Health Insurance Scams: A Pre-Existing What?

Not only is affordable health insurance tough to come across, but also trustworthy companies as well. Ever since Richard Nixon thought that HMOs were a good thing for Americans, hard-working folks have had to make slews of phone calls and send angry letters.

If you have insurance, whether it's Blue Cross, Aetna, or some other large provider, you've probably received threatening collection letters from doctors in the mail wondering when you (or your insurance company who are always on time deducting your pay) are going to shell out the cash you owe them.

It seems that insurance companies attempt to avoid payment whenever possible. This maximizes profits. One way they accomplish this is the dreaded category for your illness: The Pre-existing Condition.

When my five-year-old daughter started to develop a cough we took her in to see the doctor. The doctor said that she was developing bronchitis, a relatively common condition that is easily remedied with antibiotics. The doctor also noted that we caught it pretty early so there shouldn't be any complications with getting rid of it quickly. Just finish the antibiotics and she would be fine.

The doctor was right. We gave our daughter the antibiotics and there weren't any problems at all. Except for with the insurance company.

We received a letter from the doctor's office a few weeks later asking for their money. We called the office and said that we paid our co-pay when we visited the office and didn't know what money they were talking about.

Apparently, the insurer denied our claim. The doctor's office said that we have to get in touch with our insurance and discuss it with them.

When we called the insurer, they told us that they had denied our claim because of a pre-existing condition.

"A pre-existing condition?" I asked.

"Yes. That's what it says here."

I should note here that we have had this particular insurance for nearly two years.

"Excuse me, but how can bronchitis be a pre-existing condition? We've been with the company over two years and I don't think my daughter has had this cough since she was three."

"I'm sorry sir, I'll have to transfer your call."

After being bandied about the phone lines and talking to several different people of various nationalities, we were no closer to solving our problem.

As it turned out, they would not change their position and we were forced to pay the bill ourselves.

Sadly, this is happening to thousands of hard-working wage workers across the nation. If we had the money to hire a lawyer, we would have.

But, that's what made us easy targets for higher profit margins. We couldn't afford a lawyer. If we could, we would have a medical expense account instead of an HMO.

So, be wary. If your claim is denied, don't be afraid to call and find out why. Sometimes, a company will save money by denying every claim until you call and complain.