Wiki AARP Medicare Supplamental Plan F and pre-existing condition denial

[LorraineLane]

I recently received a denied claim from AARP (Medicare supplamental plan F), DOS 03/15/18, for pre-existing condition. According to our records the patient had this AARP plan since 2005, followed by our office since 2013, and claims were paid by AARP (same Plan F). I called and spoke to a representative who stated the patient's coverage lapsed in 2017 but was reinstated in March 2018, however, there is now a pre-existing clause attached to this policy because of the lapse in coverage. I voiced my opinion stating the policy is terrible and bad business and that the patient was a previous member for many years, etc. The representative stated the lapse was longer than 6 months and now the patient has a pre-existing condition clause, denial stands. Is there anything I can do to appeal this or just accept the fact that this is the policy, bill the patient and be done with it?

 

[CodingKing]

There is always an appeal right but if that is the terms of the supplement plan patient purchased, I don't see it going anywhere.

 

[LorraineLane]

There is always an appeal right but if that is the terms of the supplement plan patient purchased, I don't see it going anywhere.

Thanks. Had luck appealing in the past, denials were overturned. Patient may have to appeal this one.