PRE-EXISTING CONDITIONS, DO I HAVE ONE?
Within the past year, we have seen many patients with new insurance policies. New insurance policies raise the question of WAITING PERIODS and PRE-EXISITING CONDITIONS. These two terms have become the bread and butter of our Billing Office for the past several months.
What do those terms mean? First, lets discuss WAITING PERIODS. These represent time spans defined by your insurance company in your policy during which any claim sent in might be or will be held back to investigate it. What is the insurance looking for? They are looking for anything that might imply that you as a patient had a particular condition prior to starting the insurance policy. Most insurance policies have a clause that will not cover any PRE-EXISTING CONDITIONS, hence the insurance will want to find those out before they pay anything within that WAITING PERIOD. Pretty simple?
The problem with these investigations is not if or not the item in question will be paid, its the fact that the investigation itself takes a lengthy period of time to finalize. This causes the doctor’s office to receive belated payments for services rendered. Aside from that, most patients will have a hard time reconciling with the fact that the particular insurance will not pay for treatment for such conditions declared PRE-EXISTING.
How do you work around this matter? CERTIFICATE OF CREDITABLE COVERAGE (this certificate is a letter from your prior insurance company certifying that you were insured from X date to X date). For those patients who have switched policies for whatever the reason, this is the workaround. Most states allow an insured to provide evidence of INSURANCE COVERAGE to the new insurance if the prior policy terminated less than sixty (60) days of the beginning of the new one. This on itself waives the WAITING PERIOD CLAUSE of the policy. You might want to look into this matter if you have acquired a new policy within the past 12 months and have not visited a doctor.
MAKE SURE ITS DONE!
It is very important, as an insured party, to make sure your insurance does what they say they would. If you send documents to anyone, please collect their contact information, request a reference number, etc… Always keep copies of all documents sent. Aside from that, give the mail sufficient time (a week at least) before you call again to verify if the documents have been received and have been attached to your policy/account. Even though its time consuming, following up on this matters will save you time and headaches in the future. It will also save your doctors, all of them, time and efforts better spent on other matters. If you do not provide the CERTIFICATE OF CREDITABLE COVERAGE (presuming you were insured and have it or have access to it), you run the risk of having even the simplest of diagnosis declared as PRE-EXISTING and therefore excluded from your covered services. Please, for your own good, make sure your insurance acknowledges receipt of this document and that your WAITING PERIOD has been waived. At that point, once more, collect the representative’s contact information and request a reference number, if they can provide this confirmation in writing, even better.