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Good grief! That should be illegal to charge a person that outrageous amount

of money for health care. I can see why some people are force to do without.

I don't know what you do for a living, but would you be able to look for a

job that has group health insurance? That's about the only way I know that

you could get something fairly reasonable and most (mine don't anyway) have a

preexisting condition clause. My insurance wouldn't pay for my MGB, but they

don't know about it now either. Why would you have to tell them? I think

I'd have to omit that information on the form. I'm so sorry for you.... I

know that has to be terribly stressful to you. Depending on where you work,

some insurance companies will pay for the employee's insurance and then you'd

pay for spouse or children. That's the way mine is at the University. On my

plan, it went up to $200/month to insure 2 children. I thought that was

outrageous, but nothing compared to what you quoted.

Good luck to you!

in OK

In a message dated 11/26/2002 5:35:21 PM Central Standard Time,

dbell1@... writes:

<< Help!! My family of three's health insurance has gone up to $1039 a MONTH

with BC/BS. Who out there has a insurance company they like and would

recommend. BC/BS didn't even pay for my surgery. I DID! However, an agent

told me today I would be in a higher rate bracket, because of the MGB. Ouch!

They would have put me in a higher bracket, because of my weight before.

You just can't win. Thanks, for letting me blow smoke. Any good companies

out there, that you don't have to sell your house to pay for each month.

Thanks,

Darlene

>>

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  • 2 months later...

> I cant remember who asked me about health insurance. The

two major hospitals are childrens hospital of Denver Colorado and

University of New Mexico albuquerque. Military especially retired

military has no health insurance to speak of. Long story on that

one. We are not close to a military base anyway. I have a

appointment for her at denver hospital but they do not and will not

let me see a nuerologist until she has seen a developmental ist!

Polotics. It took me 7 months to get the appointment for march

31st. I cant remember who was asking me about this LOL charlene

>

>

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HI Charlene,

It was me Peggy. Did you need a referral from primary doctor to get

this appt. When we had rocky mountain hmo I couldnt get the primary to

give a referal because her school records are so great LOL. Now we have

blue cross blue shield of Texas PPO. Meaning I dont have to ask father or

mother may I. A higher copay and all they ask is youuse a in network

doctor or hospital. So if they take blue cross blue shield then thats all

I need. I think your better off seeing a Developmentalist instead

of a Neurologist anyway. By the way when I was waiting for Aislinns

appt for her testing they told me I ahd a years wait. I just asked

them to put me on a cancellation list. It works as long as you are

flexible. I got her in three weeks after I was put on the

cancellation list. Any medical facility has a cancellation list

because they hate to loose money. The important thing is that you get

a Dx from a medical facility. Oh Peggy I see the importance in a medical

diagnosis. Everyone said oh a simple milestone and why waste money when

they cant do anything anyway? Well I beg to differ because with my son

that medical diagnosis meant the world! I wouldn't tell them you think she

is

PDD. I'd tell them that you think that your dtr has a Sensory

Intergration Disorder and give examples why. The other biggy is non

verbal language disorder which has a huge effect on their ability to

socialize. Give them examples explain that she gets teased alot by

the children in school and the impact this has. Does your dtr have

behavior problems at school? Oh yes my daughter has major behavior

problems LOL. charlene

Peggy

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  • 7 months later...

I have the four of us on a plan with a high deductible so we pay around $117

every month through Blue Cross. However, I started questioning this because we

never take our children to well-baby checkups and the insurance doesn't cover

our midwifery costs. Plus, any care we do get (chiropractic, homeopathy, etc.)

isn't covered. So what's the point?

Then I think about possible traumas...my hubby being prone to doing things like,

recently, breaking his nose on the playground while playing tag with our son.

Or when our little guy was born with a newly mutated form of h-flu (thanks,

vaccinated population...grrrr) and needed about $50,000 worth of NICU. Was very

glad not to pay that.

Now, I'm considering putting myself on Medi-Cal and the kids on Healthy Families

so we have that emergency coverage and keeping my hubby on Blue Cross since he's

not covered by the other programs. That's probably what we'll do, although we

might be expecting twins and my midwife has asked me to keep what I have until

we know for sure because our preferred backup doc doesn't take Medi-Cal.

So we're kind of in insurance limbo. I do want coverage but I'm sure not

willing to pay much for it, because the chances of us using it are rather slim.

Even with my own pre-cancerous condition due to a particularly yucky strain of

HPV, I'm not going the allopathic route. I know my chances of avoiding this

outcome diminish with every step into a doctor's office.

I think also it's an important form of activism to be willing to pay for

alternative health care, at least right now while so much of America is wrapped

up in standard medicine. The $3500 we're paying to our midwives is a lot to

us...but it's perfectly reasonable when I think of some obstetrician missing out

on his/her share in cesarean- and drug-ville. :)

~Mindy Goorchenko

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That's kind of our reasoning why we dropped it. I couldn't see paying $500 a

month for something we never used. I guess if we had a major medical bill for

an accident or something then we'd just make payments on it for the rest of our

lives. I don't know what hospitals do in cases where people don't have

insurance.

I hope this baby's (or babies') arrival is much less eventful than your last! :

)

Kay

I have the four of us on a plan with a high deductible so we pay around $117

every month through Blue Cross. However, I started questioning this because we

never take our children to well-baby checkups and the insurance doesn't cover

our midwifery costs. Plus, any care we do get (chiropractic, homeopathy, etc.)

isn't covered. So what's the point?

~Mindy Goorchenko

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Thanks for the good wishes, by the way, re: an uneventful birth. :) The birth

itself WAS quite uneventful, thankfully. It was all the stuff afterward that

made it a little too exciting.

Just a funny story along the lines of hospital bills...we actually didn't HAVE

health insurance when my husband broke his nose. We have never gotten a bill.

My step-grandmother, with no health insurance, has been extensively treated for

breast cancer, and never got a bill.

????

Thanks, universe, with love from your daughter Mindy :)

<<<<<<<<<<Message: 11

Date: Wed, 10 Sep 2003 21:47:20 -0400

From: " mkphilpot " <mkphilpot@...>

Subject: Re: Re: health insurance

That's kind of our reasoning why we dropped it. I couldn't see paying

$500 a month for something we never used. I guess if we had a major

medical bill for an accident or something then we'd just make payments on

it for the rest of our lives. I don't know what hospitals do in cases

where people don't have insurance. >>>>>>>>>>>>>>>>>>

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  • 1 year later...
Guest guest

Dear Amy,

Thank you so much for sharing your experience with UHC. It sounds like

although UHC looks good on paper-- it may not be a good choice if you are

actually in need of medical insurance! It sounds awful having to go through 4

levels

of appeals to get a medicine that his doctor's wanted him to have--it seems

like there should be some penalty given to a health insurance company if they

continually refuse to pay or pay too little and then refuse to verify the

correctness of what they have done.

Martha

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Guest guest

I just want to say that we have UHC too and they pay 100% for Nick's IVIG as

long as we do it in a doctor's office. We have never done it anywhere else

yet, and we are just now exploring home infusions and it appears that it

will just be our out of pocket deductible and then covered at a 100%. So

while I do agree that UHC is not the best insurance we have had,

has always had everything he has needed. All his tests have been paid for

and he has never gone with out medical treatment.

Just my 2 cents.

Amy,

mom to , 2 years old, CVID, asthma, GERD, on prophalatic abx

(rotating Septra and Amoxicillin) and IVIG (Carimune NF) every 4 weeks,

flovent, xopenex, albuterol and claritin. Allergic to milk, soy and latex..

among other things. Visit Nick's Caringbridge site at

http://www3.caringbridge.org/ne/nicholasb/

Re: Health Insurance

>

> Dear Amy,

> Thank you so much for sharing your experience with UHC. It sounds like

> although UHC looks good on paper-- it may not be a good choice if you are

> actually in need of medical insurance! It sounds awful having to go

> through 4 levels

> of appeals to get a medicine that his doctor's wanted him to have--it

> seems

> like there should be some penalty given to a health insurance company if

> they

> continually refuse to pay or pay too little and then refuse to verify the

> correctness of what they have done.

>

> Martha

>

>

>

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  • 4 weeks later...
Guest guest

Lorri, someone somewhere posted the website www.uneedpsi.org. I believe they

will cover copay/coinsurance etc for Primary immune deficiency....I haven't

been able to speak to anyone there yet, but it's worth a shot...Hope that

helps.......

Quoting Lorri Kraft <llkraft@...>:

>

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> I am calling out for all your brains for help.  My daughter lives in

>

> Washington State.  She has been receiving her treatments through the DDD

>

> (Development Disability office) for the past 12 years.  They now have

>

> decided she no longer qualifies to be on state insurance since they

>

> classified her in the wrong category.  I tried SSI but was told that we make

>

> to much money for her to qualify.  She has to have treatments every 14 days

>

> and our insurance won't cover it.  Does anyone have ideas of where we could

>

> get help to pay for her treatments?

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Guest guest

Lorri, someone somewhere posted the website www.uneedpsi.org. I believe they

will cover copay/coinsurance etc for Primary immune deficiency....I haven't

been able to speak to anyone there yet, but it's worth a shot...Hope that

helps.......

Quoting Lorri Kraft <llkraft@...>:

>

>

>

>

>

> I am calling out for all your brains for help.  My daughter lives in

>

> Washington State.  She has been receiving her treatments through the DDD

>

> (Development Disability office) for the past 12 years.  They now have

>

> decided she no longer qualifies to be on state insurance since they

>

> classified her in the wrong category.  I tried SSI but was told that we make

>

> to much money for her to qualify.  She has to have treatments every 14 days

>

> and our insurance won't cover it.  Does anyone have ideas of where we could

>

> get help to pay for her treatments?

>

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Guest guest

Have you tried PSI? They will send you a application. Their # is

1-800-366-7741

They help with reimbursing copays, and insurance premiums.

Always, Always, Always appeal their decision and have your Specialist write

a letter stating how it is so important to your child's survival for the

coverage. Many times when appealed they approve coverage.

Take care

Amy

health insurance

>

>I am calling out for all your brains for help. My daughter lives in

>Washington State. She has been receiving her treatments through the DDD

>(Development Disability office) for the past 12 years. They now have

>decided she no longer qualifies to be on state insurance since they

>classified her in the wrong category. I tried SSI but was told that we

make

>to much money for her to qualify. She has to have treatments every 14 days

>and our insurance won't cover it. Does anyone have ideas of where we could

>get help to pay for her treatments?

>

>

>

>

>

>

>

>Frazzled mom

>

>Lorri ( CVID 15years old)

>

>

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>

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  • 1 month later...
Guest guest

Jeanne, I may be wrong but if you are going from one group plan to another

group plan with no lapse in the middle, there should be no problem switching. I

think that even preexisting things are not preexisting if you have no lapse.

Legislation was passed several years ago addressing this. I think that

private plans can make their own rules. Is your plan through your work? I

would

contact your state insurance board and ask them about it. I'm not sure the

company can exclude your son and even if they can exclude his OCD, he should

still be covered for other things. Sometimes companies that have what are called

" third party administrators " can get by the rules and that might be the case

for you. If so, contact the human resources department where you work since

they can approve exceptions. Good luck! I hate dealing with insurance. I

think

that there is a special code in the billing for people who need therapy after

dealing with issues like this! :) Kelley in NV

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Guest guest

I read an article quite a while back about how hard it can be to get

private insurance once a person has been prescribed an

antidepressant.

Some insurances have a waiting period for preexisting conditions.

Also I know when I began working where I am now, if I didn't go ahead

and put the kids on THEN, when I first signed up for insurance, but

waited until later to add them, then preexisiting conditions wouldn't

be covered at the later date.

Do you think your insurance just doesn't include mental illness or

that it's the preexisting that's being denied??

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Guest guest

On Jun 12, 2005, at 1:02 PM, kelleydinkins@... wrote:

> Jeanne, I may be wrong but if you are going from one group plan to

> another

> group plan with no lapse in the middle, there should be no problem

> switching. I

> think that even preexisting things are not preexisting if you have no

> lapse.

> Legislation was passed several years ago addressing this. I think that

> private plans can make their own rules. Is your plan through your

> work? I would

> contact your state insurance board and ask them about it. I'm not

> sure the

> company can exclude your son and even if they can exclude his OCD, he

> should

> still be covered for other things. Sometimes companies that have what

> are called

> " third party administrators " can get by the rules and that might be

> the case

> for you. If so, contact the human resources department where you work

> since

> they can approve exceptions. Good luck! I hate dealing with

> insurance. I think

> that there is a special code in the billing for people who need

> therapy after

> dealing with issues like this! :) Kelley in NV

>

>

Unfortunately, I'm not on a group plan, so they can. I was also

thinking of just getting short-term insurance for him, but I don't know

how that will effect his future portability. It is a huge mess!

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Guest guest

Contact your state insurance department, there should be people in

charge of regulating insurance etc, you might be able to get some

suggestions on what your best plan of action would be.

Amnesty

>

> > Jeanne, I may be wrong but if you are going from one group plan

to

> > another

> > group plan with no lapse in the middle, there should be no

problem

> > switching. I

> > think that even preexisting things are not preexisting if you

have no

> > lapse.

> > Legislation was passed several years ago addressing this. I

think that

> > private plans can make their own rules. Is your plan through

your

> > work? I would

> > contact your state insurance board and ask them about it. I'm

not

> > sure the

> > company can exclude your son and even if they can exclude his

OCD, he

> > should

> > still be covered for other things. Sometimes companies that have

what

> > are called

> > " third party administrators " can get by the rules and that might

be

> > the case

> > for you. If so, contact the human resources department where

you work

> > since

> > they can approve exceptions. Good luck! I hate dealing with

> > insurance. I think

> > that there is a special code in the billing for people who need

> > therapy after

> > dealing with issues like this! :) Kelley in NV

> >

> >

>

> Unfortunately, I'm not on a group plan, so they can. I was also

> thinking of just getting short-term insurance for him, but I don't

know

> how that will effect his future portability. It is a huge mess!

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Guest guest

That is a bummer. I think private insurance companies can do whatever they

want to. Are they refusing to insure him at all or is it just for the OCD?

I'm so sorry that you are having to deal with this. I hate insurance companies

and the ways they deal with things. My husband lost his job in January and

found a new one that has no benefits. We are paying for Cobra insurance at a

rate of $1046.38 a month until he finds something else. Our prescriptions each

month cost at least that (without insurance) so we opted for it. I keep

telling him that we can't go onto private insurance because everything we are

treated for: kidney stones, asthma, OCD (in three people) heart issues, etc.

can

be excluded. I hope that you find a solution that works for your family.

Kelley in NV

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  • 3 months later...

Lori: that is illegal. If you can prove it you have a cause for action.

Carol

health insurance

> thanks for the kind words here and ones that were sent privately

> about the insurance situation.

>

> Unfortunately it's even worse than I thought -- the insurance company

> is trying to get rid of us because of me and all my expenses (the

> breast cancer, Samters and other things). I'm pretty sure this is

> illegal in New York (although not in all states) and I'm going to

> fight it as far as I can after I educate myself about it.

>

> In the mean time I am lucky because I can go on my husband's

> insurance, aw awful as his insurance is, but most of my coworkers are

> not married and they will be hurt by this, which really really sucks.

>

> If anyone knows insurance law in New York State let me know. Only in

> NY, though, because the laws are very very different state by state

> and New York has the best patient protections of any state.

>

> Thanks,

>

> Lori

>

>

>

>

>

>

>

>

>

>

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Carol,

Unfortunately that IS the problem -- proving it. They will not tell

us that's why they're cancelling the policy. But they're trying to

find other reasons to cancel us, such as cashing our checks late,

etc.

In one or two states believe it or not they do not have guaranteed

issue policies for small businesses (I know Nevada is one, I'm not

sure if there's another). Actually if we weren't a small business

we may be less likely to be cancelled, but large businesses of more

than 50 employees have less protections and in many states can be

cancelled for these reasons. But that doesn't apply to us, and it

is illegal, as you say. I just don't know what to do about it. My

boss sounds very pessimistic.

I am hoping he'll listen to me on some of this, there are two

programs in NY where small groups can buy insurance through a larger

group organization, so this would not happen. I'm hoping he'll do

that when our contract is up in November.

Well, I'll let you know what happens. Ironically or maybe not so, I

feel very sick right now. Ha.

Lori

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In a message dated 9/24/2005 9:09:26 AM US Mountain Standard Time, iamthezookeeper@... writes:

I just found out I still have Tricare insurance from the military which is so weird because I haven't had it for five years and all of the sudden I do.

Trudy. You should also check with the VA for benefits. Took me about 9 months to get a first appointment, but once you're in the "program", can get prescriptions for a $7 co-pay, plus both out and in-patient care. If you had Medicaid, you may qualify in the Priority 7 class or better. Only downside is they tend to only use generic stuff which will give you crap instead of Nasonex, and no Singulair. Think they can "special request", if necessary, however. Just an FYI if you haven't considered.

(AZ)

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Lori, I am so sorry this is happening to you. I had the FMLA act

covering me for three months when I couldn't work, which lasted a

full five months. My boss laid me off so I could collect U/E which

was pretty cool. I did lose my health insurance and had to go on

Medicaid. I just found out I still have Tricare insurance from the

military which is so weird because I haven't had it for five years

and all of the sudden I do. I think the stress of all this is going

to make your immune system go into overdrive so be careful. You

already know now is the time to eat right, rest, try to relax and

meditate...and know we are sending our prayers your way. Trudy.

> Carol,

>

> Unfortunately that IS the problem -- proving it. They will not

tell

> us that's why they're cancelling the policy. But they're trying to

> find other reasons to cancel us, such as cashing our checks late,

> etc.

>

> In one or two states believe it or not they do not have guaranteed

> issue policies for small businesses (I know Nevada is one, I'm not

> sure if there's another). Actually if we weren't a small business

> we may be less likely to be cancelled, but large businesses of more

> than 50 employees have less protections and in many states can be

> cancelled for these reasons. But that doesn't apply to us, and it

> is illegal, as you say. I just don't know what to do about it. My

> boss sounds very pessimistic.

>

> I am hoping he'll listen to me on some of this, there are two

> programs in NY where small groups can buy insurance through a

larger

> group organization, so this would not happen. I'm hoping he'll do

> that when our contract is up in November.

>

> Well, I'll let you know what happens. Ironically or maybe not so,

I

> feel very sick right now. Ha.

>

> Lori

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Thank you for the info! I somehow have both Medicaid and Tricare so

one covers what the other doesn't. My co-pay for meds is $3 and that

includes name brands. I think there is a glitch in someones system

and I am not about to make any noise about it. I did call my local

admin office to tell them I didn't think I had tricare anymore and

they said I am in the system. If I run into problems I will check

into VA benefits. At the very least I know I can buried for

free...lol. Trudy.

> In a message dated 9/24/2005 9:09:26 AM US Mountain Standard Time,

> iamthezookeeper@y... writes:

> I just found out I still have Tricare insurance from the

> military which is so weird because I haven't had it for five years

> and all of the sudden I do.

> Trudy. You should also check with the VA for benefits. Took me

about 9

> months to get a first appointment, but once you're in

the " program " , can get

> prescriptions for a $7 co-pay, plus both out and in-patient care.

If you had

> Medicaid, you may qualify in the Priority 7 class or better. Only

downside is they

> tend to only use generic stuff which will give you crap instead of

Nasonex,

> and no Singulair. Think they can " special request " , if necessary,

however.

> Just an FYI if you haven't considered.

>

> (AZ)

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  • 1 year later...
Guest guest

Health insurance is regulated primarily at the state level, so the answer to your questions will depend entirely upon where you live.

Under HIPAA, if you are currently covered by an employer or association group policy which accepts everyone who is a member of the group, you can avoid their up to 12 month exclusion for coverage for pre-existing conditions. This exclusion period is reduced by the number of days you had your previous group coverage -- but only if there has not been a gap of 63 days or more since your previous insurance / COBRA extension expired.

This HIPAA provision does not force an insurance company to sell you individual health insurance or small group insurance for your company.

If you forget to disclose a health problem on an insurance application, (an error or omission), the insurer can void your policy at any time during the first two years you have your policy. If you deliberately lie on your application, proven by your own admission, there is no time limit on their ability to later void your policy.

>> Hi,> > I am considering leaving my current job, that includes health > insurance, and attempting to open my own business. Does anyone have any > recommendations for either getting health insurance as an individual or > as a business owner of a small company (4 employees maximum)?> > Also, a related question is, my understanding is that as long as you > have not had a break from health insurance, a new company cannot use > the "pre-existing condition" thing to prevent me from using it for HIV > related items such as doctor's visits and prescriptions. Is this true? > Can anyone add anything to this?> > Thanks in advance,> > >

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Guest guest

HIPAA also requires insurance companies that offer individual insurance coverage to make available their most popular individual policy at fixed rates to persons losing group coverage, for example, at the end of COBRA. You could ask an insurance broker in your area what kinds of HIPAA individual conversion policies are available. If you are fortunate enough to live in California, small groups of two or more persons can obtain group coverage without pre-existing condition limitations at fixed rates through PacAdvantage. Norm Stuart <ns02@...> wrote: Health insurance is regulated primarily at the state level, so the answer to your questions will depend entirely upon where you live. Under HIPAA, if you are currently covered by an employer or association group policy which accepts everyone who is a member of the group, you can avoid their up to 12 month exclusion for coverage for pre-existing conditions. This exclusion period is reduced by the number of days you had your previous group coverage -- but only if there has not been a gap of 63 days or more since your previous insurance / COBRA extension expired. This HIPAA provision does not force an insurance company to sell you individual health insurance or small group insurance for your company. If you forget to disclose a health problem on an insurance application, (an error or

omission), the insurer can void your policy at any time during the first two years you have your policy. If you deliberately lie on your application, proven by your own admission, there is no time limit on their ability to later void your policy. >> Hi,> > I am considering leaving my current job, that includes health > insurance, and attempting to open my own business. Does anyone have any > recommendations for either getting health insurance as an individual or > as a business owner of a small company (4 employees maximum)?> > Also, a related question is, my understanding is that as long as you > have not had a break from health insurance, a new company cannot use > the "pre-existing condition" thing to prevent me from using it for HIV > related items such as doctor's visits and prescriptions.

Is this true? > Can anyone add anything to this?> > Thanks in advance,> > >

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Guest guest

"I am considering leaving my current job, that includes health insurance, and attempting to open my own business. Does anyone have any recommendations for either getting health insurance as an individual or as a business owner of a small company (4 employees maximum)?"I would be very, very careful about this.   I continue with a group policy, but the premiums are straining my balance.  I find it hard to believe that you would be protected for long against, "pre-existing conditions."  The policy is not yours, it would be for a corporation.  Once that first HIV related claim is made, your premiums could put you out of business.It may be possible to do this, and I'm not a Pollyanna on the subject, but be very sure about what you're doing.JB

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Guest guest

Thanks Norm! I live in Washington DC, and I have had my health insurance covered at my company since I started in 1996. I currently have Aetna PPO, but previously had Aetna HMO and Kaiser (all with the same company). Yes, the company I work for accepts everyone who works there. I have only been HIV+ since 2005 though, so obviously this wasn't an issue when I started.

On 6/13/07, Norm Stuart <ns02@...> wrote:

Health insurance is regulated primarily at the state level, so the answer to your questions will depend entirely upon where you live.

Under HIPAA, if you are currently covered by an employer or association group policy which accepts everyone who is a member of the group, you can avoid their up to 12 month exclusion for coverage for pre-existing conditions. This exclusion period is reduced by the number of days you had your previous group coverage -- but only if there has not been a gap of 63 days or more since your previous insurance / COBRA extension expired.

This HIPAA provision does not force an insurance company to sell you individual health insurance or small group insurance for your company.

If you forget to disclose a health problem on an insurance application, (an error or omission), the insurer can void your policy at any time during the first two years you have your policy. If you deliberately lie on your application, proven by your own admission, there is no time limit on their ability to later void your policy.

>

> Hi,> > I am considering leaving my current job, that includes health > insurance, and attempting to open my own business. Does anyone have any > recommendations for either getting health insurance as an individual or > as a business owner of a small company (4 employees maximum)?> > Also, a related question is, my understanding is that as long as you > have not had a break from health insurance, a new company cannot use > the " pre-existing condition " thing to prevent me from using it for HIV > related items such as doctor's visits and prescriptions. Is this true? > Can anyone add anything to this?> > Thanks in advance,> >

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