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

UPDATED: Sep 30, 2022

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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


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 6 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.

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

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