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.
pre-existing conditions specifics
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donheff
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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.
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.
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?
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?
TromboneAl
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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."
After the five years were up, they said "We've changed things, so now you are just denied."
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.).
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.
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.
Blue Cross praised employees who dropped sick policyholders, lawmaker says - Los Angeles Times
The exclusion period for my plan is 5 years.
stargazer08
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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.
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.
Rich_by_the_Bay
Moderator Emeritus
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.
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.
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!
Poundkey
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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?
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 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.
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.
Insurer targeted HIV patients to drop coverage - Health care- msnbc.com
With any luck, these types of lawsuits will no longer be needed.
bbbamI
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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.
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.
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.
oliverdickens
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They can deny you for anything and have in my case.
I have been denied because I had a high blood pressure reading at my annual pyhsical 140/87, it is normally 130/80's by have white coat syndrome, and my cholesterol was 202. I take meds for the Cholesterol and now well into low 160.
Still denied by BCBS.
Other than that, very healthy, thank goodness. I am 57 so locking me out due to age is my thought.
Good luck on you search for insurance
I have been denied because I had a high blood pressure reading at my annual pyhsical 140/87, it is normally 130/80's by have white coat syndrome, and my cholesterol was 202. I take meds for the Cholesterol and now well into low 160.
Still denied by BCBS.
Other than that, very healthy, thank goodness. I am 57 so locking me out due to age is my thought.
Good luck on you search for insurance
Although 140/87 is pretty high, a follow-up test showing a lower reading would have likely gotten you approved. Sometimes it's a combination of HBP + height/weight, or a combination of ratings for HBP + cholesterol + height/weight that cause automatic denial (e.g. the 3 strikes rule). That said, BCBS is pretty lenient on that compared to other companies.
explanade
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I've heard people on other forums defense pre-existing conditions and rescission. Basically the right of insurers to make profits trump care for the insureds.
There's a video of anti-reform folks taunting a guy who had some condition which prevented him from standing up. He had signs about why he supported reform but they gave him a lecture about how people don't deserve care for free and threw dollar bills at him.
Some people believe that the much-publicized high double-digit premium increases by BCBS were and attempt to drive out customers whom they thought were likely to make expensive claims. Either that or incredibly clumsy political timing.
There's a bad apple in every bunch. If you took a poll of Americans that thought rescission should be banned except in cases of fraud, I would bet the numbers would be well over 90% in agreement. Double-digit premium increases are nothing new, it's been happening for years....it's the 30-50% rate increases that are more out of the ordinary, but things are changing very rapidly. They didn't just single out one or two policyholders to get them to drop coverage. Rate increases must be applied across the board to all policyholders in that block of business.
I don't understand people's logic though. If you get rid of pre-existing conditions, you have an immediate 50-200% rate increase, and that's on top of any other increases that would have came along anyway. How's that any better than a 30% annual increase with what's there now? Some people seem to think the health insurance fairy will come along and sprinkle its magic insurance dust, magically giving everyone coverage and dropping premiums for all.
ERD50
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Yes, and I wish that this was the approach they took with the HC 'reform' bills. Instead of one massive thing that you can't get enough agreement on, tackle it in chunks that are understandable and less controversial. If they did that, they probably could have passed some bills that really made a difference and had gone into effect by now. Instead, we've had a year of bickering, with a bill that doesn't bring most of the intended benefits in until 2014.
If it passes, I bet a lot of people are gonna be surprised when they can't just sign up for these benefits.
I think the answer is, and I don't mean to be condescending to those people, but they just have not thought through the consequences. Denying someone for a pre-existing condition is a heart-wrenching problem, so it is easy to see why people (rightfully) get worked up about it. But it is a symptom of our current situation, and you can't fix the symptom w/o making changes to the underlying causes.
But if they did just try to 'wish it away', yes, those same people would be upset at the inevitable price increases.
-ERD50
