Can my health insurance company deny coverage if my initial hospital stay started 2 days before coverage?

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Can my health insurance company deny coverage if my initial hospital stay started 2 days before coverage?

Unfortunately, 09/29 I visited the ER with abdominal pain. My hospital stay extended to 10/06. For months now my insurance at the time keeps rejecting to cover my stay from 10/01 to 10/06. From 09/29-09/30, I was not under coverage, however my insurance coverage was set to start 10/01. I have tried calling the insurance company several times. I get the yes we will help answer only to find a new bill in my mailbox from the hospital.

Asked on February 17, 2016 under Insurance Law, Illinois

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 5 years ago | Contributor

As a general matter, the insurer should cover all medical costs, subject to the coverage you bought and terms of the policy, from and after the start date of the policy, so generally, they should cover from 10/1 on.
However, if the policy, which is a contract, has any provisions which would bar or restrict coverage in this case, such as a clause saying that they will not cover for any medical care or hospitalizations which began before the coverage start date even it continued after, or that you had to notify them in writing of any expected claims pending as of when coverage began, such a limitation, being in a contract, is enforceable. So you need to check the terms of the policy itself to see what limtations there are.
Note that whether or not the insurer ends up paying some or part of the bill, *you* are liable for it--you have to make sure the hospital is paid in full. If they are not, you, not the insurer, will be the one sued.


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