Legal Question in Health Care Law in California

pre existing medical question
we have insurance through NASE and Mega Life and Health. We do not have maternity insurance. I was told by the agent when I signed up 2 1/2 years ago( because i told her my wife had a cesarean on our first child) that everything relating to my wifes medical expenses would be covered. She said to negotiate w/ our doctor, which we did, for $2,500 for the prenatal care and child birth. Now they are threaten to cancel us because the reason for the cesaean before was genital herpes and they are calling it a pre-existing condition and they do not want to cover it this time ,if it is even required (70% chance it will be). My wife had insurance before through work then we switched to this...I do not remember if I included that condition on the form nor was it a question that pertained to it..

In general this is the worst insurance experience I have had ( raised my premiums to $600)after claiming to be affordable and that they would be lowered over time. Can they cancel me for something that happened before that ''might not happen again'' this was in our medical history with my wifes doctor ( they are still the same ) Help.

Asked on 10/27/04, 6:20 pm

2 Answers from Attorneys

Armen Tashjian Law Offices of Armen M. Tashjian

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Re: pre existing medical question

I am familiar with Mega Life and their borderline fraudulent radio ads. You might have a case for fraudulent inducement, since I'm pretty sure you were promised and sold bunch of goods by their salesman.

I do not want you to think this will be an easy case. It will not. Nevertheless, you need to get your contract reviewed and keep copies of all your correspondence.

Let me know if you'd like my help.

Answered on 10/30/04, 12:20 am

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