Re: Medical Coverage Excluded/Pre-existing conditions

[Guest guest]

>Get this.... My group insurance company said >that they will not cover the

>visits since it is a pre-existing condition. I looked up the Kentucky law

>and the insurance >company can >apparently exclude me for as many as 18

>months. >Has anyone else had a >similar experience in Kentucky?

Ante,

This " pre-existing condition " exclusion is actually quite common in the

US. California has a similar law, and you can be excluded from coverage for

a pre-existing condition for a full year.

Since I was just our of Uni and was exploring career options and getting

experience with different kinds of jobs when I first got the PA, this became

a nightmare for me. Every time I changed jobs, I lost coverage for the PA

for one year and ended up with lots of doctor bills.

Even with the COBRA law making my previous employer extend my coverage with

the old insurance company (at my expense of course) for a full year it

wasn't enough to get everything I needed covered, esp when I needed physical

therapy. Also paying two insurnce premiums was not financially feasible for

me with all the co-payments I already had for the doctors and drugs.

At one point, I felt forced to stay in a job I was very unhappy in because

otherwise I would lose my prescription/medical benefits, or even worse, need

to change doctors and basically start all over again. Without the insurance,

my monthly medicines were about US$300. I had no way to afford it.

It's hard being sick and having few options!

I didn't want to leave California, but when the option came up for me to

move to Taiwan and have the full medical, dental and prescription coverage

for about US$7 per month-it was hard to refuse. I have decent medical care

now at prices I can afford.

I have been trying to find out what other states have these laws, and how

we can get around them, or what other options I may have when I return home.

I'd be interested to know if any other states have the " Pre-existing "

condition clauses in their policies or what those of you in the US have

learned about your health care plans.

Also, has any found any loopholes or other ways to cope.. (other than not

giving any prior history to your new doctor/company and thus starting with

the diagnosis all over again)

I'm hoping to come back to the US next year if I can get the health coverage

I need to prevent myself from winding up in debt again. Any

suggestions/experiences would be greatly appreciated!

Hope everyone's having a pain-free day....

Take care!

Christie

The American in Taiwan

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[Guest guest]

Hi Christie,

I know it's off topic, but I find it very interesting that you moved

from the US to Taiwan for employment. Usually, it seems like it's the

other way around - ie; Chinese coming to the US to work. I wonder if

you'd be willing to share a little more info on the circumstances

that led up to it?

-- Ron

> I didn't want to leave California, but when the option came

> up for me to move to Taiwan and have the full medical, dental

> and prescription coverage for about US$7 per month-it was hard

> to refuse. I have decent medical care now at prices I can afford.

> Christie

> The American in Taiwan

[Guest guest]

All I had to do was get a form (Certificate of Group Health Plan Insurance)

and my next employer has no choice with the pre-existing condition. I hope

this helps! I am starting a new job on Tuesday and I made sure I had this

form in my hands. Also, I got them to waive my waiting period for INS for

them to hire me. Alot of Options out there.

Thanks,

Janet

ps. I Live in IN and the best group of physicians are assembled at

Rheumetology and Assoc!

[Guest guest]

In a message dated 5/25/01 3:50:20 AM Pacific Daylight Time,

lovetravelin2@... writes:

> Also, has any found any loopholes or other ways to cope.. (other than not

> giving any prior history to your new doctor/company and thus starting with

> the diagnosis all over again)

>

Christie,

I am so sorry that you have to fight so hard for benefits/coverage. If a

state has the preexisting clause your insurance company can deny coverage for

whatever their time frame is. In Illinois with BC/BS the waiting period is

a year. Don't even try to find a loophole none exist and whatever you do not

deny prior history because your health history is on file for any insurance

company to search out and believe me they do. My son was a severe asthmatic

up till about 5 years ago. When he started a new job he was ecstatic at

being insured just in case his asthma ever started to act up again. He had

not had an attack for years and kept an OTC inhaler with him 'just in case'.

Well. 7 months later when they started rehabbing the building he was employed

in his asthma came back with a vengeance. He was taken by ambulance 4 times

to emergency rooms, twice straight from work. To make matters worse he was

declined coverage because his asthma was pre existing after they did a

background check. It took a lot of fighting with them to do a

reinvestigation of the claims that were made against his name and SS# as to

when his last attack was. We did win - and they did pay the bills but it was

a longggggggggggg process. Be as honest as you can upfront because it is a

no-win situation with insurance companies.

Hope you won't have as many problems when you come back. Good luck.......

Chicagoland Sharon

[Guest guest]

In a message dated 5/25/2001 6:50:14 AM Eastern Daylight Time,

lovetravelin2@... writes:

<< if I can get the health coverage

I need to prevent myself from winding up in debt again. Any

suggestions/experiences would be greatly appreciated! >>

Christie - My advice would be to get a " certificate of insurability " from

your current carrier. Many insurance companies will cover a pre-existing if

you can prove you were covered previously.

[Guest guest]

I wasn't going to put my two cents in here since employees of insurance

companies are sometimes looked at as fondly as IRS agents *LOL* but I

figure I might as well add something to the mix. I'm no longer in the

health insurance biz but was for about 15 years.

What Janet is referring to is part of the Health Insurance Portability

and Accountability Act of 1996 (HIPAA). When someone terminates with a

health insurance company, the company is required by this act to provide

a Certificate of Creditable Coverage which basically is a letter stating

your affective and termination dates. When you enroll with a new

carrier, if they are subject to HIPAA, they are required to give you

credit for this time period towards any pre-existing period that might

apply as long as there hasn't been a significant break in coverage

(usually defined as greater than 63 days). HIPAA, however, is directed

towards group plans only. This wouldn't apply to enrolling under an

individual plan.

If you did have a significant break in coverage or didn't have prior

coverage, a carrier can apply their pre-existing limitation to your

coverage. HIPAA does limit this to 12 months unless you are a late

enrollee (didn't enroll during first eligibility period) and then it can

be 18 months.

A previous post on this subject said, " I have been trying to find out

what other states have these laws, and how we can get around them, or

what other options I may have [text omitted]. I'd be interested to know

if any other states have the " Pre-existing " condition clauses in their

policies [text omitted]. "

One of the best sources of information, especially at the state level is

from the state insurance commission. HIAA (Health Insurance Association

of America) has a listing of all the state insurance commissions on

their web site. The URL is

http://www.hiaa.org/cons/state_insurance.html. Although HIPAA is a

Federal act, your state representatives should be able to answer your

questions and also let you know if the state has enacted any additional

mandates (which would be stricter towards the insurance company).

There was also a previous comment that read, " Also, has any found any

loopholes or other ways to cope.. (other than not giving any prior

history to your new doctor/company and thus starting with the diagnosis

all over again) [text omitted]. "

I would definitely want to caution people on this one. Omitting

information on a document that you sign stating the information is

complete and true is illegal. Worse than that, it can very possibly

result in your coverage being terminated and the insurance company can

even file criminal charges of fraud against you. It's just not a smart

thing to do.

I encourage everyone to become educated on insurance. We are the

consumers and need to research insurance just like we would research

buying a new car or a refrigerator or a camera. The part most people

don't like to hear is that along those same lines, an insurance company

is a business. They are offering a set service for a set rate. The

part that makes it harder to deal with is that we usually feel like we

have little to no choice in the matter (most employers only offer one or

two choices) and that this revolves around our health which is very

personal.

Here are some other links with good insurance information for those

nights when you can't sleep. )

http://www.nlm.nih.gov/medlineplus/healthinsurance.html

http://www.dol.gov/dol/pwba/public/health.htm

http://www.money.com/money/101/lessons/17/intro.html

http://insurance./lh/hipaa.hin.html

Judy

Janet Craig wrote:

> All I had to do was get a form (Certificate of Group Health Plan

> Insurance)

> and my next employer has no choice with the pre-existing condition. I

> hope

> this helps! I am starting a new job on Tuesday and I made sure I had

> this

> form in my hands. Also, I got them to waive my waiting period for

> INS for

> them to hire me. Alot of Options out there.

>

> Thanks,

>

> Janet

>

[Guest guest]

To Judy, , Chicagoland Sharon, Janet, and everyone else who commented

on the insurance rules & pre-existing conditions,

Thank you so much for all the helpful advice and links to the government and

insurance websites. I am planning to research all the sites and see what

other information I can find. I've had terrible luck with insurance

companies over the past 7 years and even with multiple appeals, was not

always able to get the coverage I needed. It's nice to hear from people who

have the exerience working in this industry and can give first hand advice

about the best ways to get coverage.

I hope with this information I can start to get a better understanding of

the big process, so I can learn how to function better in it. Insurance is

one of the

things we never really learn much about in school, so it's so hard to learn

how to protect yourself.

I was unaware of the 1996 law you mentioned, so I want to read through it

more carefully, so I can plan my return to the US and make sure I can have

full insurance coverage.

I'm actually trying to get full copies of all of my doctor records, so I

will have them to present to my next rheumy and have full copies should they

be needed by my future insurance company as well. However, I noticed that

most group plans in the States did not ask for copies of prior records..it

was only when I was applying for an Individual plan that such detail was

needed. Is this common to have to provide full records even for a group plan

through your employer?

Also, A few people mentioned getting a certificate of insurability. Since

I am currently in Taiwan, do you think it's likely that a certificate from

outside the US would be accepted?

I can probably get a letter to verifiy my coverage, type and also dates of

coverage. Since it would like be in Chinese, I could get it translated and

have it notarized by the American Inistitute in Taiwan (pseudo-embassay) as

being genuine. Do you think something like this could be accepted by a US

insurance company and help me to get coverage during the

exclusion period? By the time I leave here, I will have had three years of

coverage under the National Health Care plan in Taiwan.

Any suggestions/advice would be greatly appreciated!

Thanks again for all the helpful info!

Christie

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[Guest guest]

Hi Christy - I don't know how the insurance companies would handle coverage from

a foreign country and translated over to English, but I guess it couldn't hurt

to try. There have to have been other cases where U.S. citizens came home from

foreign countries with pre-existing conditions and were able to be insured. I

don't know anything about health insurance there, but maybe someone from the

U.S. Embassy could provide some info?

Good luck,