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HCC Medical Insurance ServicesClaim non-fulfillment

I bought Atlas Insurance product from this company in effective on March 2nd 2016 for my mother. Her ear started hurting on the night of the same day. We thought it might go away so waited overnight. Unfortunately, It still hurt the next day. Given her age and her ear never hurt before, I took her to nearby Urgent Care Center for a checkup to be sure. It was a simple outer ear infection and doctor prescribed antibiotics. It was a simple 15-min office visit with prescribed antibiotics bills for 5 days. The Urgent Care Center filed claim directly to HCCMIS. Since then claims were pending for over 3 months and finally after numerous phone calls and emails, we received an EOB for claim denial. Denial reason is: pre-existing limitation. We called for further explanation and were told that it was classified as pre-existing because we went to the doctor's office the day after the effective date. How is that reasonable? So a claim is only valid if the insured doesn't fall ill after, say, a week? If that's the case, it should be clearly stated in the policy agreement/conditions about the pre-existing conditions. So people are aware of what they are getting into.See Top 10 Worst Companies in Farmington, MIFollowing is the definition of pre-existing condition per HCC.
"PRE-EXISTING CONDITION – Any (1) condition for which medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or received during the 2 years immediately preceding the Certificate Effective Date; (2) condition that had manifested itself in such a manner that would have caused a reasonably prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) within the 2 years immediately preceding the Certificate Effective Date; (3) injury, illness, sickness, disease, or other physical, medical, mental, or nervous conditions, disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed at the time of application or within the 2 years immediately preceding the Certificate Effective Date. For the purposes of the Complications of Pregnancy coverage offered hereunder, Pregnancy will not be included within the definition of a Pre-existing Condition."

Co
Jun 20, 2016

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