How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dwayne B. Your Own Question

Dwayne B.
Dwayne B., Attorney
Category: Legal
Satisfied Customers: 27093
Experience:  Began practicing law in 1992
11068102
Type Your Legal Question Here...
Dwayne B. is online now
A new question is answered every 9 seconds

Last year I left my job to do private consulting. I purchased

Resolved Question:

Last year I left my job to do private consulting. I purchased a high-deductible health insurance policy with Humana, which began in 9/1/12. Later that month, I was hospitalized and had surgery for diverticulitis, which was not a pre-existing condition. Good timing for me, but of course Humana checked out medical records for pre-existing conditions. Since they could not find any pre-existing diverticulitis, they accused me of partial disclosure on my application, not disclosing MRI findings of spinal stenosis, spondylosis, and degenerative disc disease. Humana threatened to void my policy retroactively. The application asked for problems that occurred or were active in the past 5 years; the back pain associated with the MRI findings was over 8 years ago and resolved with physical therapy and exercise. I explained that, and now they say I can retain my policy, but those MRI diagnoses are excluded from coverage until at least 9/1/14 (2 year anniversary date). Their website says that pre-existing conditions are excluded for only 1 year. BotXXXXX XXXXXne- I have not had back issues for over 8 years, the Humana application asked for information from the past 5 years, and they keep threatening to cancel my policy retroactively (so my hospitalization and surgery would not be covered) unless I agree to sign a rider to the policy excluding back problems. This doesn't seem ethical (or legal) to me. Any suggestions are welcomed!
Submitted: 1 year ago.
Category: Legal
Expert:  Dwayne B. replied 1 year ago.

JD 1992 :

Hello, and thank you for contacting Just Answer. I am an expert here and I look forward to assisting you today.

JD 1992 :

I need you to be a little more specific in your question(s) if you could. When we answer general ones we have to give general answers and, invariably, the customer responds with "I already knew that". This type of forum works better if you ask specific questions so we know exactly what you are looking for.

Customer:

My goals are to retain the insurance coverage ($10k deductible) but I do not agree with having to defer pre-existing conditions that are over 5 years old, that Humana did not ask for on the application. Further, if it is legal for them to do this, do they have the right to defer it for 2 years when their own website says 1 year? How do I fight this?

JD 1992 :

You have a couple of ways to attack it.

JD 1992 :

First you can file a complaint with the insurance commissioner in your state. There is information on how to do that at this link.

JD 1992 :

They can sometimes be helpful but it depends to what extent they are in the pocket of hte insurance companies.

JD 1992 :

If that doesn't work then the only thing to do is file a lawsuit.

JD 1992 :

In cases like this they will have to prove that they would not have written the policy if you had revealed whatever they say you didn't.

JD 1992 :

In addition, it sounds like you revealed exactly what they asked.

JD 1992 :

It isn't unusual for insurance companies to write policies and then look for ways to get out of them once a claim is made. It doesn't happen as often in health insurance as it does in things like credit life, but it does happen.

JD 1992 :

If they've done it this time then it is likely a policy for them to do it every time a claim is made within a certain period of time.

JD 1992 :

So a jury would frown on their behavior.

Customer:

Exactly. Underwriters are difficult to reach. Is there an another approach I can use directly with Humana to negotiate this? I have a feeling that the underwriter doesn't have the proper expertise to make this decision.

JD 1992 :

Not one that would be likely to work. Your best bet is to hire an attorney to handle it. Let them contact the insurance company, negotiate, etc. When they are doing this they will be papering the insurance company's file with self serving letters that can be used against them if you have to sue later.

Customer:

Many thanks.

JD 1992 :

Anything else I can assist with?

Customer:

That's it- thanks!

JD 1992 :

Best wishes to you.

JD 1992 :

Please ask any follow up questions in this thread. When all of your questions have been answered, then I would ask that you give a Positive Rating (of course I'd suggest Excellent) since that is the only way I get credit for my work and also please consider clicking "BONUS" as a nice way of saying "thanks" for a job well done, although this is neither required nor expected. When looking at the answer I ask you to bear in mind I can’t control what the law is and whether it helps you, I can only tell you what it says, and I assume you want truthful information. Also, issuing a positive rating keeps the question from “timing out” so you can return in the future if you think of a follow up.


 


However, please do not issue a rating of any kind until all of your questions have been answered and please use the Reply button to ask additional questions or to provide answers to my questions.

JD 1992 :

Please don't forget to leave a Positive Rating so I get credit for my work and always feel free to ask any follow up questions that you have. Once you issue your rating the question will remain open in case you ever need to ask anythingelse.

Dwayne B., Attorney
Category: Legal
Satisfied Customers: 27093
Experience: Began practicing law in 1992
Dwayne B. and 4 other Legal Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • Mr. Kaplun clearly had an exceptional understanding of the issue and was able to explain it concisely. I would recommend JustAnswer to anyone. Great service that lives up to its promises! Gary B. Edmond, OK
< Last | Next >
  • Mr. Kaplun clearly had an exceptional understanding of the issue and was able to explain it concisely. I would recommend JustAnswer to anyone. Great service that lives up to its promises! Gary B. Edmond, OK
  • My Expert was fast and seemed to have the answer to my taser question at the tips of her fingers. Communication was excellent. I left feeling confident in her answer. Eric Redwood City, CA
  • I am very pleased with JustAnswer as a place to go for divorce or criminal law knowledge and insight. Michael Wichita, KS
  • PaulMJD helped me with questions I had regarding an urgent legal matter. His answers were excellent. Three H. Houston, TX
  • Anne was extremely helpful. Her information put me in the right direction for action that kept me legal, possible saving me a ton of money in the future. Thank you again, Anne!! Elaine Atlanta, GA
  • It worked great. I had the facts and I presented them to my ex-landlord and she folded and returned my deposit. The 50 bucks I spent with you solved my problem. Tony Apopka, FL
  • Not only did he answer my Michigan divorce question but was also able to help me out with it, too. I have since won my legal case on this matter and thank you so much for it. Lee Michigan
 
 
 

Meet The Experts:

 
 
 
  • Tina

    Lawyer

    Satisfied Customers:

    8436
    JD, BBA Over 25 years legal and business experience.
< Last | Next >
  • http://ww2.justanswer.com/uploads/MU/multistatelaw/2011-11-27_173951_Tinaglamourshotworkglow102011.64x64.jpg Tina's Avatar

    Tina

    Lawyer

    Satisfied Customers:

    8436
    JD, BBA Over 25 years legal and business experience.
  • http://ww2.justanswer.com/uploads/RA/ratioscripta/2012-6-13_2955_foto3.64x64.jpg Ely's Avatar

    Ely

    Counselor at Law

    Satisfied Customers:

    19941
    Private practice with focus on family, criminal, PI, consumer protection, and business consultation.
  • http://ww2.justanswer.com/uploads/FL/FLAandNYLawyer/2012-1-27_14349_3Fotolia25855429M.64x64.jpg FiveStarLaw's Avatar

    FiveStarLaw

    Attorney

    Satisfied Customers:

    8189
    25 years of experience helping people like you.
  • http://ww2.justanswer.com/uploads/jespoag/2008-12-17_222355_jessepic.jpg JPEsq's Avatar

    JPEsq

    Attorney

    Satisfied Customers:

    2132
    Experience as general attorney, in house counsel, SSDI, Family Law attorney, and law professor
  • http://ww2.justanswer.com/uploads/gsenmartin/2008-04-22_214950_me1.jpg Guillermo J. Senmartin, Esq.'s Avatar

    Guillermo J. Senmartin, Esq.

    Attorney

    Satisfied Customers:

    110
    7+ years of experience handling various legal matters.
  • http://ww2.justanswer.com/uploads/PA/PaulmoJD/2013-10-10_195858_JAImage.64x64.jpg Law Educator, Esq.'s Avatar

    Law Educator, Esq.

    Attorney

    Satisfied Customers:

    31621
    JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
  • http://ww2.justanswer.com/uploads/dkaplun/2009-05-17_173121_headshot_1_2.jpg Dimitry K., Esq.'s Avatar

    Dimitry K., Esq.

    Attorney

    Satisfied Customers:

    15975
    Multiple jurisdictions, specialize in business/contract disputes, estate creation and administration.