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November 16, 2004

HMO woes

What does this mean?
Preexisting Condition - a physical or mental condition, regardless of the cause of the condition, for which medical diagnosis, care or treatment was recommended or received within (1) the six month period for groups of two or more employees and for groups of fewer than two employees who have had the Continuous Creditable Coverage, ending on the person’s Enrollment Date.
This comes from a document called the Preexisting Condition Amendment. What I understood when I signed up with this United Health Care policy that for two or more employees the Continuous Creditable Coverage trumped the preexisting condition clause. The wording in the contract is fairly ambiguous, leading one to believe that it applies to groups of two or more employees who have had the CCC as well as fewer than two employees who have had the Continuous Creditable Coverage. So why separate them out? Why not just say any employee who has had Continuous Creditable Coverage?

I think this is one of those clauses that seems to be intended to be ambiguous—but the helpful young woman from the State of Florida Department of Financial Services seems to feel that I wasn’t covered. But I’m still going by my original understanding.

Now after talking with the State of Florida Agency for Health Care Administration, they suggest I call United Health Scare again (gasp!) At least they opened a complaint for me. I do desperately hope that this will conclude with United figuring out they made a big mistake.

I hope this saga ends soon?

Posted by Bastique at November 16, 2004 10:25 AM

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