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Emergency admission before Medical Insurance policy start date

Stamford, CT |

The medical-insurance company denied coverage for my father's treatment (March 12 - March 14, 2014), since he was admitted to the hospital on March 11th, and the policy start date was March 12th.
My father died on March 14th.
We requested the insurance company to cover only the costs incurred on March 12th and 13th, but they refused. Is there a way to contest their denial ? Please help.

Attorney Answers 1


  1. I am an attorney licensed in the Commonwealth of Pennsylvania, and the States of Delaware and New Jersey. My practice includes employment, business and health care law. Before I respond to your inquiry, I must state that we have not spoken, I have not reviewed the relevant documents and facts, and I do not represent you. Therefore, my discussion below is not a legal opinion, but is informational only. Finally, my discussion applies only to issues to which Pennsylvania, Delaware, New Jersey or Federal law applies.

    That being said, the policy has an internal procedure - get a copy from the company. It sounds as if he was denied for a pre-existing condition (treatment of the 12-14 for a condition of the 11th) - OR he was denied because they are claiming that his condition was not disclosed for underwriting. Get a written denial with the reasons therefore from the company. This will be the start of your fight. You may need an attorney to assist you.

    /Christopher E. Ezold/

    I am an attorney licensed in the Commonwealth of Pennsylvania, and the States of Delaware and New Jersey. My practice includes employment, business and health care law. Before I respond to your inquiry, I must state that we have not spoken, I have not reviewed the relevant documents and facts, and I do not represent you. Therefore, my discussion below is not a legal opinion, but is informational only. Finally, my discussion applies only to issues to which Pennsylvania, Delaware, New Jersey or Federal law applies.