Eating Disorders Forum - Denied coverage for wife's pre-existing eating disorder?

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Q: Denied coverage for wife's pre-existing eating disorder?

asked by: avppro on April 14th, 2008

New User

I recently received a letter from my HSA plan wanting to know previous docs that had treated my wife for bulimia and why it wasn't disclosed to them, because they just received a claim from her. The answer is because I didn't know about it then. Apparently she had been treated on our previous insurance without my knowledge, and I personally filled out the application for our current HSA. She had her previous insurance for years and it even overlapped our current HSA coverage for 1 month. Does that mean that she can be denied coverage or is she protected under the "Portability" in HIPAA?
What are our options at this point?

Replies(3)

JM1983

replied on April 16th, 2008

New User

How long ago was her last treatment for the eating disorder? What state are you in? Both of these variables are very important.
In most cases, HIPAA portability only applies to those who are coming off of a group health insurance plan with an employer. To be HIPAA eligible, youi must have either not been offered COBRA, or accepted COBRA and exhausted the 18 month period.
Do you own your own business?

Once you answer these questions I might be able to extend some advice to you. Thanks!

avppro

replied on April 16th, 2008

New User

Well I have since learned that portability doesn't apply since it was an individual plan and the current HSA is an individual one. We live in CO and I would say that previous treatment was over a year maybe 2 prior to changing insurance.
I do own my own business. Are you asking because it might make sense to start a group policy of my own?

Thanks!

JM1983

replied on April 16th, 2008

New User

yes I would recommend starting your own small group policy. As long as you have between 2-50 employees working at least 24 hours a week (This could be yourself and wife) , and you have been in business at least a year, you can get small group coverage. This is "guaranteed issue" coverage. If you PM me, I can try and help you find some rates on this

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