Does this make DH "uninsurable"

[Corporate ORphan]

DH was recently diagnosed with an episode of REM sleep disorder when he fell out of bed and broke his back in 3 places. We have a HD HSA policy with BCBS. We were planning to relocate, preferably out of Missouri. I told him I don't think we can do it now unless the Supreme Court leaves the Health Care Act alone.

He is not taking the medication prescribed at the ER (due to the long list of possible side effects) nor will he go for a "sleep study" after the circus and high cost of the ER visit (where they ruled any "serious" out and sent us on our way with 2 prescriptions and a $15,000 bill.)

Anyone know if REM Sleep disorder is one of those things that makes you "uninsurable"? I know sleep apnea will do it.

Thanks!

[braumeister]

I know nothing about insurability, but your existing insurance may very well cover the testing he needs (at a sleep clinic) to accurately determine his condition.

[Zero]

With an ER bill of $15,000 I am assuming you have exceeded your deductible, so why not go get him checked out for any and all things that might be health issues.

Wouldn't the current insurance have to cover 100% of the cost from now till the end of 2012?

[TromboneAl]

Is REM sleep disorder a new name for sleepwalking?

[obgyn65]

Another very good example why the healthcare reform is so important to so many people. I wonder what its usual detractors and critics on this forum would advise you to do... I doubt they will I am sorry you have to face this situation. take care Corporate ORphan, best of luck to you and your husband.

Quote:

Originally Posted by Corporate ORphan DH was recently diagnosed with an episode of REM sleep disorder when he fell out of bed and broke his back in 3 places. We have a HD HSA policy with BCBS. We were planning to relocate, preferably out of Missouri. I told him I don't think we can do it now unless the Supreme Court leaves the Health Care Act alone. Thanks!

[obgyn65]

No.

Quote:

Originally Posted by TromboneAl Is REM sleep disorder a new name for sleepwalking?

[REWahoo]

Quote:

Originally Posted by obgyn65 Another very good example why the healthcare reform is so important to so many people. I wonder what the usual detractors and critics on this forum would advise you to do... I doubt they will

Hey, watch it. Your halo is slipping...

[Bestwifeever]

The REM issue is already going to be on the record if that's what was diagnosed as the reason he fell out of bed. So go get it treated--at least you can get a handle on it while he's insured this year.

And I don't think your insurance company can drop you for filing a claim.

[toofrugalformycat]

Quote:

Originally Posted by Bestwifeever The REM issue is already going to be on the record if that's what was diagnosed as the reason he fell out of bed. So go get it treated--at least you can get a handle on it while he's insured this year. And I don't think your insurance company can drop you for filing a claim.

+1 to the first part, the incident has happened and is on the record.

On the second point, rescission is a problem sometimes (ins co drops you when you file an expensive claim, researching your application and looking for something they can claim is inaccurate, even if you've been paying them for years) but that also is addressed in the new healthcare law (and some state laws, I'm told).

That's the pisser, life happens, and suddenly through no fault of your own you may become uninsurable. But there's nothing you can do about that, other than support health care reform, and take care of your own health as best you can.

Best of luck, and I hope for quick and complete healing.

[2B]

Insurability for "pre-existing conditions" generally makes anyone in Texas over 50 ineligable for any heathcare other than the Texas High Risk Pool. Other states may have other issues.

Generally, insurance companies don't want to insure anyone but perfectly healthy 20 somethings. After 50 it seems that the only insurance available to someone in Texas is either the high risk pool or from an employer. In Texas that means an individual would pay around $8,000 per year for a policy with a $7,500 deductable. There are some premium discounts for low income individuals. Even then, it's no wonder that many people don't get the insurance.

Even heathy people will pay a significant amount of money for a private policy so the typical 20 something tends to "self-insure" without the assets to cover anything but the most basic doctor visits and medication.

This could definitely degenerate into a political discussion but that would be pointless, unnecessary and just piss off the moderators. It is not an easy question on how to address our current situation. The current law doesn't really address anything about the cost of insurance. Many of the current law's features will ultimately mess up things in the process so something has to be done to correct these which isn't looking too likely. Then, we also still have the ultimate wild card of the Supreme Court throwing the whole thing out so we'd be back where we started. Bottom line here is we have no clue at this point what our heath care system will look like in two years.

Back to the OP, I think your husband will be branded as having a "pre-existing condition." You should be able to keep your current insurance but insurance companies have a way of discontinuing plans every so often requiring people to reapply. Definitely don't hide anything or you run the risk of getting any benefits cancelled after a major incident. It's possible that the no pre-existing condition clause in the current law will remain but I'm concerned how many private insurance companies will be willing to write policies to individuals when the applicant may have just been diagnosed with an expensive condition.

[Corporate ORphan]

We are trying to decide if it is worth our time to continue to look outside of our state for places to relocate. Sounds like we need to stick with states where Anthem BCBS sells policies since they will say he now has a "pre-existing" condition.

[REWahoo]

Quote:

Originally Posted by Corporate ORphan We are trying to decide if it is worth our time to continue to look outside of our state for places to relocate. Sounds like we need to stick with states where Anthem BCBS sells policies since they will say he now has a "pre-existing" condition.

Remember that a lot could change in a couple of years, depending on what the Supreme Court decides in a few months...

[Accidental Retiree]

Check out Oregon's state insurance pool. They don't have a waiting period for certain pre-existing conditions and the rates were reasonable -- at least, that was how I read it.

It is also a beautiful state!

[Buckeye]

Although it may be a "pre-existing condition", is it something relatively easy to live with? Don't folks on BP meds get a bit of a pass if they show they are stable on their meds?

Is this condition expensive to live with other than treating the symptoms, i.e. falling out of bed?

I agree with the other poster who said to go ahead and follow-through with treatment/investigation. The condition is on record so you might as well get your money's worth on your current insurance.

[FinanceDude]

Quote:

Originally Posted by obgyn65 Another very good example why the healthcare reform is so important to so many people. I wonder what its usual detractors and critics on this forum would advise you to do... I doubt they will I am sorry you have to face this situation. take care Corporate ORphan, best of luck to you and your husband.

What does that have to do with anything? Congress can address pre-existing conditions in a bill without forcing the individual mandate..........

[fisherman]

Quote:

Originally Posted by FinanceDude What does that have to do with anything? Congress can address pre-existing conditions in a bill without forcing the individual mandate..........

You are totally correct that congress could address pre-exisiting with a bill although the content of that bill would be interesting and hotly debated. The problem is no one has ever tried before and no member of the party not currently holding the presidency has ever tried to help this situation with a bill to address it in congress before it was forced by the current law. I sure wish they would as it could be better. The new law if it stands is the only time anyone has ever really tried to improve the situation and the fear for many is with out it no progress will be made for a long time and we will go right back to our broken system.

To the OP I wish you and your husband the best as you deal with his situation.

[2B]

Quote:

Originally Posted by Buckeye Although it may be a "pre-existing condition", is it something relatively easy to live with? Don't folks on BP meds get a bit of a pass if they show they are stable on their meds?

Not in Texas to my knowledge. I saw an application for health insurance and the question asked if you had ever been diagnosed with high BP and/or taken medication for that condition. I've talked with people that said their BP was normal but since they had once been diagnosed the insurance company would only give them insurance that did not cover heart or stroke issues. In that case, why bother?

I have not personally applied for private health insurance. I get it through my employer but that will probably change in the near future. Right now, I am planning a budget that includes $16,000/year for me and DW for heath insurance and normal medical spending of $5,000/year. An emergency fund would be tapped for significant spending above this. Basically, we will have insurance that would only be of use if we were diagnosed with cancer or were hospitalized.

[2B]

Quote:

Originally Posted by Corporate ORphan We are trying to decide if it is worth our time to continue to look outside of our state for places to relocate. Sounds like we need to stick with states where Anthem BCBS sells policies since they will say he now has a "pre-existing" condition.

I suspect that if you move to another state BCBS will require you to buy a new policy which would not give you any benefit for a "pre-existing condition" that occurred while you were on another BCBS policy. I believe you are now going to be trapped with your current policy or the high risk pool in any new state you move to.

[PaddyMac]

You might check out New Mexico. My DH has fairly high blood pressure which is controlled with medication. When we moved from CA to New Mexico, we had no trouble getting another BCBS HD HSA policy. It was slightly better coverage than in CA and at half the price (in 2008). We are 50-51 and now pay $316 a month for $5K deductible, going up to $338 in June. We are non-smokers, fairly healthy otherwise.

[Old Microbiologist]

Whatever the decision of the SC re: pre-existing and/or high risk conditions, the health care industry is a serious business in the US and they will do whatever it takes to make a profit at your expense. Even if the SC leaves the HCA intact (IMHO they will toss out the entire law) it will get circumvented once it starts to be put into place. As a retired military who was promised free health care for life I can say one thing, the government will screw you at every opportunity. If you believe our government is a benevolent institution out to assist it's citizens then you are in big trouble. Same for insurance companies. Getting adequate health care is one of the big reasons we opted to live outside the US in Hungary where health care is excellent, cheap, and easy to get. We pay cash for everything (which also bypasses all lines and waiting times) and as we are still covered by the military's Tricare Overseas (crappy plan with a $150 deductible and 75% of "reasonable" expenses). There is a cap of $3000 of out of pocket for catastrophic care which hopefully we will never need to find out about. For this reason alone we keep a cash reserve of $250k for that eventual emergency which we don't need otherwise and it is easy to get when and if we need it. But under Tricare, you must pay cash up front, submit a claim, and wait for payment. The error rate on claims is over 400% but eventually they get it right (it requires hours of phone calls and resubmissions of claims) and we get generally re-imbursed sometime between 6-12 months later. We have had our fair share of expenses here with my having cataract surgery and retinal re-attachment (cheap at a bit more than $1000), my wife fell and broke her tib/fib with extensive surgery which also came to a bit more than $1000 (inclusive of everything including ambulance and emergency room. A doctor's visit to the house costs $35 and she is getting physical therapy at home for $15 and hour. It is actually hard to spend a lot on health care here. There is a national insurance plan which for permanent visa costs a bit more than $25 a month. But up until you get permanent status (3 years) it costs roughly $500 a month for 2 people. My advice is to start realizing that the entire health care system model in the US is broken and not likely to get better regardless of what politicians say. Greed motivates everything and costs are rising roughly 30% a year (why is it again that the inflation rate is so low?). There is a good reason health care CEO's get some of the largest bonuses in the US and it isn't for paying out for services. Health care shouldn't be a business and everyone in the industry shouldn't be expecting to get rich. It should, and would be in a country that cares about it's citizens, be low cost or even covered by the government. [mod edit] After all, the US is a fiat currency which has no actual value and they can print money with no end in sight (recall the debt ceiling debacle last year) so why not just print a little more for something like this? Anyway, there are plenty of places outside the US with good and low cost health care. [mod edit] We opted to leave the US forever and haven't looked back once (well we do miss Costco, but then again it is coming to Europe this year). I encourage others to start thinking along the same lines about life outside the US where values are placed more appropriately.