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Pre-exisiting insurance, No coverage?

This is a difficult question. I have about a 20k medical bill now. I just got insurance again in July 07. Lost my insurance in Oct. 06. Had knee pains twice before went to the hospital (Oct 06 and I'd say Oct 05, needed an aircast and crutches both times). X-ray showed nothing. Got MRI recommendation but school doctor told me my knee was alright and I just needed time. Current doctor said I was probably misdiagnosed by school clinic. Never got an MRI. Recently got MRI on knee with new insurance showed ACL tear. Now insurance is claiming it's a preexisiting injury and I won't be covered. My question is this is the first time I was diagnosed with ACL tear, shouldn't that count for something. Worse comes to Worse can I make a back claim on my old carriers? I went from Pomco (school insurance) ---> Medicaid ----> Aetna PPO

Public Comments

1. First call your carrier and asked for a supervisor. Then explain and inform her/him what you just told us. At that point let her/him know you are prepared to send in all medical records supporting that. Get a mailing address and a contact person to send the info. It will cost a little but go to the post office and request a signiture apon receipt so you will know who they have to question if when you call back they say they did not get it yet. Let this person know that you will need a signature. Then you will have to go to everyone who miss diagnosed you and get a copy of the chart for the visits related to your knee. True it is a pre exisiting condition but common sense you would of rectified the situation if you knew it because you did have medicaid. Good luck those bills can be a bi t ch and so can the people running the insurance company
2. Nope, you had the knee trouble before the policy. It's definately pre-existing. You've also been TREATED for it, even if it was misdiagnosed. Sure, you can try to make a back claim on your old carriers - but they only cover for services provided during the coverage period. They won't cover all future services for your knee, after they're not on it any more. If you had NOT had a lapse in coverage, this wouldn't be an issue. But it is. Sorry.
3. You will need to present documentation that you were unaware of the condition prior to your enrollment date. In order for it to be pre-existing, you would need to have been treated, recommended for treatment, or sought treatment during the 18 month (depending on your plan) prior to the effective date of coverage. You should be able to prove that you were completely unaware of the condition based on your medical records. Your old carriers won't cover anything beyond the cancellation date.
4. Was this disclosed on your application for the new health insurance? Any health insurance application I have ever seen asks about previous hospital admissions. You said you went to the hospital two times and both times you needed an aircast and crutches. If you disclosed the fact that you were hospitalized twice for a problem at the very least the insurance would be issued with a rider excluding coverage for your knee for a specified minimum period of time. The company could also have declined your application all together had they known of this condition. You cannot go back to your previous insurance because it only covers treatment while the policy is in effect. I know this isn't what you want to hear but just be glad that your new company is not rescinding your policy from its inception.
5. You were treated for problems with your knee. It doesn't matter that you weren't *specifically* diagnosed with an ACL tear - you were still treated for knee problems. Unless your doctor's could specifically demonstrate that your current knee problems are completely unrelated to your old ones (ex - a brand new injury that just occurred and can be medically documented), you're stuck. The only hope you'd have of getting it covered under your current policy would be if you'd had insurance coverage without a break longer than 63 days. Sorry. :( But I'm not terribly optimistic about your chances for getting this covered. Also your previous insurance policy would only cover expenses from dates of service during the policy term. It would not cover current services.