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N Cal Attorney
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Category: Consumer Protection Law
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Experience:  since 1983
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I changed my insurance policy from State of FL Blue Cross/Blue

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I changed my insurance policy from State of FL Blue Cross/Blue Shield to AL BCBS in January 2013. My son (adult child in college covered on the policy) needs open heart surgery from a heart defect he has had since birth and has been fully disclosed. BCBS AL says this surgery is not covered due to it being a preexisting condition. I have not had a lapse in coverage and I believe HIPAA covers me from this exemption. The insurance company is being very combative and insists the pre-existing condition applies even though there was not a lapse in coverage.

Please help me get this surgery approved.
Submitted: 1 year ago.
Category: Consumer Protection Law
Expert:  N Cal Attorney replied 1 year ago.
I am sorry to hear this.

You need a local attorney to review the policy and all correspondence to and from the insurer.

Starting in 2014, discriminating against anyone with a pre-existing condition will be illegal, see
http://www.whitehouse.gov/blog/2010/07/29/insurance-americans-with-pre-existing-conditions
but it is not per se illegal yet. The denial of coverage may or may not be legal, but it depends on the terms of the policy, which I cannot read from here.

You can get a free consultation from some of the attorneys listed by location at
http://lawyers.findlaw.com/lawyer/practicestate/Bad-Faith-Insurance/Alabama

If the denial of coverage is made in bad faith, the insured can recover punitive damages in addition to the damages for breach of the insurance contract, see
http://www.nwkt.com/menus/documents/bad%20faith.pdf

Only a local attorney can provide legal advice. Please follow up on this with a local attorney, who can review the documents and advise you on how to proceed. Sometimes a demand letter from an attorney is enough to get an insurer to reverse a denial of coverage. Sometimes, a lawsuit is necessary.

I hope this information is helpful.
N Cal Attorney, Attorney
Satisfied Customers: 8079
Experience: since 1983
N Cal Attorney and other Consumer Protection Law Specialists are ready to help you
Expert:  N Cal Attorney replied 1 year ago.
Thank you for accepting my answer!

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