Can an insurance drop medical coverage because they claim you had the illness before you were covered by them?

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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UPDATED: Aug 28, 2010

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Insurance Question from Lone Tree, CO

Asked on 08/28/2010

Can an insurance drop medical coverage because they claim you had the illness before you were covered by them? NULL

Answer given on August 29, 2010

Yes.  It doesn’t matter if you lied, or simply forgot, or just plain didn’t fill out the application correctly, for serious medical conditions in particular.  If the carrier ( the insurance company ) discovers that you have had a particular condition or illness prior to their coverage of that condition, and you were without coverage for more than 63 days for that particular condition/illness ( HIPAA ), they can deny paying for care for that particular condition/illness.  It doesn’t mean they will necessarily “drop” you from their plan, they most likely will just exclude coverage for this condition and may even demand reimbursement if any claims were paid prior to their discovery.


This is related to one of the hotter topics in the new health insurance reform, with respect to “pre-existing conditions”.  However, removing the ban on excluding pre-existing conditions with respect to the carriers, still doesn’t allow you to fill out an app incorrectly or lie about something and then be covered for it.  You can still be pre-x’d if you don’t fill out the paperwork correctly, or if you go more than 63 days without coverage ( HIPAA – federal law ).  


I imagine in the near future, when the “no more pre-x-ing” part of the bill becomes law for everyone ( 2014 ), if you fill out an app wrong or lie, you will probably have an instant rate adjustment and benefit adjustment, and probably have to reimburse for anything over and above what was paid in benefits.  


So in short, yes they can, so fill out the app carefully and honestly.  If you aren’t sure about something, call the carrier and ask.  

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