Wiki Pre-Existing Condition Insurance Plan

[jyoung]

Since Pre-Existing Condition Insurance Plans (PCIP) are no longer in existence, how/who would my hospital call to verify that a patient had coverage during the 2013 year under PCIP. I am aware that with the plan no longer in existence that all phone numbers, etc. are not working, but would like to at least have the information verified. Also, how long did the provider have to bill the service under PCIP (I am assuming until May 2014) and if they are not attempting
to bill until now (July 2015) for services rendered in December 2013, what are the ramifications. The hospital is attempting to bill for services in 2013 when the patient was covered under PCIP, but now the plan is not funded. Thank you for your feedback as this has been a frustrating process.

 

[CatchTheWind]

I do not know what the specific "timely filing" requirement was for PCIP, but for Medicare and Medicare Advantage plans it is 12 months and for some commercials it's as little as three months. So I would say that you are way past the timely filing deadline anyway. Add that to the fact that the patient's insurance is no longer funded, and don't think there is any possibility of getting paid. You cannot bill the patient either, since missing the timely filing deadline is the hospital's fault. (Unless it is the patient's fault; ie: he didn't give you the correct insurance information... but if you can't get verification, you have to give him the benefit of the doubt.)