Insurance claims can be rejected for what?

JustBeachyNurse, LPN · May 29, 2014

Generally one who is a full time student is fully dependent on another adult for tax purposes (usually a young adult 18-25). Full time student status qualifies the individual to remain on a parent/guardian's insurance plan when they would normally be automatically removed at either age 19 or 21 depending on the state insurance regulations. A few years ago legislation was enacted to permit full time students to remain on their parent/guardian's insurance plan as a dependent until age 25.

Therefore if one is self-supporting and working full time they are not eligible to full time student dependent status on their parent's insurance plan as technically they appear to be independent.

I know when I was 18-21 (21 was the max age back then) in order to stay on my parent's health insurance as a qualified dependent I had to submit proof of full time status for each semester and proof of enrollment for the subsequent semester for summers/breaks. Any break in full time status as a student you were dropped from eligibility.

It's sort of like claims being rejected for being marked as male & female or a hysterectomy on a patient marked as male. Mark the wrong box or too many boxes and the claim will be automatically rejected.

This is following the standard guidelines of submitting insurance claims. If you are primary insured and happen to be a full time student the correct answer is full time employee (as some companies differentiate between full & part time employees for level of benefits)

nurseprnRN, BSN, RN · May 30, 2014

It's up to age 26 now that the ACA is law. :)

And people who are employed full time are supposed to have health insurance available to them from their employers. Therefore a student plan may not accept you for coverage.

Suggest you call your state health insurance exchange, or the federal one covering your state if your state doesn't participate, and ask the counselors there for more details.

Altra, BSN, RN · May 30, 2014

Here's a link to CMS Form 1500: Form CMS1500 - Centers for Medicare & Medicaid Services

It does not ask whether or not the claimant is employed. Nor does it ask if the claimant is a full-time student. It only asks if the claim is related to an occupational injury/illness, or if the injury/illness described in the claim means that the claimant is unable to work in his/her current profession.

CT Pixie, BSN, RN · May 30, 2014

I work for an insurance company and see the CMS form daily...for the last 20 years and I don't ever recall seeing anything asking for employment or student status.

JustBeachyNurse, LPN · May 31, 2014

I think the dental insurance forms still do as I filed one recently

Altra, BSN, RN · May 31, 2014

See the link I posted, as it contains the actual form.