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  • Writer's pictureAhsan Malyk

Can Health Insurance Cover Past Medical Bills?

Medical expenses for treatments received while the policy was in force are covered by health insurance. Any medical treatments rendered before or after the insurance policy's effective dates are not covered. Only the health insurance in force during service would pay for past medical expenses.

Health Insurance Beginning on the Effective Date

An effective date is assigned to each health insurance plan.

Your coverage starts on the effective date.

If you enroll as a new hire and are an employee, your effective date is when your eligibility waiting period expires. Your effective date will probably be January 1 if you enroll during the open enrollment, though it might be at a different period of the year. To find out your effective date, you should speak with your employer.

You will be informed of the start date when you enroll in health insurance through the Health Insurance Marketplace.

If you can safely postpone any medical procedures until after the effective date of your health insurance, you should do so.

Can Medical Insurance Be Retroactive?

After your effective date, some employers will provide you with a 30-day grace period to sign up for health insurance. They will then retroactively apply the coverage to the start date you were initially qualified for. If they do this, you will still be responsible for paying the back premium to the effective date.

In the event of a child's birth, coverage may also be retroactive to the child's birth date. During a special enrollment period for a qualifying life event, the child must be enrolled within 30 days. You are protected by health insurance during the plan year.

The period of time that your health insurance coverage is in force is known as the plan year. For most of us, the plan year runs from January 1 to December 31. Your plan year could change.

A new plan year with a new effective date starts once the previous one has ended.

The Start Date and Plan Year Must Be the Same.

The day that medical services were rendered is known as the date of service. Every claim must have a date of service that falls within dates that are within the policy's plan year.

The claim will be rejected if the date of service does not coincide with the plan year for the insurance policy it is filed against.

You should claim the policy that was in force at the time if you previously had coverage that was in place on the day of service.

How far in the past is health insurance valid?

The window of opportunity for making a health insurance claim is open-ended. However, it is advised that you submit claims as soon as possible (within a year). If the service date fell within the policy's plan year, you should submit a claim even if you anticipate being rejected.

Only the period following the policy's effective date is covered by health insurance.

Will My New Insurance pay an Old Medical Bill?

Any previous medical bills with dates of service before the new coverage's start date won't be paid by your new insurance once the plan year expires. To make a claim under the previous health insurance plan, you must do so.

Medical Bills Following the Termination of Your Health Insurance

The terminated insurance won't cover any medical bills with a date of service after your policy's termination.

60-Day Cobra Loophole

You have 60 days to sign up for Cobra after ending your employer-provided health insurance. Any enrollment in Cobra is effective backwards from the day your prior plan ended.

If you initially didn't plan on enrolling in cobra but had a claim in the first month or so, you may possibly enrol in cobra to have that claim covered, albeit you would have to pay back premiums to the termination date.

Medical Bills Following the Termination of Your Health Insurance

Any medical expenditures incurred after the policy's termination date won't be covered.

From the foregoing, it is clear how crucial it is to submit a claim on time and within the plan year in order for it to be approved. If and when the insurance was in effect on the day that medical services were rendered, the insurance company is responsible for passing the claim of your old medical bill.

Will My Insurance Pay for a Past Due Medical Bill?

Only if your insurance was in force on the day that medical services were rendered will it pay for an old medical bill. Any new insurance wouldn't cover that old medical cost if you didn't have health insurance in force on the date of service.

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