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Once in the risk pool can you get out of it?
Old 01-05-2012, 12:04 PM   #1
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Once in the risk pool can you get out of it?

While I suspect the answer to be "No", I am wondering if health insurance companies that place you in a risk pool due to conditions such as high blood pressure, high cholesterol, diabetes for which you are taking medication, will move you back to healthy status if you make life style changes where by you no longer need medication and have normal test results?

I guess if Obamacare holds, this may become moot in 2014, although I'm not 100% sure of that.
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Old 01-07-2012, 03:30 PM   #2
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Well, I don't know from first hand experience, but since I just got turned down for health insurance yesterday (due to a steroid injection in my hip almost 2 years ago) - the paperwork says that you can re-apply when you have been "sign, symptom and treatment free for 12 months". Not sure how they track that - but if you don't have any doctor visits or meds for a year, then I guess you can re-apply.

This whole process is very frustrating!
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Old 01-07-2012, 03:33 PM   #3
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Quote:
Originally Posted by DFW_M5 View Post
While I suspect the answer to be "No", I am wondering if health insurance companies that place you in a risk pool due to conditions such as high blood pressure, high cholesterol, diabetes for which you are taking medication, will move you back to healthy status if you make life style changes where by you no longer need medication and have normal test results?

I guess if Obamacare holds, this may become moot in 2014, although I'm not 100% sure of that.
The might move you back, but they also might refuse to pay in the future saying you had a improperly reported preexisting condition or something similar. Will you give them the benefit of the doubt?
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Old 01-09-2012, 07:59 AM   #4
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The might move you back, but they also might refuse to pay in the future saying you had a improperly reported preexisting condition or something similar. Will you give them the benefit of the doubt?
If they knowingly move you back out of the risk pool, I don't see how they could refuse to pay in the future, although I suppose if charges related to the previous pre-existing condition reemerged they may elect to bump you back into the the risk pool and charge a higher rate vs refusing to pay.

Given the limited input, this must not have occurred much if at all. I find the medical insurance area to be the most unsettling part of ER, especially not knowing what is going to happen to medicare and whether Drs will continue to support it as cuts continue.
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Old 01-09-2012, 08:07 AM   #5
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I doubt you'd get moved out of the risk pool unless the pre-existing condition was excluded from coverage.
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Old 01-09-2012, 09:11 AM   #6
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7 years ago when I was underwritten by BCBS, I had a history of elevated cholesterol from years before. I showed 2 recent blood tests where I was just under the wire. I explained I lowered my cholesterol by diet changes and exercise. I had no exclusions for pre-existing conditions on my policy.
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Old 01-09-2012, 09:51 AM   #7
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There may be some conditions which can be managed with medications, such as cholesterol and hypertension, and possibly with diet/lifestyle changes as well. I would think it's possible to get out of the risk pool for these if your "numbers" are well within the normal range with medication, but it's far from a sure thing and I'm sure there would be some fights with insurance companies about it.
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