Insurance

June 14, 2005

Dale is right about being able to get COBRA. In fact you have 45

days after coverage was ended to let them know you want it. Your ex

may have gotten a letter to that affect. I'm so sorry you are

having to deal with that. A good lawyer will also collect their

fees from you ex. He could be held in contempt of court for what he

did. Sadly that does not fix the problem you now have. You also

may want to look into getting your daughter on medicaid. Your

income doesn't have to be as low as you might think. The nice thing

is if she qualifies, they may back date it so her last infusion is

covered. In addition once the coverage is reinstated, medicaid can

stay as a secondary. Hang in there,

Kris Mom to Konner and Keegan both with CVID

> > Ok, I now realize I have the biggest jerk of an ex-husband than

anyone I know. I realize this is not a support group for the

divorced but........he cancelled the health insurance as of May 31

and never told me. Not only is he responsible to maintain it but he

never told me and Hannah had an infusion last week that is not

covered now! I am so angry!!! The home healthcare company said to

appeal to the insurance company and see if it would be considered

a " qualifying event " . Has anyone heard of this at all? Please help?

> >

> > (Hannah, 14, CVID, JRA, Lupus)

> >

> > ---------------------------------

> >

> > __________________________________________________

> >

October 15, 2005

Contact your State Insurance office. My state (Oregon) offers health

insurance (at a high price) to uninsurable folks.

Sally

insurance

How does one get health insurance if you're hep C positive? I'm self

employed, I've tried a few (Kaiser) and was told I'm uninsurable. Should I

just assume I'm not eligible for health care? Thank god we don't have

national health care, that socialist ruse.

It's a pleasure having you join in our conversations. We hope you have found

the support you need with us.

If you are using email for your posts, for easy access to our group, just

click the link-- Hepatitis C/

Happy Posting

October 26, 2005

I'm no insurance expert so anything I say may be incorrect but it is my

understanding that private insurance companies can do what they want as far as

pre-existing conditions are concerned. If you have a heart problem, for

example,

they can choose to not cover anything related to it at any time. Some

companies will offer higher rates or will agree to cover a condition after a

certain

length of time--a year for example. With group health insurance, if you do

not have a lapse in coverage--whether it be because your coverage starts

immediately after leaving one job and starting another or because you have

purchased

COBRA or have obtained insurance to cover the time between the old and the

new--it is against federal law to consider any of the conditions you were being

treated for as pre-existing. If there is a lapse, some companies make you wait

the length of the lapse before providing coverage. If you are uninsured for

three months, for example, some make you wait three months before providing

coverage for pre-existing things. We have been paying for COBRA for several

months now at a rate of $1,042.63 per month. We are allowed to keep it for

about

eight more months and then we will be forced to decide whether we will go

private and have everything pre-existing or if my husband will give up the

benefit-less job he really likes to return to retail (which he hates.) Kelley

in NV

October 26, 2005

I'm no insurance expert so anything I say may be incorrect but it is my

understanding that private insurance companies can do what they want as far as

pre-existing conditions are concerned. If you have a heart problem, for

example,

they can choose to not cover anything related to it at any time. Some

companies will offer higher rates or will agree to cover a condition after a

certain

length of time--a year for example. With group health insurance, if you do

not have a lapse in coverage--whether it be because your coverage starts

immediately after leaving one job and starting another or because you have

purchased

COBRA or have obtained insurance to cover the time between the old and the

new--it is against federal law to consider any of the conditions you were being

treated for as pre-existing. If there is a lapse, some companies make you wait

the length of the lapse before providing coverage. If you are uninsured for

three months, for example, some make you wait three months before providing

coverage for pre-existing things. We have been paying for COBRA for several

months now at a rate of $1,042.63 per month. We are allowed to keep it for

about

eight more months and then we will be forced to decide whether we will go

private and have everything pre-existing or if my husband will give up the

benefit-less job he really likes to return to retail (which he hates.) Kelley

in NV

October 26, 2005

This is true since the benefit scenario I described was employer

based, and when it is employer based, the employer gets tax incentives

to offer benefits and COBRA or bridge benefits. It's hard to imagine

that anyone can afford individual insurance policies these days. I

have a friend married to a lucrative doctor whose son has cerebral

palsy. She still works part-time to maintain her benefits for their

family because of the very high costs of therapy and remediation for

her son. They would not be able to save for his future otherwise.

WHen we talk about the kinds of things we give up as Americans - this

is a biggie that affects children and the elderly or infirmed the

most. Something to think about in this and future elections.

Bonnie

>

> OK, found the article (after all this time!). It's for when you look

> for your own coverage (not thru work). I did a copy/paste, so hope I

> took out all extras (ads, etc.) after, if you see something odd

> anywhere in the text.

>

> *******

>

> " Prozac may be hazardous to your health insurance "

>

> If you've had even a mild bout of depression, you may find buying an

> individual health insurance policy a challenge. Here's how to succeed

> in the process.

>

> Imagine many years ago you suffered mild depression when you broke up

> with your significant other and you briefly sought mental health

> help. Now you're happy and healthy, but you get a rude awakening when

> you try to buy individual health insurance: One by one your

> applications for individual health insurance are denied based on the

> six counseling sessions you had a decade ago, which are permanently

> recorded in your medical history.

>

> You've all but forgotten about your ex, so how can this seemingly

> insignificant episode be coming back to haunt you? Are you really on

> your way to becoming uninsured?

>

> You could be if you're trying to obtain individual health insurance,

> according to Pollitz, a town University researcher who co-

> authored a study on the individual health insurance market for the

> Kaiser Family Foundation (KFF) with Sorian and Kathy .

> Individual insurers might deny you coverage based on your medical

> history if it includes:$100? $200?

> $300?

>

> Use of prescription drugs to treat anxiety, depression, or a physical

> condition, including Ativan, Klonipin, Paxil, Prozac, Serzone,

> Zoloft, Xanax, and Wellbutrin.

>

> Counseling for anxiety, depression, grief, or an eating or sleep

> disorder. Even if you briefly sought counseling as a way to cope with

> the September 11th terrorist attacks, you could be denied individual

> health insurance, according to researchers with town's Health

> Privacy Project.

>

> " People who've always had group health insurance are completely

> unprepared when they're forced to seek coverage in this [individual

> health insurance] market, " says Pollitz. " They think they're going to

> get the same coverage they had in their jobs, except they'll just

> have to pay a little more money. It's absolutely not like that at

> all. The individual health insurance market is unpredictable,

> inconsistent, and expensive. "

>

> Dr. Deborah Peel has seen the unpredictability of the individual

> health insurance market up close. Peel, a former-president of the

> National Coalition of Mental Health Professionals and Consumers,

> recalls a young graduate student whose sleep apnea was treated with

> antidepressant medication. When he was dropped from his parents'

> group health insurance plan due to his age, he began applying for a

> policy in the individual market. He was turned down several times

> because his medical records showed he had taken an antidepressant --

> even though the medication was for a physical rather than mental

> condition.

>

> Peel says all doctors should give their patients a " Miranda-like

> warning " that anything they say or treatment they receive might be

> shared with a third-party payer (such as an insurer). " Ethically,

> doctors and all mental health professionals are responsible to

> disclose anything that might possibly harm their patients, including

> the fact that information they share with you might possibly be cause

> for an insurance denial later on. "

>

> Unpredictable, inconsistent, and expensive

> A number of everyday circumstances can force someone to seek

> individual health insurance coverage. They include: losing status as

> a dependent on a parent's health plan; getting a job that doesn't

> offer group health insurance benefits; becoming self-employed;

> retiring before age 65; and coming to the end of your health

> insurance benefits under COBRA, the federal health insurance safety

> net for families in the midst of crisis, such as unemployment,

> divorce or death.

>

> One of the biggest shocks you might encounter when moving from a

> group health insurance policy to an individual policy is the

> individual health insurer will consider more than just your age and

> personal medical history when deciding whether to offer you a policy.

>

> In their study " How Accessible is Individual Health Insurance for

> Consumers in Less-than-Perfect Health? " Pollitz and her co-authors

> say 90% of the time, the less-healthy health insurance applicants in

> their study were unable to buy policies from individual insurers at

> standard rates, and 37% were rejected. Of the 63% who were accepted,

> most had benefit restrictions placed on them (28%), or premium

> surcharges (13 percent), or both (12%).

>

> KFF warns even if you're in perfect health, you might still face

> barriers to getting a policy, based on your age. KFF's study found

> premiums for a healthy 62-year-old man were three to six times higher

> than for a healthy 24-year-old woman.

>

> Another shock you might encounter when buying an individual health

> policy is health insurance is often not subject to any kind of rate

> regulation. Only five states (Maine, New Hampshire, New Jersey, New

> York, and Vermont) guarantee you access to the individual market at

> community-rated premiums that are not based on your health status.

> These states also limit coverage exclusions that insurers can impose

> because of pre-existing conditions.

>

> Very few consumers who seek individual health insurance have

> protection through federal law. The Health Insurance Portability and

> Accountability Act (HIPAA) requires insurers to sell a health

> insurance policy without coverage limits to you if you have had at

> least 18 months of continuous coverage and are moving from one group

> health insurance policy to another group policy. HIPAA does not limit

> what health insurers can charge for such coverage.

>

> Why are individual health insurers so picky about whom they choose to

> insure? According to , the statistics tell the story: " The

> sickest 1% of your policyholders can comprise between 40 to 50% of

> all your claims. That's what makes health insurance such a risky

> business. "

> While life insurers only have to pay out a death claim once, health

> insurers may have to pay out numerous claims over many years for one

> sick person. Individual insurers can't spread out that risk among

> groups of many people the way group health insurers or self-insured

> employers do.

>

> The impact on consumers

> Approximately 18.8 million adult Americans suffer from some form of

> depression in any given year, according to the National Institute of

> Mental Health. Statistics show one in five of us will experience a

> major episode of depression during our lives. Mental health

> professionals and privacy advocates say people who need mental health

> help should not go untreated for fear that they might be denied

> health insurance in the future. Even so, there is evidence some

> people are already putting off treatment for fear of being penalized.

>

> According to the California Health Care Council's " Medical Privacy

> and Confidentiality " survey, 15% of American adults say they have

> done something " out of the ordinary " to keep their personal medical

> information confidential. The steps they have taken to protect their

> medical privacy include:

>

> Paying out-of-pocket when they already have health insurance in order

> to avoid disclosure.

>

> Not seeking care to avoid disclosure to an employer.

>

> Giving inaccurate or incomplete information on a medical history

> form.

>

> Asking a doctor to not write down a health problem or to record a

> less serious or embarrassing condition.

>

> Child psychiatrist Dr. Barry Herman says many of his patients'

> parents, who he says tend to be well-educated and financially stable,

> understand the possible ramifications of having their child's

> treatment disclosed to a third party. " It's not at all unusual for

> them to pay cash or ask for free samples of medication [instead of a

> prescription], " says Herman. " They don't want a paper trail. "

>

> What about the paper trail you create when you complete an

> application for individual health insurance? A standard application

> will ask you more than 20 specific questions about your medical

> history, going back 10 or more years. Not only are you asked to

> disclose whether you have ever had any " symptoms of, diagnosis of, or

> treatment or medication for " such obvious health problems as cancer,

> diabetes, high blood pressure, and HIV, but you must also inform the

> insurer about any allergies, anxiety, benign cysts, breast

> augmentation, depression, earaches or sexually transmitted diseases.

>

> While you might be tempted to lie, this is never a good idea. Lying

> on your health insurance application is fraud. If you are caught, the

> health insurer can cancel your policy. If you don't think you can be

> easily caught, think again. Select individual and small group health

> insurers now have access to medical information on more than 16

> million people contained in files warehoused by the Medical

> Information Bureau (MIB).

>

> The MIB provides medical information that insurers use to compare

> notes on applicants.

>

> What can you do?

> What if it's already too late for you to pay cash for your

> antidepressants or counseling sessions. Can you still get individual

> health insurance? It's possible, say the KFF study's authors, but it

> will probably take a great deal of persistence and there are no

> guarantees. Even if you are offered a policy, it will inevitably be

> more expensive than group health insurance and it will no doubt limit

> or even exclude certain coverages.

>

> The best you can do is to fill out any applications for individual

> health insurance to the best of your ability and be truthful. An

> experienced health insurance broker who knows the underwriting

> criteria of several individual insurers might increase your chances

> of acceptance.

>

> If you're denied, ask your doctor to write a letter supporting your

> re-application, particularly if you are no longer taking medication

> or receiving mental health treatment. " When we did the study, we

> found that there aren't any hard and fast underwriting rules, " says

> Pollitz. " There's a great deal of variability from insurer to

> insurer. "

>

> Additionally, once you are denied, you will have to answer " Yes " to

> the question that asks you to disclose whether you -- or anyone to be

> covered under your policy -- has ever had an application for life,

> disability, or health insurance " declined, postponed, rated up,

> modified, or terminated. "

>

October 26, 2005