Wiki Pre exisiting condition

[lindam@caricures.com]

I have a patient that has familial polyposis. Has had it for many years. His insurance now - UHC/GOLDENRULE - is telling us that his flexible sigmoidoscopy with polypectomies won't be covered due to a pre-existing condition clause in his plan. They paid for his procedure previously, but now they are say no. Is this even legal?

 

[sls314]

I have a patient that has familial polyposis. Has had it for many years. His insurance now - UHC/GOLDENRULE - is telling us that his flexible sigmoidoscopy with polypectomies won't be covered due to a pre-existing condition clause in his plan. They paid for his procedure previously, but now they are say no. Is this even legal?

Golden Rule plans are generally short term, limited benefit plans.

If the patient is on a limited-benefit plan vs. an ACA compliant plan, there can be prexisting exclusions.

The Golden Rule brochure has a chart explaining the difference between a limited short-term plan vs. an ACA plan from Healthcare.gov. (The chart is part of a legally required notice given to people before they enroll in this type of plan, which should make it pretty clear to the patient the limitations of the plan before purchasing it.):

https://www.uhone.com/api/supplysystem/?FileName=46998P-G202409.pdf

 

[lindam@caricures.com]

Golden Rule plans are generally short term, limited benefit plans.

If the patient is on a limited-benefit plan vs. an ACA compliant plan, there can be prexisting exclusions.

The Golden Rule brochure has a chart explaining the difference between a limited short-term plan vs. an ACA plan from Healthcare.gov. (The chart is part of a legally required notice given to people before they enroll in this type of plan, which should make it pretty clear to the patient the limitations of the plan before purchasing it.):

https://www.uhone.com/api/supplysystem/?FileName=46998P-G202409.pdf

Thank you for this information!