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Pre existing conditions and Individual Health Insurance
Old 12-29-2005, 06:15 PM   #1
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Pre existing conditions and Individual Health Insurance

I'm looking around trying to get an idea of how much it will cost me to buy individual health insurance when my CORBA plan runs out in 18 months. The biggest concern is the uncertainty around pre existing conditions. I need to find out whether there will be a problem getting insurance... the most significant conditions I can think of that I have are:

- I've been treated for depression including trying some antidepressants. I haven't received treatment or filled any prescriptions for depression in about a year and a half, but I suppose this might be a concern.

- About 2 years ago I had a traumatic ear injury that required a $15k ear operation and left me legally deaf in my left ear (but not my right ear out of which I hear fine). Since then there have been approx 10 followup appointments and a I see the ENT about 3 times a year now for office visits to monitor the situation, but there isn't any indication that anything is going to require any expensive treatments.

- About 3 months ago I felt a strong sharp chest pain and went into the emergency room to have it checked out. They did $2500 worth of tests and determined that my heart seems fine. I'm 35 and have never had any indication of heart problems. The ER didn't know what caused the pain but said they ruled out all the serious stuff.


I was tempted to just apply for an individual health insurance plan and see whether I'd get rejected, but then I thought better of it when I learned that doing so would store my answers to their questions in the MIB:

http://www.privacyrights.org/fs/fs8-med.htm

I figure I had better get my story straight about exactly what the proper truthful answers to their questions should be.

Anyone have a sense of whether the things mentioned above would be likely to cause me to be problems getting health insurance, or where I could find that out?

For what it's worth, I will be continuously covered for more than 18 months under COBRA before applying for individual coverage, so I don't think I can be denied, according to

http://www.calpatientguide.org/v.html

But I'm sure they could make the premium so high as not to be worthwhile, right?





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Re: Pre existing conditions and Individual Health Insurance
Old 12-29-2005, 06:31 PM   #2
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Re: Pre existing conditions and Individual Health Insurance

I found an old post recommending the following report on denial for pre existing conditions by the kaiser family foundation. It's a huge file and causes my internet explorer browser to hang but I can open it in Netscape:

http://www.kff.org/insurance/loader....m&PageID=13679
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Re: Pre existing conditions and Individual Health Insurance
Old 12-29-2005, 06:32 PM   #3
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Re: Pre existing conditions and Individual Health Insurance

Health insurance rules are determined by state. You can get more information on you individual state rules and requirements here:

http://www.healthinsuranceinfo.net/

Just prior to retiring and going on COBRA, I applied for individual policies for DW and I. We were both approved, but DW had three conditions that were excluded. Her conditions were similar to your ear problems...no indication they would require future treatment, but nevertheless, they were excluded.

Based on this, I would be surprised if any of the conditions you mentioned were not excluded.

Have you investigated the coverage available to you through your state health insurance pool? Not available or affordable in every state, but worth a look.


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Re: Pre existing conditions and Individual Health Insurance
Old 12-29-2005, 07:12 PM   #4
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Re: Pre existing conditions and Individual Health Insurance

I live in California. According to the kff.org report I linked above,

"California and Indiana prohibit exclusion riders that limit benefits while other states we studied do not"

That report really does a good job of clarifying how hard it is to get good coverage with pre existing conditions. It is pretty clear that some or all of my conditions could pose problems for getting individual insurance.

The results seemed to show people getting applications denied more in California than other states. In other states they would exclude illnesses, but it looks like in CA the insurers just deny completely instead. Perhaps since I have previous coverage this denial would not be an issue.

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Re: Pre existing conditions and Individual Health Insurance
Old 12-30-2005, 12:52 AM   #5
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Re: Pre existing conditions and Individual Health Insurance

Hi fireme,

I would try to carefully evaluate how much the specific excluded conditions will cost you. In some cases, this may be entirely manageable and a good tradeoff. In other cases (e.g., diabetes complications) it would be ludicrous.

I have posted before about medical vacations to cheap health care countries and this could be a solution for treating certain excluded conditions inexpensively. An example would be a bad hip that needs replacement that is excluded from your insurance -- this is not necessarily a chronic condition and can be treated quite well and inexpensively in Thailand Bumrungrad or India Apollo hospitals.

Kramer
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Re: Pre existing conditions and Individual Health Insurance
Old 12-30-2005, 02:13 AM   #6
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Re: Pre existing conditions and Individual Health Insurance

I found out that an insurance agent can do a dry-runfor your health insurance questionnaire. He can tell you by the score what your situation will be. My wife is just 2 points over the "you are on your own" score. Just make sure that it will NOT be official. If official, it goes into all the computers in the world and you are stuck forever.

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Re: Pre existing conditions and Individual Health Insurance
Old 12-30-2005, 02:38 AM   #7
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Re: Pre existing conditions and Individual Health Insurance

Quote:
Originally Posted by Ed_The_Gypsy
I found out that an insurance agent can do a dry-runfor your health insurance questionnaire.* He can tell you by the score what your situation will be.* My wife is just 2 points over the "you are on your own" score.* ** Just make sure that it will NOT be official.* If official, it goes into all the computers in the world and you are stuck forever.

Ed
Ed, you are in Washington. In Washington, once you exhaust Cobra benefits, you are not even required to fill out the health questionaire. If your wife has been covered under your group policy, she would fall under the same rules.

Ha
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Re: Pre existing conditions and Individual Health Insurance
Old 12-30-2005, 08:07 AM   #8
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Re: Pre existing conditions and Individual Health Insurance

Georgetown University is updating its consumer guide for California health insurance. That could mean that there have been some recent changes. REWahoo provided the link to Georgetown's consumer guides.

The significance of having a group plan and using COBRA is that under federal law, HIPAA, you have some rights to move to an individual plan. However, states deal with HIPAA rights in a variety of ways. HIPAA requires that an individual insurance plan of some sort be made available to you without exclusions and without preexisting condition waiting periods. However, HIPAA does nothing to regulate cost so in many states the individual plan made available to you is prohibitively expensive if you have preexisting conditions.

You will have to check with the California Department of Insurance for your rights. My recollection is that in California HIPAA eligible people cannot be turned down for individual insurance, cannot be given pre-existing condition exclusion periods, and their also are limitations on the cost of the insurance. I also recall that California has a risk pool option. One source of information is http://www.healthinsurance.org/california/default.lasso

HIPAA also provides for guaranteed renewability, inotherwords once you have individual insurance it cannot be cancelled if you get sick. However, because HIPAA doesn't regulate cost, a state could allow insurance companies to increase premiums based on health or age. If I recall correctly, California does not allow premiums to increase solely based on an individual's declining health.
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Re: Pre existing conditions and Individual Health Insurance
Old 12-30-2005, 09:48 AM   #9
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Re: Pre existing conditions and Individual Health Insurance

I had a false positive on a blood test 5 years ago that showed a slight elevation in a liver enzyme; the test was repeated twice and never recurred. The doc said I probably just ate something funny, which is odd because I dont usually eat clowns or comedians. Although I might have had a mime that morning, but those arent funny at all.

Anyhow, I digress. I was turned down by several insurance companies for healthcare on the basis of that 5 year old, slightly off, non recurring thing that according to my doctor, wouldnt have meant much if it had recurred.

My reading from that is that an insurance company, at least in california, wont touch you with an eleven foot pole if there is anything at all anywhere in your medical history.

Martha - I may be wrong but I think in CA they use zip codes to set whether they offer insurance and at what cost. That approach prevents any suggestion of individual discrimination, but clearly allows them to group discriminate. Several companies offer no health care to a zip code a couple over from me; that area is primarily minorities with weak employment and high substance abuse levels.

So what part of town you live in might have a huge effect on whether you can even get insurance, and at what cost.

Funny thing is, one of the insurers, who will remain nameless because it was blue cross, ended up getting me as a customer anyhow once I got signed onto my wifes insurance. I was really ticked at them because they told me on the phone that they accepted me, I cancelled my old insurance, and then a month later they send me a postcard with a decline notice. At least my old insurance took me back with no problems. But I was sweating bullets for a week or two that I might end up without insurance.
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Re: Pre existing conditions and Individual Health Insurance
Old 12-30-2005, 10:26 AM   #10
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Re: Pre existing conditions and Individual Health Insurance

Quote:
Originally Posted by ()


My reading from that is that an insurance company, at least in california, wont touch you with an eleven foot pole if there is anything at all anywhere in your medical history.
This is true, unless you are HIPAA eligible. There are no HIPAA rights in moving from one individual plan to another.

Quote:
Martha - I may be wrong but I think in CA they use zip codes to set whether they offer insurance and at what cost. That approach prevents any suggestion of individual discrimination, but clearly allows them to group discriminate. Several companies offer no health care to a zip code a couple over from me; that area is primarily minorities with weak employment and high substance abuse levels.

So what part of town you live in might have a huge effect on whether you can even get insurance, and at what cost.

I also believe this is true in California and it is the case in a number of states. Someone someday may be able to make a discrimination claim if they can tie the failure to cover to race or some other prohibited classification.
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Re: Pre existing conditions and Individual Health Insurance
Old 12-30-2005, 12:01 PM   #11
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Re: Pre existing conditions and Individual Health Insurance

Ha,

I think there are still gotchas.

A year or two ago, we ran out of COBRA. The COBRA health insurance was from BC/BS out of New York state through a contracting agency from a previous job. The health insurance company could cover us in WA on the group policy as long as I was either working for the agency or on COBRA, but because we were not in their primary coverage area, they were not required to offer us an individual policy when COBRA dried up. I changed jobs and got back with the same agency before we lost coverage, so it worked out OK.

I have a new work contract in Canada this week with a different agency, a Canadian one who can't give me US health insurance (it is illegal for them to pay for private health insurance...how about that?). Fortunately, for 2006 my wife's employer has got group health insurance, so once again we squeeked by. I feel like Liza crossing the ice. Since we are inside the primary coverage area this time, I am expecting that we will be able to convert to an individual policy if and when she separates from this company. Whew!

I originally went to an individual policy because my at-that-time employer changed benefits packages three times in six weeks and I figured I needed to take care of myself. I gave it up later when I was at a different company to save a few bucks a month by taking part in their benefit plan. Dumb idea!!! That job didn't last (surprise!) but at that time health insurance companies had stopped writing new policies in Washington State. (This was in response to a populist state insurance commissioner who thought that she could squeeze insurance companies dry and they would stand still for it. Didn't work.) By the time they were back to writing new policies, my wife was on record. Lesson: Do not lose your health insurance coverage.

The difference between staff an contract used to be two weeks. Today it is morning and afternoon and sometimes they bring the contractors back on Monday. There are reasons to be a loyal staff employee, but I can't remember what they are anymore.

Cheers,

Ed The Gypsy
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