My COBRA is running out soon

[JDConnell]

My COBRA expires on 2/15/2009. I was diagnosed with carpal tunnel on 9/15/2007. I don’t have diabetes, but my doctor was concerned with my blood work and put me on a diet and exercise program to help prevent it. I have put in about 50 percent effort with the diet and exercise.

I would like to have an MRI regarding the carpal tunnel symptoms but I feel I am held hostage by the need to get my own individual policy and all the pre-existing stuff that might surface.

Any advice in how to deal with the transition from COBRA would be welcome. Any pitfalls I should look out for?

Thanks,

Jim

 

[Martha]

Have you applied for insurance yet? You should soon. Are you working with an agent? An agent should be able to tell you how companies are viewing carpal tunnel. You then can decide whether to get it addressed before your COBRA expires. You might want to do this to avoid having to pay out of pocket because of a preexisting condition exclusion or other exclusion.

Each state differs. You might want to read our FAQ on buying private health insurance.

MRI for carpal tunnel? I thought they did an EMG and nerve conduction test. That is what my spouse had anyway before he had the carpal tunnel surgery.

 

[JDConnell]

I have applied for private health insurance using ehealthinsurance.com with the provider to be BCBS. I read the FAQ this morning, there is a lot to digest.

If I discuss anything with an agent is it between the agent and me? Or would the agent share information with BCBS? I worry about that.

I had an EMG in Sept 2007 that showed I had “Mild Carpal Tunnel”. I have resisted surgery because I have read and talked with people about the many horror stories associated with CTS surgery.

I am currently seeing a chiropractor who believes the problem is in my neck, based on his x-ray. My neck has lost its natural curve. I thought an MRI might show what is really happening.

Also, I am battling depression. If I see a shrink MD now, wouldn’t that also be a pre-existing condition for my new policy?

Jim

 

[Martha]

I think that you have enough issues that it may be a good idea to talk to an agent, even though you already have one application out there. Though there isn't agent-customer "privilege," I don't know why your agent would go out of his way to share things you don't want shared with BCBS. In any event, you have to disclose conditions you have on the application. To start, you might want to call this helpline for the uninsured: 800.234.1317 This is sponsored by the Foundation for Health Insurance Coverage based in California, but they try to provide information concerning all states. I have no experience with the help line.


EDIT: It looks like you live in illinois, you might want to read this: http://www.coverageforall.org/pdf/matrix/IL_Matrix.pdf

If it turns out that you are not insurable by private insurance, be sure to look at the HIPAA options for Illinois: http://www.chip.state.il.us/planalt.htm and http://www.chip.state.il.us/

(Be sure to look at my signature line--these are just my general thoughts, not legal advice).

 

[JDConnell]

I live in Illinois.

Yes, I have read your disclaimer. I appreciate your sharing your opinions and your experience. They are helpful to me.

My frustration is with the fact the BCBS can take this opportunity of my COBRA (also BCBS) expiring to further protect themselves financially while jeopardizing my security by limiting the new policy.

18 months ago, I chose to go on COBRA instead of accepting a private policy that had been approved for me. The price was about the same and I got dental with the COBRA. Hindsight tells me what a mistake I made.

Thanks for letting me rant.

Jim

 

[JDConnell]

Thank you once again.

I read the IL-Matrix; it partially answers the next question I was going to post.

I was told by my ex-employer’s admin that I could not be denied insurance if I was coming off of 18 months COBRA. Also, no pre-existing conditions could be excluded.

In reading the matrix, as I understand it, I would have to remain on COBRA for the full 18 months and then apply for a HIPAA Plan. The HIPAA Plan would cover everything but would cost much more.

These guarantees do not apply to a private plan, correct?

Since I have applied for a private plan to become effective on 1/1/2009, 45 days shy of my 18 months of COBRA; I guess if I have problems getting insurance, I’ll have those 45 days to work something out.

Jim

 

[Martha]

You have it basically correct. However, if you get turned down for a private plan you can and should apply for a HIPAA plan before COBRA expires so you don't have gaps in insurance. As the FAQ states, there is a deadline for applying for a HIPAA plan.

HIPAA plans are for the otherwise uninsurable. It can be quite expensive and might have low lifetime limits. I have not read about Illinois's HIPAA plan so I don't know the details.

You want to get private insurance if possible, rather than the HIPAA plan. You may or may not be uninsurable. Find out before COBRA expires. This is where working with an agent helps. You may or may not have pre-existing condition waiting periods, depending on your state's law. If you get insured on a private plan it might have permanent exclusions for certain conditions, like your carpal tunnel. Again, I am not familiar with Illinois law regarding exclusions. Some states don't allow them. This is also where an independent agent can help.

 

[lazygood4nothinbum]

correct. a private plan is not a group plan even if you move to a private plan of the very same company as the group plan. so a condition covered under the group plan becomes a pre-existing condition to the private plan.

also note that you probably need to be with the private plan for six months before they will cover a "new" condition as non-pre-existing.

(edit: oops, i see martha got there first)

i was just at doc for checkup. while there i asked her to check those odd age spots on my skin as i haven't gone to a derm guy yet. but since i am considering going international which would be with new insurance, i had to ask the doc first if she could examine and give me an opinion without reporting it in any case. turns out no problem at all, simply sun spots as the doc called them, but suggested i have them removed anyway which i will.

that i should be made to feel like i have to hide from the people to whom i pay so much money to protect me, well, this is just really stupid.

 

[socca]

FWIW, I was suffering from carpal tunnel syndrome last year - very painful. I went to CVS and bought a Futuro wrist brace. The directions said that it could take up to 4 weeks to see any results, but in my case the effect was 'miraculous' - within a couple of days the pain was negligible. About 6 months ago, I bought a Kinesis Freestyle keyboard (Kinesis Corporation - Computer Ergonomics), and am no longer using the wrist brace. I like the keyboard solution best, because I think it gets to the root cause of why I was suffering.

Your results may vary, but good luck nevertheless!

 

[Zoocat]

St. John's Wort can alleviate depression. I'd avoid going to a therapist or any prescription medications for depression if you are going to apply for health ins. Insurance companies do not like to insure people with any kind of mental illness. Disclaimer: This is my semi-informed opinion and may not be true for all companies.

 

[KB]

Call your current insurance company and see what your options are for an individual plan with them. They might have a conversion plan that guarantees coverage at a price somewhere between Cobra and an Individual plan. It's worth checking into.

 

[JDConnell]

Thanks agiain to everyone for their advice.

I received verbal notification that I have a policy but Sciatica and related issues are being excluded.

I had an interview with a Pakistani RN that apparernly did not go well. I had a lot of trouble understanding her.

If I apply elseware, how much of this must I disclose?

Thanks.

Jim

I should be getting the letter today and I'll post the details of the exclusions.

 

[REWahoo]

If I apply elseware, how much of this must I disclose?

You don't have to volunteer any information but they will ask broad questions covering any and all past medical history. This will include questions like, "Have you ever been denied health insurance coverage, and if so, for what reasons?"

As I understand it, if you fail to answer any of their questions completely and it is discovered at a later date, you may not only have your insurance canceled but also be required to return any payments the insurance company has made on your behalf - including those made for illnesses or injuries completely unrelated to the conditions you failed to disclose.

IOW, you run a big risk by omitting past medical history.

 

[FIRE'd@51]

Yep, and to add to REW's post, it is my understanding that insurance companies will often issue the policy based solely upon your answers to the health questionnaire, without checking with your doctors, etc. This reduces their cost of processing your application. Then later, if you have a claim, they may do a more thorough background check. If they found you knowingly lied on your application, they can cancel your policy. If they determine it was an honest omission, they may just refuse to pay for claims associated with that particular "pre-existing" condition. So it's not like once they issue the policy you are home-free.

 

[JDConnell]

Thanks REW and @51.

I have a call in to an agent instead of the online folks (although I have no complaints w/ eHealth) and I'll see what can be done.

It may be best just to accept the BCBS offer since I'll be on my own in 45 days.

I believe my application was complete and accurate but it is still scary as to what the companies can do.

Thanks,

Jim

 

[mickeyd]

If I apply elsewhere, how much of this must I disclose?

If you conceal any medical information on the application the company can later on, not only deny the claim on grounds that you w/h information and signed the application but they could cancel the policy. The agent is generally a representative of the insurance company and is obligated to advise the company of any relivant information that he discovers acting in that capacity as their agent.

An agent may look the other way when writing the application, but he is putting his job, state license and your insurability on the line if he does get caught.

 

[Rustward]

If you conceal any medical information on the application the company can later on, not only deny the claim on grounds that you w/h information and signed the application but they could cancel the policy.
. . .

I certainly do not doubt that this is how it works. Wishfull thinking, I guess, but it seems that the companies should be required to do their due diligence before approving the policy so you can't be canceled for forgetting to mention the wart you had removed from the back of your hand 45 years ago. But I guess that all this investigation would cause the insurance (or at least the application process) to be much more expensive and that would reduce the competitiveness, I dunno.

 

[JDConnell]

I certainly do not doubt that this is how it works. Wishfull thinking, I guess, but it seems that the companies should be required to do their due diligence before approving the policy so you can't be canceled for forgetting to mention the wart you had removed from the back of your hand 45 years ago. But I guess that all this investigation would cause the insurance (or at least the application process) to be much more expensive and that would reduce the competitiveness, I dunno.

Hi hear you but mickey is right. My agent told me today there would be no pre-existing conditions beyond the exclusions. I called the insurance company and everything prior to my policy start date is a pre-existing condition and they won't pay for it. The ins rep laughed and said the agents don't know very much about what the sell and that's it, they just want to sell.

Jim

 

[JDConnell]

My nightmare is starting to come to an end. I spent an hour today with the INS Company and was told that everything is pre-existing.

Different agents told me BCBS would likely waive that because I have been with BCBS for years. I called BCBS back and they denied this.

I called the agent again and was told I would need a letter of credible coverage and then I could apply to have the pre-existing clock reset in my favor. I called BCBS this evening and talked to them again and the rep told me they are already aware of this and all I need is the letter once I cancel my existing policy. Then this rep told me that this information was not supposed to be given to me and I should have been transferred to member services. She said she wouldn’t transfer me because I already got the answer from her and she may get talked to about letting this out.

How is that for more crap? Keeping this from me. The rep today knew this and just kept telling me everything is pre-existing. What was their point?

At least it looks like I will have a decent policy going forward.

Thanks all,

Jim

 

[mickeyd]

How is that for more crap?

They are doing an "admirable" job of shoveling. Never believe an agent who works for commission and always get in writing whatever a rep at the home office tells you.

 

[DallasGuy]

I'm looking forward to the day that congress passes a law that outlaws denying coverage based on a pre-existing condition. How is a person supposed to go through life completely healthy and never need any medical care that might trigger a pre-existing condition? I'm extemely healthy but had ONE episode of a bleeding ulcer 14 years ago which never re-occurred and yet I'm still turned down for coverage or at the very least stuck with a rider on my insurance policy not covering stomach ulcers. Our health care system is broken!!!!! (just venting...especially when I read about experiences mentioned similar to the one in this thread)

 

[ERD50]

I'm looking forward to the day that congress passes a law that outlaws denying coverage based on a pre-existing condition.

....

Our health care system is broken!!!!! (just venting...especially when I read about experiences mentioned similar to the one in this thread)

I hear you, but the flip side of that is: the only way an insurance company can be in a position to *not* deny coverage based on a pre-existing condition, is if *everyone* is required to have insurance, and pay for it (or have the govt pay for it).

Imagine if you were in the business of offering hurricane insurance, and you were told that you had to accept coverage for people who wait for the hurricane warnings before buying insurance. And you have to charge them the same rate as everybody else. You would have to make hurricane insurance VERY expensive for *everybody*. Is that sustainable?

-ERD50

 

[DallasGuy]

If other countries can provide insurance for all citizens then I guess, yes, somehow, some way, everyone should be covered. Our leaders will eventually have to deal with how to do this. I feel that eventually it will be done.

On the other hand, if there was a way to force insurance companies to enlarge their risk pools there might be a way to keep the cost of insurance "reasonable" and include people with pre-existing conditions. Also, I feel that insurance companies should be run more like a utility company in that they should be guaranteed a fair profit, not an outrageous one...that might help keep the cost of insurance at a reasonable level. Health insurance should be something for the good of the public, not for the good of shareholders. I know many people would disagree with this view big time and I really don't care to argue about it...it's just a view I've come to as health care in the US has gotten too expensive for many people.

 

[Zoocat]

Yep, and to add to REW's post, it is my understanding that insurance companies will often issue the policy based solely upon your answers to the health questionnaire, without checking with your doctors, etc. This reduces their cost of processing your application. Then later, if you have a claim, they may do a more thorough background check. If they found you knowingly lied on your application, they can cancel your policy. If they determine it was an honest omission, they may just refuse to pay for claims associated with that particular "pre-existing" condition. So it's not like once they issue the policy you are home-free.

This is true, according to my health insurance agent, and her recommendation to me was to NOT apply to companies that do not request and look at your health records. You want everything laid out clearly on the table. Most reputable companies will request records. Some HMOs such as Kaiser Permanente do not.

Also, in response to DallasGuy, from reading different proposals I think that if we do end up with a universal health insurance system we may find that insurance will cost about the same, will be subsidized for low income people, but will cover pre-existing conditions. Medicare is going broke so that system has to be fixed, which means raising costs for all. With that fact in mind there's no way that a universal health insurance premimum can cost less for the individual than what they are paying now. That's my take on it. Still a universal health insurance system would be much better than what we've got now.

 

[ziggy29]

Still a universal health insurance system would be much better than what we've got now.

Anything could be better OR worse depending on the details. I'll reserve judgment until seeing the details.

"It couldn't be any worse" is a fairly dangerous philosophy, IMO, because it can always be worse potentially. Done properly it may be an improvement, but this is Congress we're talking about.