Read the Fine Print, and Don’t Forget About It

What!?Let’s set the stage for a tale of a 3-hour tour I took today. Imagine you have a physically and medically exhausting genetic condition that necessitates 16+ specialist visits per year, well over $2k/mo in prescription medications, and a PPO insurance plan that is just shy of costing the same as a second mortgage. Now imagine you just received a letter in the mail from your health insurance company that informs you that your recent doctor’s visit was not covered due to said condition and that no expenses due to said condition will be covered for the first year after enrollment in the plan.

My wife and I are complete and total medical opposites; she’s only been to the ER once, can count her lifetime usage of antibiotics on one hand, and doesn’t even like doctors. Every fiber of me wanted that for one year. Just one year.

That’s not exactly true, though, because there were fibers that were upset with the insurance, upset that I’d left my office job, upset that I might have chosen the wrong insurance plan, and upset that I am not independently wealthy to pay for my own condition by the age of 30. Okay, the last one was ridiculous, but those fibers were there, too.

After two hours of discussion our options and mentally and emotionally preparing to call my old boss, I looked up our plan details since our paperwork didn’t mention anything about that clause. After 20 minutes of searching, I found the page that states that prior creditable coverage within 63 days of enrollment waives the exclusion.

Shoot, we didn’t have any lapse at all! What gives!?

A quick call to customer service and I was in touch with a rep. within 3 minutes. I told her about the letter and that we had continuous coverage with them for the last 9 years, and wondered if that didn’t count as “creditable” coverage. She immediately saw my previous plans with starting and ending dates and was prompt to apologize for any inconvenience and anguish the letter had caused.

Now THAT’S customer service!

The company?

Aetna.

  • http://kuronoir.net Kuronoir

    And yet the fine print disclaimers have been deliberately typed at 3pts with caps just to throw us off. Sometimes I get a sense of accomplishment after all that scrutiny.

    • http://www.cffatboy.com/ Jesse Petersen

      In my case, it was on page 20 of an obscurely-named PDF.

  • http://kuronoir.net Kuronoir

    And yet the fine print disclaimers have been deliberately typed at 3pts with caps just to throw us off. Sometimes I get a sense of accomplishment after all that scrutiny.

    • http://www.perfectlypetersen.com Jesse Petersen

      In my case, it was on page 20 of an obscurely-named PDF.

  • http://twitter.com/jpetersen/statuses/1698152220 jpetersen (Jesse Petersen)

    A heart-warming personal experience with terrific customer service I received from a Big 3 health insurance company: http://is.gd/wFlz

  • http://www.yolospat.com Jen

    That’s who I have 🙂

  • http://www.yolospat.com Jen

    That’s who I have 🙂