Pre-Existing Conditions

I am a 35yr old female that started a new position with a company and received their benefits and medical insurance. I injured myself Friday and by Monday I am having surgery set up for a full knee replacement. The injury is so bad they can not even repair all the damage to the knee and must replace it. My surgery was approved and scheduled now I received a call from my employers contact at the insurance company telling me they are fighting to have me denied because it was caused by pre existing problems and wear & tear. If i do not have this surgery i may not be able to walk...the pain to extreme....I will lose my job most definately and have no income..I am scared because i can't even walk...please help!!!!

Katt-Baltimore,MD

My daughter is 5 years old and has a pre-existing heart condition. She was born with pulmonic stenosis.
I live in Texas, and before I worked my way up the corporate ladder she was covered by CHIP. Now, I do not make loads of money but I have risen above what the state will allow me to make for her to be covered by CHIP.
I am a single mother, and the only insurance I know of that will cover her is the Tx Health Risk Pool.
That insurance plan costs over $700 per month for her to be fully covered for all of the health care she may need.
I just can't afford that. I don't receive child support and I have 2 children.
Is there ANY advice or direction someone can give me.
It's my child and I have run out of options after a full year now of no coverage for my babies.
Thank you,

Les

Hello Jeannette

Have you looked into the Texas Health Insurance Risk Pool?

They have a stipulation, however, that a pre-existing condition is only covered if you had prior insurance at least up to 63 days prior to becoming insured by the Texas Assigned Risk Pool. From your post, I’m not quite sure if you have coverage but are subject to the pre-existing condition clause, or you elected to decline coverage because of the extreme cost.

Here’s what the Texas Assigned Risk Pool says about the preexisting condition limitation:

“The Preexisting Condition limitation does not apply if an individual was continuously covered for an aggregate period of at least 12 months under Creditable Coverage that was in effect up to a date not more than 63 days before the individual's effective date of coverage through the Health Pool (excluding any waiting period under the prior health coverage) provided that the individual's application for coverage through the Health Pool was made no later than 63 days following termination of the prior health coverage."

Unless someone else here has had experience with the Texas Assigned Risk Pool and can offer sound advice, I would suggest that you contact them directly: 1-888-398-3927.

I hope this helps.

Unfortunately, I don’t have anything new to report regarding Expatriation Insurance coverage.

I contacted the following insurance companies via e-mail on April 15th and here are the responses I received from each one:

1. http://www.goodhealthworldwide.com/expat-medical-insurance.asp

Thank you for contacting Goodhealth Worldwide from where we would like to acknowledge the safe receipt of your enquiry.

Our Client Services Team will now deal with your query and advise you of any action to be taken, as soon as possible. Our aim is to respond to all general enquiries within a maximum of 5 working days. If your correspondence relates to a change to your policy, we aim to process this within 10 working days.

Thank you again for contacting Goodhealth - should you need to speak to us directly regarding this matter, please call Client Services on +971 4 324 0040 ext 216

Kind regards
Client Services Team
Goodhealth Worldwide (Middle East) LLC
Tel No - + 971 4 324 0040
Fax No - + 971 4 324 3550

2. http://medexpat.com

The e-mail never got to them. After several days I got a failure notice.

3. http://www.medicare.co.uk/contactmedicare.htm

No Response.

I think that part of the problem is that I used their “info” e-mail address rather than complete the online contact information form. All I wanted was a general question answered, but apparently to be taken seriously, you must provide more information than an e-mail address.

My suggestion at this point in time is for you to contact these companies directly. They will most probably answer you since you will be providing them with the information necessary to obtain a quote.

I’m sorry I couldn’t be more helpful.

If you’re not too busy, please drop me a line to let me know how everything worked out.

Best Wishes,

Felicia

Hi, Im a 49 year old female who cannot afford the surgery that I am needing. I have applied to many insurance companies, but cannot afford to wait the whole year for pre existing coverage. I work a job making hardly anything, and my husband as well. He is on health insurance through his employer, and had me on it, but having to wait a year, and paying over $400 a month for health insurance, that I couldn't even use, was becoming a financial burden. I have scoliosis and a herniated disk as well as sciatic nerve condition. I have had MRIs that I have had to pay out of pocket, and am tired of living off of pain pills to keep the pain away. I need surgery and cannot afford to get it. I do not know where else to go, and really need some advice on what to do. If anybody knows of any Texas laws, or any assistance, or insurance companies that can assist me I would be very appreciative. Thank you so much.

Just an update...

I'm still researching your situation. I'm not very familiar with expat insurance, so I've got to
do a little digging. There are three companies that I've contacted and am awaiting response
as to how they handle pre-existing conditions.

Once I get some sort of response from them, I can then compare it to the catastrophic
health insurance only.

I'll let you know what I find.

Hi Nina,

I received your post and will research your medical insurance options.

I'm not guaranteeing that I'll find a resolution to your situation, but I'll do my best. Upon finding an answer, I'll e-mail you directly.

I will also post the results on my blog because I find that although your situation may seem unique, there are other individuals with the same or similar situations so I post the answers on my blog in an attempt to help them too.

P.S. - To protect your privacy, I removed your email address from the blog post.

I'll get back to you soon.

i am a u.s.a citizen but currently living in madagascar. i have cobra insurance until august. i had breast cancer 2 years ago.
what do you suggest for options in expat insurance or finding catastrophic insurance only.
TY.
i can't find an email for you. could you email me directly, please?

Hi Judy,

I made a call to the Ohio Department of Insurance. Actually, they were very helpful. They sent me the following information:

The first plan option is the HIPPA plan. It is available to applicants once their COBRA has run out. The plan will accept you even with a pre-existing condition.

The second option is the Open Enrollment plan. You may only approach these carriers during their open enrollment period. If you contact them any other time, they'll turn you down. They must accept you even with a pre-existing condition.

The person I spoke to at the Department of Insurance mentioned that the Open Enrollment plans are "somewhat more expensive."

If any of the information is confusing to you, call them. They seem to be very helpful.

I wish you the best of luck!

Hi Judy,

It's going to take me a few days to look into the Ohio situation. Ohio seems to be a strange bird when it comes to insurance.

I'll get back to you.

We will have to be off COBRA in June and have never been without ins. However, we are being denied individual coverage (both of us) for pre-existing conditions. We live in Ohio and are not seeing any state pool. Do you have any suggestions?

Hi Elisa,

I'm not sure if I'll be able to adequately answer your question, but the one thing I do know is that you should keep your COBRA coverage.

I did a little research and found these two documents that outline their definition of pre-existing conditions. There's one for Group policies and another with similar wording for Individual Policies

It's a tough situation and I strongly suggest that you speak to someone who is very familiar with Arizona health insurance. Start with the Arizona Department of Insurance .

I don't know if I was much help. I wish you luck with your situation.

Hi Betterthanyou,

As weird as it may sound, the insurance companies find out about your pre-existing condition from you when you truthfully complete the application for insurance coverage.

They will also find out when your doctors submit their papers.

Hi. I was covered by BCBS for 6years though Waste Management of Idaho. I no longer work for WM, But 4 years ago while being covered, my wife also with BCBS, though my plan at work, my wife had a gastric bypass. She now is working for a company and is covered by BCBS. Anyway to make a long story short, about a year ago one of the staples came loose in her stomach and now she has a hole in her stomach and she is starting to gain the 120 pounds she lost because the food is going though the hole into the big stomach, Now since she had the surgery under BCBS and she is covered now under BCBS,she should be covered under then to get this fixed, right? It would not be considered a pre-existing condition would it?please help with this Question.

Thanks Greg

(Originally posted: March 5, 2008 1:33 AM)

Hi,

I am currently a teacher in NJ. I plan to relocate to AZ shortly. I was diagnosed with bladder cancer last year and now require regular cancer screenings as a result. What should/can I do before the move to protect myself against being denied coverage of my screenings? Is this something I should be worried about? Does having COBRA when in the process of switching insurances help?

(Originally posted: March 1, 2008 11:00 AM)

Can someone PLEASE tell me how doctor ordered bloodwork can be pre-existing? I really do NOT understand.Please help :-(

(Originally posted: January 29, 2008 6:13 AM)

How do the insurance companies find out about pre existing conditions?

(originally posted: January 10, 2008 6:52 PM)

I was recently laid off from my job and am currently paying COBRA premiums for my college student daughter and myself. I have been offered a new job, however, will not be eligible for health insurance benefits for 6 months. My daughter had back surgery while I worked for my previous employer. Can I continue paying my COBRA premiums while working for the new employer? Also, does my daughter have to exhaust the COBRA benefits in order to be HIPPA eligible so that she is not denied for pre-existing conditions. What exactly constitutes HIPPA eligibility? When I am eligible for insurance with the new employer, can the insurer underwrite to exclude the pre-existing condition or increase the premium? We live in Virginia. Just trying to plan adhead. Thanks for your help.

(Originally posted: November 27, 2007 8:50 PM)

I am married 8 months ago; my wife is now 27yrs old. When she was at 18, she had a tumor on her brain (SEPTAL GLIOMA ASTROCYTOMA GRADE-1) and it was successfully removed with a surgery. Since then, she did not have any issue. It is been almost 7 years now since she visited doctor on this.

6 months back I enrolled her in my Cigna insurance plan. Recently we thought of planning children and met gynecologist, she suggested us to see neurologist just to make sure every thing is good, because its been long time since we saw neurologist on this. Neurologist asked us to get MRI done and found very thing to be good.

But my insurance company (cigna)denied my wife's claims towards MRI and neurologist visits. They say that they do not cover pre-existing condition. (i am residing in MA and my employer is in NY)

How can this be considered as pre-existing condition when we are not using any medication for the 8 year back surgery and healthy now? Also, I am more worried about my wife’s future health situations. Just in case, if she gets sick on any brain related issue, will she be covered? Please advice, how to handle this situation.

(orignial post: October 3, 2007 3:22 PM)

Hello missiek and matthew:

I decided to answer both of your comments in the same post.

I'm going to be honest with you. I am not an expert in Blue Cross Blue Shield of NC, but I did go to their website to see if I can get a better understanding of their policies.

In my research I came across a name that claimed, "...he has years of experience finding the exact plan that will fit his client's needs. He specialized in Blue Cross plan and will help you to understand how they work." I'm going to defer to the expert.

Here is his contact page: Richard Day. I do not know Richard Day personally. Being that he is in North Carolina, he should be able to help you better than I can.

Please let me know what happens. I'd hate to have referred you to someone who was unable to help.

(Originally posted: September 27, 2007 12:18 PM)

Hello Armando

No, I can't say that I've ever heard of United Benefits of America, but I did go to their webpage.

As far as your company saying that they did not receive the papers you sent, that is so unfortunate. It has forced me to send insurance company letters certified mail return receipt requested. It may be a bit cumbersome to do, but at least you will have proof of their receipt. You might have to do that with any future correspondence with them.

I don't know which state you are living in, but did you try your state's Insurance Pool? Go to your state's Department of Insurance website. They should have information on a state run health insurance pool.

As far as your husband's condition it's hard to say what to put on the application. Although you've gone from doctor to doctor and are willing to try non-traditional insurance, have you tried non-traditional health care?

I know the topic here is insurance, but my frustration with health insurance companies also spills over to the medical community. Many of the ailments that doctors receive insurance payments for and that they write prescriptions for are manageable and many times cured with natural remedies.

As admitted by the medical community, your husband's condition appears hard to diagnose. In addition to searching for insurance, I would suggest that you both get into the drivers seat and start researching his symptoms and looking for non-traditional remedies. Sometimes food or environmental allergies manifest themselves in unusual ways. Don't limit yourself to finding your answers through the traditional methods only.

I wish you and your husband the best of luck in resolving your issues.

(Originally posted: September 27, 2007 12:07 PM )

Hello,

My husbands cobra ends in march.He was awarded SS disability,which starts Oct.2008.We sent the paper work in on time to extend cobra,but now they are saying they never received anything , even though I have the fax transmittals to prove otherwise. No,is still there answer.With that we are trying to get him insurance.We have been to drs. for two years to find out what is wrong with my husband,they have him diagnosed as muscle weakness.They can not find the reason.,He has been diagnosed with ms, Parkinson and many other illnesses that have all turned out to be false..How can we get insurance with the condition that he has. What would we put down on the insurance papers and have you ever heard of united benefits of America which they say it has a large network and it is not traditional. Help

(Originally posted: September 26, 2007 12:10 PM)

Hi. We live in TX - my husband sold his business and was able to continue coverage through Cobra. Once that was over, he wanted to continue paying for coverage, but was advised that we were both uninsurable - I was diagnosed with breast cancer on May 2005 and am presently on a 4 month check up program. Also, my husband has high blood pressure and 1st stage of diabetes, which is under control. Other insurance companies have told us that they cannot write a policy for us because we are in the database marked as "uninsurable". We don't know what to do in order to keep from spending all of our savings. The PET Imaging scans are very expensive and so are my husband's meds. We still have a son in his 2nd year of college and we can't even insure him. Is there a solution to our problem.

(Originally posted: September 20, 2007 1:54 AM)

I noticed after posting that there are many similarities between Missiek's post and mine. They're worded differently, but the essential question seems to be the same.

(Originally posted: September 17, 2007 9:56 PM)

I'm a recent college graduate (May '07) who until 7-31-07 was insured on my father's insurance, Blue Cross of California.

Two years ago I was diagnosed with an inguinal hernia, which was not a medical emergency, but would need surgery eventually. I wanted to stay physically active during college, so I opted to wait for the surgery. I did not realize that after I graduated I was no longer covered on my dad's insurance.

I've got a certificate from the previous insurer that effectively says if I get a new plan within 63 days I'll be covered even for pre-existing conditions, but some limitations apply.

What type of insurance do I need to get to insure that I'll be able to receive surgery soon? And I'm assuming I'll have to disclose this medical condition to the new/potential insurance company?

I'm moving to Maryland in three weeks, so I'll have to find insurance in that area.

Thank you for your help!

(Originally posted: September 17, 2007 9:51 PM)

Perhaps I need to be more specific. My daughter had a stroke. She is 3 - has always been covered by health insurance. We are coming off of Cobra and going to be looking for an individual plan in NC for our family. We plan to apply before 63 days of termination from our old plan.

What will be considered a pre-exiting condition? I thought only things in the 6 month period prior to enrolling in a new plan according to federal and state mandates. But, on BCBS website they say they can consider anything in the 12 month period prior. How could that be?

I'm trying to determine when I need to stop all outpatient treatments and therapies prior to enrolling in a new NC plan. My daughter needs expensive outpatient surgeries every 5 months or she will suffer severe physical consequences.

Thank you,
Kelli - I simply can't sleep anymore.

(Originally posted: September 17, 2007 6:09 AM)

I am so confused.

I read that federal and state mandates say that insurers may consider a pre-existing condition to be only services related to a health issue within the prior 6 months due to application.

And that the maximum pre-existing condition coverage waiting period is 12 months for timely enrollees and 18 months for late enrollees.

Is a timely enrollee one that applies for new insurance within 63 days of his old policy terminating?

Also -- how is it then that blue cross claims that it can consider pre-existing conditions up to 12 months prior to enrolling in their plan if federal and state mandates say that a pre-existing condition must be for services rendered within the 6 months prior?

I also read that under HIPAAs increased portability plan that if there was no lapse in coverage for more than 63 days that credit must be given for the time a previous condition was considered.

So, does that mean if one was covered for more than 18 months and there was NO lapse in coverage that a new plan must pay for pre-exiting conditions -BUT at whatever premium they assign?

Are there limits on how exorbitant a plan can make their rates?

Thanks,
Kelli

(Originally posted: September 17, 2007 5:59 AM)

Hello age_shepp

I'm not sure if this will be the solution to your situation, but have you tried the Utah Comprehensive Health Insurance Pool?

The problem you'll face pretty much anywhere you look for insurance is that you will be subject to the pre-existing condition clause which will mean that your existing condition will not be covered for anywhere from 9 to 12 months depending on the insurance carrier.

Unfortunately, insurance companies do not like to insure individuals who most likely will file a claim, the very same individuals who need the insurance the most. As a result, they will get their pound of flesh by charging high premiums as evidenced by the $400 addition premium your husband's insurance company would look for in order to add you to his policy.

In researching your situation, I came across a link for United American Insurance Company who claims "We cover most pre-existing conditions."

At this point, you've got nothing to lose. Why not contact them to see if they can help you.

Do your homework, however. Before you sign on with an insurance company, check their credentials with the Utah Department of Insurance.

(Originally posted: September 12, 2007 12:30 )

I'm wondering if you can help me - I have a pre-existing mental condition (Bi-polar) and live in Utah. My husband's work doesn't cover me in his Group plan except for an additional $400 a month and we can't afford that - we are actually going bankrupt because of previous medical bills. I haven't had insurance since June 2006 when he graduated from college. I have called the State Dept. of Health and they said I can't get Individual with a pre-existing condition and basically there were no other options. Can you please help and let me know if there is anywhere else I can go?

(Original Post: September 7, 2007 1:52 PM)

Hello tbrummer,

I did a little research into your situation and this is what I found.

According to the Health Insurance Carriers website under the state of Virginia , if you scroll down to the "Individual Health Insurance in Virginia" section, bullet points 2 and 3 state:

*Except for Blue Cross Blue Shield, private individual insurance providers may deny coverage based on health problems, unless the applicant is HIPAA eligible.

*Anthem and CareFirst Blue Cross Blue Shield companies must write an individual policy, despite any health problems.

To me, this means that you shouldn't be denied coverage. You may pay dearly for the coverage, but you should not be declined.

Further to that information, I found in the .pdf document Virginia Health Insurance Guide for Consumers prepared by the Bureau of Insurance State Corporation Commission Commonwealth of Virginia, on page 26 under the frequently asked questions, it states "

"Q: I had a serious health condition that appears to be stabilized; however, I am having difficulty finding an insurance company that will accept me for coverage. I am not eligible for guaranteed coverage under HIPAA. What options are available to me?

A. Each insurance carrier has its own underwriting guidelines. The type of condition and when/how it was treated will factor into how the insurance company will respond. Contact several insurance companies, then compare options available to you. If none of the options suit you, you may contact Anthem Health Plans of Virginia, Inc. (formerly TRIGON) at 1-800-334-7676 or Carefirst Blue Cross Blue Shield at 1-800-544-8703. You may qualify for an open enrollment program where you cannot be denied insurance. However, there may be a waiting period for pre-existing conditions. There is no risk pool in Virginia. Therefore, the Open Enrollment product may be the only way for you to secure insurance if you can not get it anywhere else."

This sounds like a situation similar to yours. In my humble opinion, I believe you should have a leg to stand on as far as securing coverage through Anthem Health Plans of Virginia or Carefirst Blue Cross Blue Shield.

Please do a little more investigating. You should be able to get coverage even with your pre-existing condition. You might pay an arm and a leg, but you should be able to get coverage.
I'd be interested to know how you fare.

Best of Luck!

(Originally posted: September 6, 2007 12:31 PM)

Hi Insurance Helper,

I had a question about my situation and am desperately trying to avoid being screwed over. I just want to know my options and what the best case scenario is, even if the answer is "You're outta luck!"

My scenario is this: I was a full time college student who had graduate student health insurance coverage. I was in a car accident in October 2006 which resulted in whiplash and various back injuries (but no surgery or disk involvement whatsoever...in other words, the remaining liability for any health insurance to cover me would be minimal).

My student insurance covered all they were supposed to (X-rays, MRI, physical therapy, doctor's visits, etc.) until I graduated in August, 2007. I am no longer a student so I no longer am eligible for this coverage. The cost for "continuation coverage" for this plan was over $7500 for the next year...not worth it to me. I went shopping for individual coverage.

However, I have been declined for health insurance by Blue Cross because of this pre-existing condition. All other policies I have come across are either not Major Medical insurance (i.e. they are guaranteed issue but are mini-medical plans, so I have no clue what they will cover, if anything) or will exclude my pre-existing condition. Do you have any tips/recommendations for my situation? I am located in Virginia.

If I have left out any relevant/pertinent details, please feel free to e-mail me (tyson.brummer@gmail.com). Thanks for any time/advice you could provide.

(Originally posted: September 6, 2007 11:48 AM)

Dan & Jo,

I'm sorry to hear about your father's condition.

I did a little research and found a link to the Illinois Uninsured Ombudsman Program.

I would suggest that you check it out and contact the Office of Consumer Health. They might be able to offer you solutions to your father's problem.

I wish you the best of luck. Let me know how it turns out.

(Originally Posted: September 6, 2007 6:15 AM)

Hi,

My dad is 58 years old with Parkinson's and was can canceled from his previous private insurance and has not had luck getting insurance. he is stable in term of his health and rarely goes to the doctor. How can I get him coverage or at least the major medical. He lives in IL.
thanks..

Frustrated

(Originally posted: August 29, 2007 12:11 AM)

Hello confused and mad in wy,

I truly understand your confusion and anger. I took a look at the Wyoming Health Insurance Pool information and was saddened to see that there appears to be a 12 month waiting period for pre-existing conditions.

Was your husband insured previously? Is there anyway to extend that coverage?

There is something wrong with our system when folks like you who are willing to pay for coverage cannot secure coverage.

It's time to contact your Legislator. If something is broken, it's got to be fixed.

Unfortunately, it does not help you in your current situation. I'll keep researching to see if I can find anything that might be of help.

Best of luck!

(Originally posted: August 24, 2007 9:51 AM)

Hello Margincharge,

Sorry to hear about your difficult time in getting health insurance. Check out the New Jersey Individual Health Insurance Program.

Unfortunately, you will still be subject to the pre-existing conditions clause (read the section under pre-existing conditions and portability).

Contact the NJ State Insurance Department. Maybe they can give you more information.

Good Luck!

(Originally posted: August 24, 2007 9:36 AM)

I live in the state of NJ. I have no health insurance. I have arrhythmia a pre existing condition. I'm finding it difficult to find an insurance company that will cover pre existing conditions without a waiting period. I need major medical. Can someone please help me. Does the state of NJ have a health insurance pool? Does anyone know how I can get into an insurance pool in NJ? or have some idea other than one of those discount health plans which isn't health insurance. Thanks

(originally posted: August 24, 2007 1:36 AM)

Confused and mad in WY, I'm sorry to hear of your situation.

I'm going to do some investigating to see if I can uncover anything to help you and your husband.

'm not making any promises that I can resolve this issue, but I will give it my best to see what I can uncover.

Feel free to e-mail me off line.

(originally posted: August 21, 2007 9:25 AM)

Who can help! My husband is even being declined at the insurance pool! Only because I have group insurance,unfortunately he cannot sign up until next July with my plan. How about the months up until then? His line of work needs him to be insured. He has a pre existing condition that I am not worried about, I need him to be covered for something major medical that might happen at work! Her is self employed so workers comp is not available. How do I cover him until next July?? Please help! It is ridiculous that I WANT to pay for health Insurance but nobody will cover him!! What kind of country do we live in? Please help!

(Originally posted: August 20, 2007 8:53 PM)