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Pre-existing problems
Old 09-04-2010, 08:34 PM   #1
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Pre-existing problems

Interested in experience in pre-existing illness.
How picky do the insurance companies get on determining what has happened in the past?
For example, if a person has a knee replacement on the right knee but no problem seen on the left. Then 1 or more years later, the problem might be showing up on the other knee. What happens? Do the insurance companies say oh but you have a weak knee problem and throw it all together? Or do they give you a fair shot, and consider it a new problem? When it comes to a rather new insurance coverage and a major operation it can be a financial big deal, don't you know?
Any experience or comment/thoughts really appreciated,
Steve
PS. Had a little trouble getting this into words so please over look my grammar etc. Thank You !!
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Old 09-04-2010, 09:02 PM   #2
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More common in that scenario is that they might carve out any future right knee problems from coverage. Or deny it altogether. Depends on the disease, how long ago, recent evaluations, and whether the medical underwriter was in a good mood that day.

Underwriting of that type is not a science. I have written numerous letters on behalf of patients in such situations.
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Old 09-04-2010, 09:51 PM   #3
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In his final year at college (2006) our son suffered from clinical depression and was on medication for about a year. On graduating he moved back home and I tried to get high deductible, catastrophic insurance for him but couldn't get coverage at all (I had expected an exclusion on mental illness), Fortunately he got a job within 6 weeks and has had full employee insurance since then. He's been off midication since mid-2007 but I don't know if that history will stay with him forever or not.
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Old 09-05-2010, 02:07 AM   #4
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We bought individual insurance coverage less than a year ago. The coverage began right at the time I retired. There was no mention of any kind of re-existing problems (nothing noted or written up) when the company gave us coverage. But I think I remember reading (fine print) that there would be a waiting period (1year) on any joint replacements and other surgeries.. I better try to find that information to be sure exactly what it does say. If its one year, we are close to that so probably not a big deal.
So you all think that a problem in a different limb would not be considered pre-existing even if it was the exact same thing showing up a year or so later.
We are not going to have it checked out until sure about how the insurance company will categorize this. By the way, the problem is not with me but a family member.
Thanks for thoughts again,
Steve
I hate having to worry about medical coverage and the tricks and treats it can bring to the table.
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Old 09-05-2010, 08:18 AM   #5
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Quote:
Originally Posted by Alan View Post
In his final year at college (2006) our son suffered from clinical depression and was on medication for about a year. On graduating he moved back home and I tried to get high deductible, catastrophic insurance for him but couldn't get coverage at all (I had expected an exclusion on mental illness), Fortunately he got a job within 6 weeks and has had full employee insurance since then. He's been off midication since mid-2007 but I don't know if that history will stay with him forever or not.
Remember that the Obamacare rules call for coverage by parents til age 26 and I recall that one kicks in soon.
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Old 09-05-2010, 10:24 AM   #6
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Quote:
Originally Posted by Stevewc View Post
We bought individual insurance coverage less than a year ago. The coverage began right at the time I retired. There was no mention of any kind of re-existing problems (nothing noted or written up) when the company gave us coverage. But I think I remember reading (fine print) that there would be a waiting period (1year) on any joint replacements and other surgeries.. I better try to find that information to be sure exactly what it does say. If its one year, we are close to that so probably not a big deal.
So you all think that a problem in a different limb would not be considered pre-existing even if it was the exact same thing showing up a year or so later.
We are not going to have it checked out until sure about how the insurance company will categorize this. By the way, the problem is not with me but a family member.
Thanks for thoughts again,
Steve
I hate having to worry about medical coverage and the tricks and treats it can bring to the table.
Are you sure its major medical insurance? Was there any underwriting done or it was just guaranteed coverage? If that's the case, run away fast and find real coverage. Surgery and joints should be covered from day one unless specifically excluded.

For companies that offer exclusion riders, they would only exclude the one knee, not both. Companies that do not offer exclusion riders would likely decline altogether for a full knee replacement, but that could vary depending on the company.
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Old 09-05-2010, 02:27 PM   #7
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Originally Posted by Rich_in_Tampa View Post
Remember that the Obamacare rules call for coverage by parents til age 26 and I recall that one kicks in soon.
I do remember hearing that, but it wasn't the case 3 years ago. Anywho, all's well that ends well. He didn't have any medical problems during his time out of coverage. About 4 months after he started work he fell off his bike while out riding with us and broke both wrists, with one them requiring surgery including pins, so he was really fortunate to have good coverage at that time.
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Old 09-05-2010, 03:36 PM   #8
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Originally Posted by dgoldenz View Post
Are you sure its major medical insurance? Was there any underwriting done or it was just guaranteed coverage? If that's the case, run away fast and find real coverage. Surgery and joints should be covered from day one unless specifically excluded.

For companies that offer exclusion riders, they would only exclude the one knee, not both. Companies that do not offer exclusion riders would likely decline altogether for a full knee replacement, but that could vary depending on the company.
Now that I see the waiting period is only one year I'm not as worried. We will have that covered in Dec. 2010. I thought it was 2 years and that had me more concerned. We should be able to wait out a few more months I think.

This is what the handbook says about surgery & such:

For Pre-Existing Conditions
For the first 365 days you are covered under this plan there are no benefits for “pre-existing conditions.”
This does not apply to children properly enrolled in a family plan within 30 days of birth or placement for
adoption. A pre-existing condition is any condition, no matter how caused, for which you received medical
advice, a diagnosis, care, or for which treatment was recommended or received during the two-year
period preceding your effective date. Even if your condition is not diagnosed until after your effective date,
we will treat your condition as pre-existing if treatment was recommended or received during the two-year
period preceding your effective date for symptoms that are consistent with the presence of your condition.
Exclusion Period for Some Surgical Procedures
For the first 365 days you are covered by this plan there are no plan benefits for removal of tonsils and
adenoids, a hysterectomy, to put tubes in the ears, to replace any joint such as a knee, or to treat a birth
defect. This applies to any related surgery, such as removing the ovaries with a hysterectomy. This does
not apply to eligible children properly enrolled in a family plan within 30 days of birth or placement for adoption.



Here is the plan I have. Opinions of this coverage are welcome. I'm not very good at comparing the plans and this was recommended for us by Blue Cross.
https://www.ibcbsal.com/plans/iblue/pdfs/booklet750.pdf
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Old 09-13-2010, 12:19 PM   #9
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So here's a question. If you quit your job at say 50, have your last colonoscopy and perhaps prostate antigen exam just prior to your old employer group medical insuance policy being replaced. And either one comes up positive, is it possible you get dumped by your old insuance company at the end of Cobra and then have an impossible task to get new insurance? Any one have any experience with this?
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