or not (I have epilespy). Not sure where in Tennessee you are located, but you might also want to look into organizations such as Epilepsy Foundation of East Tennessee Epilepsy Foundation of East Tennessee (http://www.efeasttn.org/ClientServices.htm).

Most of the community organizations such as that will do what they can to assist you or guide you to the organization that can. If you are interested in getting in contact with these organizations I will track down websites and phone numbers of these organizations/agencies if you need assistance with that.

A quick two-cents from a former HR person, cut the person some slack. It's entirely likely they don't have all the info. At my company, we used a third-party benefits coordinator/company... all I knew was very basic info. Getting mad wouldn't have changed what I knew.

Any luck? :hug2: