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Old 05-29-2007, 12:11 AM   #21
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Originally Posted by mykidslovedogs View Post
Well - if you live in a state that forbids insurance companies to exclude costs associated with minor illnesses such as Acid Reflux Disease, then you could be declined, but that would only be because of the state mandates requiring the carrier to cover meds that cost more than the premium. In CO, if you have a minor illnesses like Acid Reflux, the carrier can still accept you for coverage, but exclude the condition, thus, they won't be on the hook for the cost of Nexium, which would cost far more than the average monthly premium for a 50 yr old male in the individual market.

So, I guess you got me there....you CAN be declined for a minor pre-exisiting condition, but most of the time, that only happens if you live in a state that forbids the insurance carrier from excluding the costs associated with just that condition. In states like that, you can bet they are going to decline if their only choice is to decline or accept, without having the option to exclude.
Wrong again, MKLD. You tell a good story, full of lots of details. It's just that none of them are true.
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Old 05-29-2007, 08:19 AM   #22
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Wrong again, MKLD. You tell a good story, full of lots of details. It's just that none of them are true.
Please give me some examples. The information I am posting here is correct, at least for my state. If you don't believe me, take a look at the BCBS underwriting guideline booklet:

http://www.anthem.com/member/co/f4/s...w_ad080042.pdf

Every carrier has one of these booklets, and for the underwriter's use, the booklets go into much greater detail....telling the underwriters when they can make exceptions, how long a person must wait until a decision can be appealed, when medical records must be ordered to aid in decision making, etc.

I know that CA has laws on the books forbidding insurance carriers from excluding even minor conditions from coverage, and this is why, in CA, it is possible to be declined for minor conditions, especially if the cost of meds is expensive. For example....you can be declined there for:

1.) Acne -- due to the possible risk of needing to take Accutane, which costs about $400.00 or more per month.

2.) Osteopenia -- due to the risk of needing to take Boniva, which costs about $300.00 per month

3.) Acid Reflux or GERD - due to the risk of needing to take an expensive med like Nexium or Protonix (running approx $200.00/mo).

In my state, these conditions CAN Be excluded from coverage, or the carrier can choose to rate a person higher to compensate for the cost. In a few states, carriers are forbidden from working around minor conditions in such a way, so they must make the decision to either accept or decline, in which case, they will always decline if the risk of costly treatment exists.

If you are going to say I'm wrong, then give me some examples to prove otherwise. I want to see details, and proof that appeals were filed if applicable, and what the division of insurance had to say about it, etc.
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Old 05-29-2007, 08:59 AM   #23
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I think the point is being missed here.

Instead of niggling over whether acne is an excluded condition due to Accutane, isn't it inherently unacceptable that the system and laws which govern it put well-meaning people with prior illnesses in a position where they can't get complete health insurance, even when willing and able to pay for it?

Yes, if I were an insurance carrier CEO I'd do everything I could to cherry-pick and underwrite. The current system makes that necessary for corporate survival. It would be corporate suicide not to do so. That's the system. That's the problem.

Change the rules and enforce universal coverage, and let them duke it out on that playing field. Everyone gets coverage for acne. In fact, the carriers shouldn't even need access to your medical history when taking you on as a subscriber, and their competition is in the same boat. Level field, broad basic coverage.
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As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
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Old 05-29-2007, 09:17 AM   #24
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I agree that there should be broad BASIC coverage (catastrophic with preventive care included)....but what people who advocate universal care want is full coverage for pre-existing conditions, little or no out of pocket responsibility, and someone else to pay for it all. It's idealism that is not possible without serious trade-offs. You can't have it all. Private carriers, IMO, are going to be the most efficient at controlling costs through market forces, vs. counting on the goverment to control costs through price controls and care rationing.


The point I am trying to make here is that private carriers DO NOT decline people from coverage for minor illnesses, unless the risk of costly treatment exists or unless crazy state laws force carriers to choose to either accept or decline with no other alternatives such as exclusions or premiums ratings for particular conditions. Take away the stupid coverage mandates for minor conditions, and we could probably insure several million more people at a reasonable cost WITHOUT having to count on the goverment OR raise taxes.

I've gotten many people insured who have had pre-existing conditions, with satisfactory coverage at an affordable price. You just have to sometimes know what information to provide with the application. Too many people give up after trying to get covered on their own without a broker (because they try to place themselves with the cheapest carrier rather than trying to find one that will be a good match based on underwriting guidelines....or because they get pissed off at the insurance company and refuse to take the extra step to obtain their records and do what is necessary to get through underwriting, because they take the underwriting process too personally.
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Old 05-29-2007, 09:48 AM   #25
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I think the point many are trying to make is that even the application process has gotten too complicated - in fact, so complicated that even the insurance companies don't do a thorough check of past medical history during the underwriting process. So even if you are lucky enough to "qualify" for insurance, you still don't know if you really have it, since the insurance companies can "re-underwrite" after you file an expensive claim and possibly rescind your policy. Perhaps, their should be a 6-month period afterwhich the insurance company can no longer challenge the application. I believe something like this exists with life insurance policies.
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Old 05-29-2007, 10:26 AM   #26
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In Colorado, it's a 2 yr. period for mis-statements, but unlimited for blatant fraudulent failure to disclose. The laws on that limit vary from state to state.
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Old 05-29-2007, 10:41 AM   #27
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Did you send them the medical records showing that it tested normally later on?
They had access to all of my medical records, thats how they found the original test information. I let them know it was just a bad test, they didnt care.

Whats really sweet is that they told me on the phone that they had accepted me, then sent me a letter 2 weeks later declining me. In the interim I canceled my old insurance. Fortunately the old carrier gave me a 30 day "uncancel" period.


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what people who advocate universal care want is full coverage for pre-existing conditions, little or no out of pocket responsibility, and someone else to pay for it all.
We already have that. You just walk into an emergency room, get treated and dont pay the bills. And the good news is that its completely unadulterated by preventative care!

In between that, we have insurers and health care providers wasting billions of dollars a year trying hard to extract money out of each other.

And we and our employers are all paying for the indigent care and overhead out of our pockets.

It just seems reasonable to believe that we could offer complete reasonable health care to everyone at the same, or even a lower cost. Of course bureaucracy doesnt work that way.

But this is neither sustainable nor good.

And hey look! SG is annoyed again!
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Old 05-29-2007, 10:58 AM   #28
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The metric used to measure the performance of a healthcare system should measure the efficiency and effectiveness of that system and keeping people healthy.

MKLD seems to believe that the metric we need to apply is related to the profitability of the insurance system. In other words, MKLD wants to preserve insurance profitability first and then live with the inefficiencies and ineffectiveness of the actual healthcare that the insurance profitability requires.

Sorry, MKLD, you're not going to make that sale here.

CFB, I'm amused, not annoyed.
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Old 05-29-2007, 10:59 AM   #29
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CFB, I'm amused, not annoyed.
I can change that!
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Old 05-29-2007, 11:30 AM   #30
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They had access to all of my medical records, thats how they found the original test information. I let them know it was just a bad test, they didnt care.
That's not necessarily true. Abnormal test results may be reported through the MIB, while normal test results may not. I hate to say this, but if you had had the patience to appeal the decision with medical records, it probably could have been done. A copy of the normal test result from the doc and a quick fax to the underwriter would have been all that would have been needed to fix the problem.
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Old 05-29-2007, 11:36 AM   #31
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Trust me. ALL of my medical records were sent to them. And I told them the test was a bogus one. It didnt matter.

Fortunately it was just me trying to save a few bucks and my original more expensive insurer kept me.
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Old 05-29-2007, 11:45 AM   #32
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hmmm....as a broker, I would have taken that to someone higher up. I once had a client who had been misdiagnosed with skin cancer (on purpose, to get the insurance company to pay for the removal of the skin lesion on her nose), and it took several months to get her through underwriting because of the error, but at no cost to her, we got the Dr. to correct the records, write a letter to the insurance carrier and we got her covered. Sometimes, it just takes extra effort. I'm not one to give up easily.
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Old 05-29-2007, 11:46 AM   #33
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At what point did I give the impression that I give up easily?
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Old 05-29-2007, 12:09 PM   #34
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Look at it from their perspective...lots of potential customers, and the only ones they want are perfectly healthy ones who never get sick or injured.
And they have customers who would only buy their product when they were already sick, unless they excluded preexisting conditions.
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Old 05-29-2007, 06:09 PM   #35
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... BUT, when people buy individual health insurance, they want the insurance company to pay for illnesses they had BEFORE they bought it? ...
I don't want to buy insurance AFTER I get sick, I just want the cost of the insurance to be in line with the fact that they exclude pre-existing conditions. Essentially, if there are pre-existing conditions that have been excluded, I'm getting less insurance, so I should pay less, not more.
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Whoa!
Old 05-30-2007, 12:05 PM   #36
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Whoa!

Fatness and zits will prevent you from regular med insurance?:confused:

While neither fat or pimpled, I shudder to think how much I'd have to pay one of these policies. The VA rules!! - all my service connected (read: pre-existing) conditions are covered there - and NO ONE hassles me the way it sounds like you guys have to fight with the insurance companies. Yet another reason to continue being a state troll - for the medical bennies.

Insurance companies are simply out to make a buck (or several cool mil!)

So basically, the ins. companies are saying you should have just died from your pre-exisiting conditions? That way they won't have to even entertain your request!
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Old 05-30-2007, 12:17 PM   #37
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"Fatness" often leads to diabetes and other weight related problems including joint difficulties.

And acne may have been previously excessively treated with accutane, which can lead to some serious liver problems later in life.

Its all a bit complicated, but the goal is to minimize the risk of insuring someone while maximizing the profit.
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