Legal Question in Health Care Law in Michigan

past medical history

I have been paying Continental General Insurance since December 2002, they have been taking a monthly bank draft from my account for premiums. In March 2003 I was hospitalized and in September they deny paing the hospital bill, but they pay the attending Physician. They said I with held past medical history. On the application there is not a specific question regarding past medical histor. The questions on the application all relate to certain conditions they have listed. My past medical history did not relate to those conditions, there fore my past medical history was not revealed. I answered the questions correctly. They say I am not elgible for their Insurance because of past medical conditions (pelvic Pain) which was resolved surgically in May 2002, I have been pain free since then. Can they do this after ten months of taking monthly premiums from my account? I have nothing to hide, and would never intentionally with hold medical history. I have worked in the medical feild before and I know how important it is to answer the questions correctly. What can I do?


Asked on 10/02/03, 9:24 pm

1 Answer from Attorneys
Gary Weingarden Gary D. Weingarden

Re: past medical history

Ok. Assuming that you are right that they did not ask you about pelvic pain, you are probably entitled to coverage. You should do a couple of things:

1. Make sure you take advantage of any appeals that you have within the insurer's own system. Most have one or two levels of review. If you don't use them, this may give the insurance company a defense.

2. File a complaint against them with OFIS, the state office that regulates insurance companies.

Here is a link to the page on their website where you can get more information about complaints against insurers. You can also download a complaint form there.

http://tinyurl.com/pko0

Good luck!!

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Answered on 10/03/03, 8:28 am


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