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pre-existing conditions specifics
Old 03-05-2010, 06:38 PM   #1
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pre-existing conditions specifics

I am curious about real world early retiree experiences regarding pre-existing conditions for health insurance. For example, if you had asthma how long was the exclusion period and how much more were the premiums. I'm interested in all types of examples.
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Old 03-05-2010, 11:14 PM   #2
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Totally depends on the state, insurance company, diagnosis, prescriptions, how long ago, whether it's still a problem, etc. Lots of companies will underwrite asthma without excluding it from coverage.
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Old 03-06-2010, 08:00 AM   #3
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Not a problem for me since my plan carried over into ER. But when my daughter graduated college she was flat out denied by BCBS (which she had been under in our family plan) because of meds she had taken in the past. There was no waiting period offered - just plain denied. Luckily DC has a high risk pool that she was able to slot into. This is one reason I support mandatory insurance or a universal single payer system. If your kid gets denied and then gets seriously ill, you could end up blowing your retirement funds trying to bail her out. It is purely a flip of the dice and our system doesn't currently give you a way to avoid it. Fall out of the family plan, lose your job, anything can dump you out of the system and then you are screwed.
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Old 03-06-2010, 08:39 AM   #4
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BCBS usually offers guaranteed conversion for children aging off of parents plans, though if you're in DC, CareFirst pretty much sucks at everything so it wouldn't surprise me. They also don't release any underwriting information whatsoever, so you're shooting in the dark hoping to get approved if you aren't in perfect health. Other companies may offer exclusion riders to help get approved. BCBS doesn't offer exclusions in any state as far as I know.
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Old 03-06-2010, 01:55 PM   #5
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Could an insurance company insure a person with a pre-existing condition (with an exclusion for that condition) and then deny paying for treatment for a condition that develops later which may or may not have been caused by the original pre-existing condition? Thus making paying for health insurance pointless as the insurance company would likely try to prove your pre-existing condition caused or added to your new problem.

For example, say you take meds for your pre-existing condition (which is excluded on your policy) that happens to also lower your immune system and then some years later you get cancer. Could the insurance company then refuse to pay for cancer treatment arguing that you were more likely to get cancer taking those meds for your pre-existing condition which they don't cover?
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Old 03-06-2010, 03:21 PM   #6
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DW was told she had to wait five years because of a craniotomy. Apparently it's OK to have a brain tumor, but having your head opened up is a problem.

After the five years were up, they said "We've changed things, so now you are just denied."
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Old 03-06-2010, 03:32 PM   #7
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Originally Posted by donheff View Post
Not a problem for me since my plan carried over into ER. But when my daughter graduated college she was flat out denied by BCBS (which she had been under in our family plan) because of meds she had taken in the past. There was no waiting period offered - just plain denied. Luckily DC has a high risk pool that she was able to slot into. This is one reason I support mandatory insurance or a universal single payer system. If your kid gets denied and then gets seriously ill, you could end up blowing your retirement funds trying to bail her out. It is purely a flip of the dice and our system doesn't currently give you a way to avoid it. Fall out of the family plan, lose your job, anything can dump you out of the system and then you are screwed.
Exact same experience here and also with BCBS. We are covered with retiree health from previous employer, but when son graduated from college March 2007 he had a pre-existing condition and was on meds and BCBS flat out rejected him. Luckily he was only uninsured for 6 weeks when he got a job with insurance. (just as well, as he took a tumble of his bicycle 2 weeks after starting work, broke both wrists and needed surgery with pins etc.).
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Old 03-06-2010, 11:17 PM   #8
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Could an insurance company insure a person with a pre-existing condition (with an exclusion for that condition) and then deny paying for treatment for a condition that develops later which may or may not have been caused by the original pre-existing condition? Thus making paying for health insurance pointless as the insurance company would likely try to prove your pre-existing condition caused or added to your new problem.

For example, say you take meds for your pre-existing condition (which is excluded on your policy) that happens to also lower your immune system and then some years later you get cancer. Could the insurance company then refuse to pay for cancer treatment arguing that you were more likely to get cancer taking those meds for your pre-existing condition which they don't cover?
The exclusions are worded very specifically as far as what is covered and what is not. Odds are if you have an autoimmune disease, you will probably be declined. There are simply too many things that can become a future claim with autoimmune diseases, and often the prescription drugs needed are not cheap. If you are not sure about the exclusion specifics or what might be the best option for you, I would strongly encourage you to contact an independent health insurance agent who works with all of the major insurance companies in your state. There is no charge to use the help of a broker and they can often point out a lot of things that you would never think about on your own.
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Old 03-10-2010, 05:24 PM   #9
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Could an insurance company insure a person with a pre-existing condition (with an exclusion for that condition) and then deny paying for treatment for a condition that develops later which may or may not have been caused by the original pre-existing condition? Thus making paying for health insurance pointless as the insurance company would likely try to prove your pre-existing condition caused or added to your new problem.
In a word, yes. It's called "rescission." The good news is that the insurance company will probably refund all of your premiums when they retroactively remove your health coverage.

Quote:
"But they [health execs] would not commit to limiting rescissions to only policyholders who intentionally lie or commit fraud to obtain coverage, a refusal that met with dismay from legislators on both sides of the political aisle.
Blue Cross praised employees who dropped sick policyholders, lawmaker says - Los Angeles Times

The exclusion period for my plan is 5 years.
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Old 03-11-2010, 09:30 PM   #10
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When I applied for individual insurance, BCBS offered me a policy that had a lifetime exclusion for anything headache related. I guess migraines are on their "do not cover" list. I went with another insurer who was not so picky.
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Old 03-12-2010, 08:21 AM   #11
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I have a high-deductible plan through BCBS; they've covered me only because I was with them for years through my employer. I have preexisting conditions and was denied insurance by every other company I tried. My preexitings are high blood pressure and diabetes.
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Old 03-12-2010, 08:56 AM   #12
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In my experience, pre-existing conditions, carve-outs, and similar issues are entirely at the discretion of the carrier and are not always specifically addressed in the initial contract. I am not aware of any laws or regulations which require them to meet minimal standards.

As such, they often exclude, deny, and carve out in inconsistent ways, sometimes forever, sometime for some arbitrary waiting period. And when coverage is reinstated, there are often constraints on the coverage. It's the fox and the hen house, just another area that "needs killin'" when health care reform finally happens.

Not to mention the battles: it is very hard in some cases to know whether an event is related to an excluded condition or not. For example, migraines can rarely cause strokes or heart attacks; if migraine is excluded and the patient has one of those events, the carrier may well deny it, yet the causation is statistically unlikely. Or pre-existing epilepsy is excluded and a seizure results in an accident - will the insurer cover the broken bones or will they say the seizure was the cause so they won't cover it.

A very bad decision to leave to the insurance company.
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Old 03-12-2010, 11:08 AM   #13
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My main concern about my current coverage is this: if I get sick, they'll find a loop hole so they can deny coverage of the problem. There is a lawsuit in CA covering this exact thing. BCBS hires people on commission just to find loopholes in policies so they don't have to pay. This is criminal IMO!
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Old 03-12-2010, 11:22 AM   #14
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I have a question related to this discussion.

Suppose a person had a pre-existing condition not covered by insurance. A couple of years later a different condition developes that requires an outpatient procedure. According to the doctor this new condition was most likely caused by the pre-existing condition. The insurance company (surprisingly) agrees to pay for the cost of the procedure, excluding the deductible.

Can the insurance company review the claim at a later date, decide that it should not have covered the procedure, and demand that you pay in full?
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Old 03-12-2010, 11:34 AM   #15
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My main concern about my current coverage is this: if I get sick, they'll find a loop hole so they can deny coverage of the problem. There is a lawsuit in CA covering this exact thing. BCBS hires people on commission just to find loopholes in policies so they don't have to pay. This is criminal IMO!
I agree. Let's hope that congress can pass some sort of health care reform this year. I'm not saying that as a political statement. I'm even open to having health care reform pass this year and if in 2010 the Republicans take over control of congress, that they can change it to their hearts delight. BUT, IMO something must get passed so that we have a stake in the ground. The two parties will never agree on health care reform, but clearly we have to start somewhere. I don't want to wait another 10-20 years for this start to occur.

I would hope that both parties agree on eliminating pre-existing conditions however.
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Old 03-12-2010, 12:53 PM   #16
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I totally agree that health care reform has to start somewhere and now is as close as its ever gotten. No, the present bill is not perfect, but its a start. I only wish there were a public option!
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Old 03-17-2010, 12:46 PM   #17
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Rescission denied:

Quote:
[South Caroloina] Supreme Court Chief Justice Jean Hoefer Toal wrote: "The lack of written rescission policies, the lack of information available regarding appealing rights or procedures, the separate policies for rescission documents" as well as the "omission" of other records regarding the decision to revoke Mitchell's insurance, constituted "evidence that Fortis tried to conceal the actions it took in rescinding his policy."
Insurer targeted HIV patients to drop coverage - Health care- msnbc.com


With any luck, these types of lawsuits will no longer be needed.
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Old 03-17-2010, 12:59 PM   #18
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Originally Posted by Poundkey View Post
I have a question related to this discussion.

Suppose a person had a pre-existing condition not covered by insurance. A couple of years later a different condition developes that requires an outpatient procedure. According to the doctor this new condition was most likely caused by the pre-existing condition. The insurance company (surprisingly) agrees to pay for the cost of the procedure, excluding the deductible.

Can the insurance company review the claim at a later date, decide that it should not have covered the procedure, and demand that you pay in full?
I wish I knew the answer to your question.

So, I'll assume this matter would be in the fine print somewhere on the policy regarding investigations. I hope the chances of that happening are almost nil, and paid claims are closed.
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Old 03-17-2010, 01:00 PM   #19
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I agree. Let's hope that congress can pass some sort of health care reform this year. I'm not saying that as a political statement. I'm even open to having health care reform pass this year and if in 2010 the Republicans take over control of congress, that they can change it to their hearts delight. BUT, IMO something must get passed so that we have a stake in the ground. The two parties will never agree on health care reform, but clearly we have to start somewhere. I don't want to wait another 10-20 years for this start to occur.

I would hope that both parties agree on eliminating pre-existing conditions however.
Yes - the current situation is that insurance companies are dictating your health care, not your doctor. It is inexcusable. I can understand age banding for rates, but refusing to cover pre-existing conditions is impossible for most people.

Also, they can go back and say you lied about a pre-existing condition (it could be something you forgot, or was amazingly minor) and drop your policy and bankrupt you.

I just hate it when people at work talk about working until they are 70 - they all think they won't get older and won't get sick. I've done both and I'm planning to retire around 62 this summer and wish I'd done it sooner. But I will have 18 months of uncertain health insurance after COBRA is over. It totally sucks.
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Old 03-17-2010, 02:05 PM   #20
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Rescission denied:



Insurer targeted HIV patients to drop coverage - Health care- msnbc.com


With any luck, these types of lawsuits will no longer be needed.
I think just about everyone agrees that rescission should be banned except in clear cases of fraud (such as lying about a previous heart attack/cancer/etc). The only ones fighting that are the insurance companies themselves.
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