How would health insurance providers know if I have a pre-existing condition?
Once coverage begins under any given health plan, any claims filed by you may be investigated as a possible pre-existing condition. Depending on state law, insurers can look back months or even years to see if the condition existed before your enrollment. If evidence is found, insurers can deny any claims or benefit coverage for that condition and all care/treatment related to it. However, only in the case of HIPAA qualified creditable coverage group health plans, the maximum look back period is six months. *States also differ upon which standard is used in defining a “pre-existing condition.” Some states use the “objective standard,” which defines a “pre-existing condition” as anything for which you’ve received medical advice, diagnosis, care, or treatment. Conversely, most states support a much broader definition based on the “prudent person” standard. Under this standard, a “pre-existing condition” also includes anything may not been diagnosed, but showed symptoms for which an “ordi
