Anyways they just sent me a letter saying that the services occurred within the waiting period of the policy therefore this claim is pending for receipt of physicians report.
What does all this mean? Can they deny the coverage?
Companies normally have a 60 day "underwriting period" to see if they even want to accept your application.
Since yours was a NEW application and still within this period, they are probably still waiting on reports from your doctors to see if you had any pre-existing conditions that might have caused the accident.
If not...you shouldn't have a problem - it just takes a little waiting time.
Good luck and I hope this helps!
Waiting period, pre-existing condition... very similar clauses. My suggestion to you is to get on the phone, or go to the offices of the physician's you saw. Get those statements sent out to your insurance company ASAP! Most insurance companies only have 90 days to file claims, after that ... they deny them simply because the claim is old. So you will want to know how many days you have left to get these claims completed and processed.
Document everything!!!! The person you spoke with, their job title, the date and time you spoke with each person, and the contents of the discussion. Claims get lost all the time.... sometimes it's human error, other times its a dishonest human.
And finally... they can deny the claim, even if it was filed on it, because it may not meet their criteria OR they decided that the event wasn't based on medical necessity.
They can't deny your claim due to a "waiting period". Either you have insurance or you don't. It would't matter if this accident happened on the first day your health insurance was in force. They like to use stall tactics, but don't worry. They are waiting to get all of the information from your doctor. And if the accident wasn't your fault, they will want to go after the other person's insurance. If they keep denying your claim, send all of your information (medical records and the insurance denial letters) to your state's board of insurance. They will help you get your claim paid. Good luck.
Edit: What the others have said about pre-existing condition is true, but I didn't even bother to talk about it because you were in an auto accident so this obviously isn't pre-existing. That is, unless you had an accident due to a condition you had prior to getting this health insurance such as passing out due to a low blood sugar if you were a diabetic. You didn't mention anything about that so I assume you didn't have an accident due to a health problem. Therefore, no pre-existing condition, therefore, no waiting period.
There is no waiting period for a policy -- except for sometimes maternity. But, if you just get insurance and make a claim 6 weeks into it you'd have to understand that they're going to be a little suspicious.
Obviously in your case a car accident has nothing to do with pre-exisitng conditions, but the insurance company doesn't know the particulars of the claims. They only know that you're having a medical issue.
That's why they want to know. They will also send you a form to see if someone else is reponsible for the claim (i.e. due to an accident, worker's comp, law suit, etc..). So, you can expect that as well and know that is standard operating procedure as well.
In short, I wouldn't worry about it at this point.
Good luck,
Jeff
For a private policy, they can flat out decline to pay any pre-existing conditions - they don't need to pick them up after ANY time period.
For a group policy, it's usually 12 to 18 months.
What this means is, they're going to investigate carefully, to make sure this isn't a pre-existing condition. If it's pre-existing, they will deny it.
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