Health condition not listed in plan exclusions and insurance claims it is an error in the brochure. Is this allowed?

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I recently switched insurance plans, and before enrolling I checked the list of excluded medical conditions to ensure treatment for my illnesses would be covered. Everything looked good. After signing up for the plan, I called customer support to ask about getting something covered and they claimed they did not cover my condition. I asked to speak to a supervisor, who confirmed. I asked her to direct me to where I could find that information, and she walked me through how to get to the plan benefits summary. I asked her where that exclusion was listed and after looking through the full document, she was surprised to find it wasn’t listed. She said it was an error and the condition definitely was not covered and she would put in a request to have the document amended.

I suppose my question is whether or not this is allowed? I have to imagine a health insurance company would be required to report any exclusions in the plan benefits summary, and this would have informed my decision about whether or not to sign up for this particular plan. Can they be required to cover a service not listed as an exclusion?

submitted by /u/kittykalista
[link] [comments]
I recently switched insurance plans, and before enrolling I checked the list of excluded medical conditions to ensure treatment for my illnesses would be covered. Everything looked good. After signing up for the plan, I called customer support to ask about getting something covered and they claimed they did not cover my condition. I asked to speak to a supervisor, who confirmed. I asked her to direct me to where I could find that information, and she walked me through how to get to the plan benefits summary. I asked her where that exclusion was listed and after looking through the full document, she was surprised to find it wasn’t listed. She said it was an error and the condition definitely was not covered and she would put in a request to have the document amended. I suppose my question is whether or not this is allowed? I have to imagine a health insurance company would be required to report any exclusions in the plan benefits summary, and this would have informed my decision about whether or not to sign up for this particular plan. Can they be required to cover a service not listed as an exclusion?
submitted by /u/kittykalista [link] [comments]Read Morer/HealthInsurance

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