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My neice’s 12 year old son developed diabetes about 18 months ago. She has worked with the same employer Fi 8 years and has a good health care plan. The insurance company declined her request to cover costs associated with being diabetic because it was a pre-existing condition. Can the insurance company do this?
It depends on the wording of the pre-existing exclusion under the health care policy. Your niece should ask for a detailed explanation from the insurer as to why they declined the claim, and ask them to point to where in the policy it stipulates that the pre-existing exclusion applies in this case. Unfortunately if they maintain their denial there is little she can do. She can sue the insurer but that may complicate her relationship with her employer if the employer has a relationship with the health benefits insurer.