I thought HCR eliminated most of the rating on pre-existing condition, or does that not apply to travel insurance, or does "rating and selection" only refer to insuring the member but does not speak to exclusions from coverage?
http://ift.tt/1xtT6k2
As to the case below, how would this not qualify as an essential health benefit that can't be excluded?
Putting all emotions aside (not an easy thing to do), we have assuming this travel policy is compliant and the rating is for a policy that excludes accepting of claims for pre-existing condition, what happens when the medical community disagrees on the services performed being un-related in frequency of occurrence to a pre-existing condition? Or why wouldn't the physician and hospital networks be able to prompt the patient that under their policy terms, these services would not be covered, before continuing with the performing services?
The concept issue is was this operation of the same risk of frequency and severity vs a couple without the pre-existing condition. Doctor says it is. Insurer disagrees.
Arguably the error of judgment was on the hospital and physicians, if they told the patient the services were covered. Then there's factual misrepresentation that the patient reasonably relied on and the hospital/physicians should eat some of the cost by not passing it onto the member as well.
And I thought HIPAA requires communication of these terms of coverage
http://ift.tt/1xtT6k2
As to the case below, how would this not qualify as an essential health benefit that can't be excluded?
Putting all emotions aside (not an easy thing to do), we have assuming this travel policy is compliant and the rating is for a policy that excludes accepting of claims for pre-existing condition, what happens when the medical community disagrees on the services performed being un-related in frequency of occurrence to a pre-existing condition? Or why wouldn't the physician and hospital networks be able to prompt the patient that under their policy terms, these services would not be covered, before continuing with the performing services?
The concept issue is was this operation of the same risk of frequency and severity vs a couple without the pre-existing condition. Doctor says it is. Insurer disagrees.
Arguably the error of judgment was on the hospital and physicians, if they told the patient the services were covered. Then there's factual misrepresentation that the patient reasonably relied on and the hospital/physicians should eat some of the cost by not passing it onto the member as well.
And I thought HIPAA requires communication of these terms of coverage
Why are there pre-existing condition exclusions on US travel healthplans?
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