Pregnancy Coverage - Kaiser Permanente Application Denied

[djs]

??? Am I the only one that is confused in this conversation? Perhaps its because this conversation wouldn't even be started in California....

In Ohio, will Kaiser cover you if you are already pregnant?

Dan

 

[CHUMPS FROM OXFORD]

I assume not, but I rarely deal with Kaiser so maybe someone can check.

I think the assumption was that the applicant was NOT pregnant.

 

[DS4]

I suspect the applicant has a condition that was not indicated on the Kaiser application. Just a wild guess.

 

[somarco]

I suspect the applicant has a condition that was not indicated on the Kaiser application.

Perhaps . . . but how would they (KP) know?

They do not participate in MIB but do pull Rx history.

 

[DS4]

Rx history.

IntelliScript or Ingenix MedPoint were probably used to mine data from PBM's.

 

[somarco]

IntelliScript or Ingenix MedPoint were probably used to mine data from PBM's.

I was told which one they use, but several bottles of wine have been opened since then . . .

 

[klein123]

Thanks for your responses.

My wife is not pregnant yet. We are planning to have a family soon though. Kaiser seems to be the only in my city (Cleveland) which offers maternity with no waiting period.

I spoke to the KP rep and they asked us to appeal with the Doctors report stating her normal health condition. It takes them 30 days to review and inform us the decision.

Any other suggestions if the application is denied again?

Hmm ..No one here in the same boat?

 

[somarco]

I have used KP in Atlanta for many years and never had an application denied when the client was honest with me. The facts as you state do not match up with my experience.

 

[DS4]

Hmm ..No one here in the same boat?

Most of us responding to your post are health ins agents.
Not a consumer like you.

 

[Yagents]

I would have bet my Obama tax break (?) that she was pregnant. It now sounds like a case of a little "CYA". I've had too many of these recently. The doctor probably wrote something in her records to "Cover Your Ars". In an effort to protect themselves, they end up hurting the patients insurability.