Insurance Companies Cancelling Coverage Because of High Claims

[bluemarlin08]

I have been listening to Obamer say insurance companies can no longer cancel coverage because of claims, could they ever do this?

 

[Josh]

Re: Insurance Companies Cancelling Coverage Because of High Claim

Not to give a cop out answer, but it varies by state.

 

[bluemarlin08]

Re: Insurance Companies Cancelling Coverage Because of High Claim

Are you saying that in some states that if someone was on claim for cancer treatment that a company could cancel their coverage, thought that was illegal.

 

[somarco]

Re: Insurance Companies Cancelling Coverage Because of High Claim

Insurance is an aleatory contract. Policies can be cancelled for fraud (subject to statutory time frames), misrepresentation or non-payment of premium. I am not aware of any other conditions under which a carrier can legally cancel a policy. Perhaps MPS can enlighten us.

 

[Josh]

Re: Insurance Companies Cancelling Coverage Because of High Claim

Are you saying that in some states that if someone was on claim for cancer treatment that a company could cancel their coverage, thought that was illegal.

Not quite. Like somarco said, it's a contract and they're on the hook for it. Using your example and assuming there are no other facts, the insurance company would absolutely have to cover the treatments. That being said, it's entirely possible for things like this to happen: Health Insurance Cancelled, After Teen Diagnosed With Celiac Disease | ChattahBox News Blog. For those of you who don't click the link, the bottom line is that folks bought some insurance and when the big ticket claim came through the carrier went over the medical history and then found some reasons they could argue as being misrepresentations on the insurance application to avoid paying the claims.
Each state can have separate standards for what constitutes a "misrepresentation". In some states it can be much more lenient and allow insureds to say things like "No one ever told me I had cancer, how was I to know?" and accept that along as a lack of proof of a diagnosis as proving they had no knowledge of the pre-existing condition vs. other states, like apparently Illinois, that think that a teenager being dizzy and tired from staying up all night online constitutes a misrepresentation and a family concealing a medical condition. Make more sense?

 

[DS4]

Re: Insurance Companies Cancelling Coverage Because of High Claim

I have been listening to Obamer say insurance companies can no longer cancel coverage because of claims, could they ever do this?

Your coverage can be rescinded, and, canceled retroactively for lying on the health insurance application. Usually, claims soon after the effective date trigger an investigation.
So, "yes", coverage can be canceled because of claims.

 

[taterpeeler]

Re: Insurance Companies Cancelling Coverage Because of High Claim

Not quite. Like somarco said, it's a contract and they're on the hook for it. Using your example and assuming there are no other facts, the insurance company would absolutely have to cover the treatments. That being said, it's entirely possible for things like this to happen: Health Insurance Cancelled, After Teen Diagnosed With Celiac Disease | ChattahBox News Blog. For those of you who don't click the link, the bottom line is that folks bought some insurance and when the big ticket claim came through the carrier went over the medical history and then found some reasons they could argue as being misrepresentations on the insurance application to avoid paying the claims.
Each state can have separate standards for what constitutes a "misrepresentation". In some states it can be much more lenient and allow insureds to say things like "No one ever told me I had cancer, how was I to know?" and accept that along as a lack of proof of a diagnosis as proving they had no knowledge of the pre-existing condition vs. other states, like apparently Illinois, that think that a teenager being dizzy and tired from staying up all night online constitutes a misrepresentation and a family concealing a medical condition. Make more sense?

Hos... its called fraud... and the black jesus aint changing that part of the law.... u might ought to stick to med sups... u aint got the knowledge too sell health

 

[0b1kanobee]

Re: Insurance Companies Cancelling Coverage Because of High Claim

Seems like there should be some kind of law where after a person has insurance for a certain period of time, you cannot be cancelled unless you don't pay your premium.

 

[2112Greg]

Re: Insurance Companies Cancelling Coverage Because of High Claim

Seems like there should be some kind of law where after a person has insurance for a certain period of time, you cannot be cancelled unless you don't pay your premium.

There are such things. If you lie and don't get caught by the carrier, depends on the offense and on the carrier, a period of time (I've seen two years) must go by where the policy is non-can after that period.

 

[Josh]

Re: Insurance Companies Cancelling Coverage Because of High Claim

Hos... its called fraud... and the black jesus aint changing that part of the law.... u might ought to stick to med sups... u aint got the knowledge too sell health

He actually is changing that. If they can't deny based on pre-existing then there is nothing for them to misrepresent.

I realize this must be a common comment you receive, but have you considered complete inability to write a coherent sentence is something some might consider to be a reflection of your level of education and abilities?