Pre-existing conditions and work based health insurance

[Melkar]

Hi everyone.

Here is my conundrum:

My wife is Bi-Polar. Her work insurance does not cover mental health stuff. But it's not like she just suddenly developed this. Can they refuse to cover her expenses for this?

Furthermore, if she has to go to the hospital for this condition and they refuse to cover it based on the mental aspect of it are there portions of the bill that should be covered?

One more thing. If she attempts to get the company to cover the bills for her mental health expenses can they drop her because of that? And if they do something like that is there any lega action that we can take to force their hand.

Thanks in advance for any advice you can give me. I'll be checking in.

 

[cbg]

what state are you in?

 

[Melkar]

we are in CT. I probobly should have mentioned that in the OP.

 

[cbg]

I'm sorry, my fault. I should also have asked how many employees your wife's employer has.

I'm going somewhere specific with this, I promise.

 

[Melkar]

over 40000 people in the US

 

[cbg]

Forty thousand people in the US and there is no mental health coverage at all? That's unusual in the extreme.

However, you mentioned pre-ex. Is it possible that it's covered on the policy; it's just been declared a pre-existing condition for her?

If so, the maximum they can refuse to cover it is 12 months (unless she was a late enrollee, in which case it can be for 18 months).

Here's what you can confirm for me, and you might have to look at the policy.

Is mental health coverage mentioned in the policy?

How long has she been covered on THIS SPECIFIC policy?

Prior to being covered on THIS policy, how much time elapsed between the end of the old one and the start of this one?

All of this has a reason, I promise you. If you don't have it handy immediately, get it for me when you can - I'll be here.

In the meantime, I'll be looking up CT specific regs which I don't remember any more (been too long since I had employees in CT )

 

[Melkar]

Mental health care is mentioned in that the policy states explicitly that it is not covered.

She has been covered for 90 days and this is the first time that she has been insured by this employer.

thanks for you help