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01-24-2013 at 4:41 PM
KristinaJo...
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KristinaJones85 is not online. Last active: 06-19-2013, 9:24 PMNewbie

Insurance & Pregnancy

So, ladies, maybe someone out there can weigh in on this... I applied for insurance November 25th, 2012 because it was the beginning of ski season here where I live and I wanted to make sure I was covered in case of a ski accident (my mom called me everyday asking if I had finally done it and I gave in.) They asked me... Has it been over 40 days since your last period? the answer... "no" Are you currently pregnant... again, "no" December rolled around, I had my period early November, around the 5th or 8th... my insurance went through and started December 10th. By December 15th, I realized I hadn't had my period yet, freaked out I took a pregnancy test, then another and then another... amazingly, I was pregnant! I couldn't believe it, this amazing blessing, we were going to have a baby! I stopped skiing right away and booked an appointment at the doctors for the first week in January. January 3rd rolled around, we went in for the appointment, they did an ultrasound, I was 8 weeks, 6 days pregnant +/- 5 days. They of course take into consideration they first day of your last period to calculate that... I just got a letter from my insurance agency saying they "know about my pregnancy" and that my insurance policy is currently being reviewed and that they might terminate my coverage all together! I am obviously freaking out!!!!! Does anyone know more about this stuff? Can I fight this?
 
01-24-2013 at 4:48 PM
1026pumpki...
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I think you can push back on this a little and say that you didn't know you were pregnant until December 15th, but it's still possible for them to reject you.

I don't mean for this to sound horrible, but were you trying to get pregnant?  If not and you can document that you were using some type of birth control method, that might help bolster your case.  And I really really really don't mean that to sound offensive- just trying to think of something that would help you build your case! 


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01-24-2013 at 4:50 PM
coraggiosa
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As far as I know, they cannot terminate your coverage because you didn't lie on your application. They are going to try and say that you lied about getting your period on your application. Considering that you didn't, you should be able to fight it, but it might be difficult. 

I'm sorry you have to deal with this right now! 



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01-24-2013 at 5:35 PM
elmoali
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Unfortunately, even though you didn't know you were pregnant when they asked, it's easy enough to date a pregnancy and know that you actually were.  Even though you didn't knowingly deceive them, they have no way of knowing that and you have no way of proving it.

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01-24-2013 at 6:34 PM
MrsP7309
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elmoali:
Unfortunately, even though you didn't know you were pregnant when they asked, it's easy enough to date a pregnancy and know that you actually were. Even though you didn't knowingly deceive them, they have no way of knowing that and you have no way of proving it.


Not necessarily true... the ultrasound said plus or minus 5 days, which means she could have been 8 weeks, 1 day. That puts her at 2 weeks, 4 days on November 25, and it's not possible to get a positive HPT at 4 DPO. I'd push that angle if I were you, OP.



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01-24-2013 at 7:09 PM
foxyroxy
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If you have your insurance independently (ie, not through your work), then pregnancy definitely can qualify as a pre-existing condition and they do not have to cover it. It is up to each company and policy. Moreover, the fact that you had a gap in coverage does you no favors.
01-24-2013 at 8:24 PM
GhostMonke...
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MrsP7309:
elmoali:
Unfortunately, even though you didn't know you were pregnant when they asked, it's easy enough to date a pregnancy and know that you actually were. Even though you didn't knowingly deceive them, they have no way of knowing that and you have no way of proving it.
Not necessarily true... the ultrasound said plus or minus 5 days, which means she could have been 8 weeks, 1 day. That puts her at 2 weeks, 4 days on November 25, and it's not possible to get a positive HPT at 4 DPO. I'd push that angle if I were you, OP.

Doesn't matter. Pregnancy is dated back to CD1- the first day of your last period. 

Insurance companies like loopholes and they will use that to their advantage.

 



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01-24-2013 at 8:46 PM
coraggiosa
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GhostMonkey:

MrsP7309:
elmoali:
Unfortunately, even though you didn't know you were pregnant when they asked, it's easy enough to date a pregnancy and know that you actually were. Even though you didn't knowingly deceive them, they have no way of knowing that and you have no way of proving it.
Not necessarily true... the ultrasound said plus or minus 5 days, which means she could have been 8 weeks, 1 day. That puts her at 2 weeks, 4 days on November 25, and it's not possible to get a positive HPT at 4 DPO. I'd push that angle if I were you, OP.

Doesn't matter. Pregnancy is dated back to CD1- the first day of your last period. 

Insurance companies like loopholes and they will use that to their advantage.

 

This is true, but there is part of the ACA in effect that says that insurance companies can no longer drop you for honest errors made on applications. I think this situation would fall under that category, considering the OP could not have possible known she was pregnant when she applied.  



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01-25-2013 at 7:10 AM
elmoali
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coraggiosa:
GhostMonkey:

MrsP7309:
elmoali:
Unfortunately, even though you didn't know you were pregnant when they asked, it's easy enough to date a pregnancy and know that you actually were. Even though you didn't knowingly deceive them, they have no way of knowing that and you have no way of proving it.
Not necessarily true... the ultrasound said plus or minus 5 days, which means she could have been 8 weeks, 1 day. That puts her at 2 weeks, 4 days on November 25, and it's not possible to get a positive HPT at 4 DPO. I'd push that angle if I were you, OP.

Doesn't matter. Pregnancy is dated back to CD1- the first day of your last period. 

Insurance companies like loopholes and they will use that to their advantage.

 

This is true, but there is part of the ACA in effect that says that insurance companies can no longer drop you for honest errors made on applications. I think this situation would fall under that category, considering the OP could not have possible known she was pregnant when she applied.  

It's less likely that they'll drop her completely and more likely that they're just going to refuse to cover any bills related to her pregnancy.  Honest mistake or not, it's factual that she was pregnant to the medical world when she applied and they're not going to be willing to foot the bill for such a definite, well, bill.  It sucks, don't get me wrong and I hope for the OPs sake that they don't do this but like a PP said, they're always looking for loopholes and they find them. 


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01-25-2013 at 11:09 AM
GhostMonke...
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elmoali:
coraggiosa:
GhostMonkey:

MrsP7309:
elmoali:
Unfortunately, even though you didn't know you were pregnant when they asked, it's easy enough to date a pregnancy and know that you actually were. Even though you didn't knowingly deceive them, they have no way of knowing that and you have no way of proving it.
Not necessarily true... the ultrasound said plus or minus 5 days, which means she could have been 8 weeks, 1 day. That puts her at 2 weeks, 4 days on November 25, and it's not possible to get a positive HPT at 4 DPO. I'd push that angle if I were you, OP.

Doesn't matter. Pregnancy is dated back to CD1- the first day of your last period. 

Insurance companies like loopholes and they will use that to their advantage.

 

This is true, but there is part of the ACA in effect that says that insurance companies can no longer drop you for honest errors made on applications. I think this situation would fall under that category, considering the OP could not have possible known she was pregnant when she applied.  

It's less likely that they'll drop her completely and more likely that they're just going to refuse to cover any bills related to her pregnancy.  Honest mistake or not, it's factual that she was pregnant to the medical world when she applied and they're not going to be willing to foot the bill for such a definite, well, bill.  It sucks, don't get me wrong and I hope for the OPs sake that they don't do this but like a PP said, they're always looking for loopholes and they find them. 

Bingo.

 



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01-25-2013 at 11:58 AM
coraggiosa
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elmoali:
coraggiosa:
GhostMonkey:

MrsP7309:
elmoali:
Unfortunately, even though you didn't know you were pregnant when they asked, it's easy enough to date a pregnancy and know that you actually were. Even though you didn't knowingly deceive them, they have no way of knowing that and you have no way of proving it.
Not necessarily true... the ultrasound said plus or minus 5 days, which means she could have been 8 weeks, 1 day. That puts her at 2 weeks, 4 days on November 25, and it's not possible to get a positive HPT at 4 DPO. I'd push that angle if I were you, OP.

Doesn't matter. Pregnancy is dated back to CD1- the first day of your last period. 

Insurance companies like loopholes and they will use that to their advantage.

 

This is true, but there is part of the ACA in effect that says that insurance companies can no longer drop you for honest errors made on applications. I think this situation would fall under that category, considering the OP could not have possible known she was pregnant when she applied.  

It's less likely that they'll drop her completely and more likely that they're just going to refuse to cover any bills related to her pregnancy.  Honest mistake or not, it's factual that she was pregnant to the medical world when she applied and they're not going to be willing to foot the bill for such a definite, well, bill.  It sucks, don't get me wrong and I hope for the OPs sake that they don't do this but like a PP said, they're always looking for loopholes and they find them. 

This is likely true. As much as it sucks, it's better than being dropped altogether.

 



12/19/2012 BFP! EDD 09/02/2013
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01-25-2013 at 12:35 PM
GhostMonke...
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coraggiosa:
elmoali:
coraggiosa:
GhostMonkey:

MrsP7309:
elmoali:
Unfortunately, even though you didn't know you were pregnant when they asked, it's easy enough to date a pregnancy and know that you actually were. Even though you didn't knowingly deceive them, they have no way of knowing that and you have no way of proving it.
Not necessarily true... the ultrasound said plus or minus 5 days, which means she could have been 8 weeks, 1 day. That puts her at 2 weeks, 4 days on November 25, and it's not possible to get a positive HPT at 4 DPO. I'd push that angle if I were you, OP.

Doesn't matter. Pregnancy is dated back to CD1- the first day of your last period. 

Insurance companies like loopholes and they will use that to their advantage.

 

This is true, but there is part of the ACA in effect that says that insurance companies can no longer drop you for honest errors made on applications. I think this situation would fall under that category, considering the OP could not have possible known she was pregnant when she applied.  

It's less likely that they'll drop her completely and more likely that they're just going to refuse to cover any bills related to her pregnancy.  Honest mistake or not, it's factual that she was pregnant to the medical world when she applied and they're not going to be willing to foot the bill for such a definite, well, bill.  It sucks, don't get me wrong and I hope for the OPs sake that they don't do this but like a PP said, they're always looking for loopholes and they find them. 

This is likely true. As much as it sucks, it's better than being dropped altogether.

 

Actually it's worse. They will state that everything that happens while pregnant is related to pregnancy and reject all claims. If she is outright denied coverage, that would open her up to the state exchanges that are being set up. Since she would still have coverage, she may not be eligible for those plans.

In a perfect world, they wouldn't be bastards and would be well aware that a women wouldn't know that she is pregnant at 4 dpo. But we don't live in a perfect world and insruance companies will screw you when they can. I had one plan (many years ago, well before ACA) that technically didn't hit me with pre-existing, but since I had an abnormal pap one year, they refused to cover all thing GYN related stating they could all be tied back to the abnormal pap that I had under another company's coverage. My rates went from $40 a month to just under $300 less than 6 months later as well. I could totally see that company denying maternity coverage in a case like the OP's, just because they can.

 

 



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