Why? Client did not know he had a problem when he applied for health insurance. It might have been a pre-exist... but it was not known.
John did not say if the hypothetical client did not know he had HC. He asked for the worse case scenario, in which my thought entailed a client who "did" know that he had HC but did not disclose the conditionon the application. With the example listed above, if he saw the physician for treatment of HC and submitted a claim so quickly, the insurance company would perform a claims review and search his background. If it came up he lied, bye-bye policy (worse case), however, if he had no prior diagnosis, I take it that the insurance company would cover the condition.
Let me ask this. You buy a health policy and 60 days later you go to the doc and he says "Too bad, you have CA (or diabetes, or whatever). Will the insurance company come back and say "Hey, you obviously had this before you got the policy so we won't cover you and we are cancelling your coverage?
They may or may not deny the claim based on the aforementioned thoughts.
I've never heard of this happening in Calif. Hell two years later you could go to the doctor and they could say you have cancer and have had it for the past 5... just didn't know it. What is the 'limitation' on pre-exists when you change policies. What happened to the "credible coverage" provision... or is that a CA only thing?
12 months that may be reduced by prior credible coverage.