insurance nightmare

June 6, 2004

hi to all, first of all welcome to everyone new, and WAY to GO Janet!!!

congratulations!! get your disability is wonderful news!!!

ok, I am currently stuck in insurance hell. My hubby's company decided to chg

insurance plans. Could not find a " group " plan for the 3 people wanting coverage

in this small company so we were all forced to find individual plans and the

company will still pay a nominal amt of the premium. Ok, no problem...called up

Anthem, applied, the Agent said due to the fact we were coming off a group

policy and due to my PA being so very mild, should not be a problem getting me

covered. WELLLLLL, not so much was he right. He was stunned as was I when 10

days later they denied me, and suggested I seek High Risk Health Care coverage

offered by my state. Unbelieveable. I did not know they could turn you down if

you were coming off a continuous group policy. Fortunately, my Rheum was willing

to write a letter saying due to limited symptoms he is not willing to Dx me as a

PA patient ....of course that was my dx code for the last several mos, BUT, he

says clinically I don't necessarily fit the bill and my Tx has been ultra

conservative. God love the man!!! NOW, we appeal and wait. WORST case

scenario...I have to be untreated for 12 mos in order to reapply and not have P

or Pa count as a pre x condition.

nice huh?

annie and the pugherd

RE: [ ] Hello from newbies friend Emma

Dear Emma,

You have the right spot for good and bad times. We have plenty of both

here. I'm sure you and your boyfriend are nervous and scared with the early

diagnosis. Try to remember the best thing to happen to you is to find out

what is wrong. So many of us have gone years without knowing what was

causing our pain, while our joints continued to fall apart. Learning the

diagnosis, while can be depressing can still be a positive step. It took

over 5 years before I found a doctor who knew what I had. I felt like

kissing him.

I wish I could say I was clear and free today and things were going great.

I still haven't found the right medication to stop my disease and the

symptoms. I'm not giving up though and know there has to be something out

there to help me. I just haven't found the right thing yet. Tell your

boyfriend if he isn't happy with the rheumatologist and feels like he didn't

get a good diagnosis to please go to another one. There are so many doctors

out there who just don't take the time and who tend to group people into

categories and not let them out. It never hurts to get a 2nd opinion on

something this big and so important.

Take care and remember that life goes on even with PA. It is different, and

I would much rather not have it, than have it, but I still find things to be

thankful for each day and ways to be happy. Hopefully if he has it at all

it will be a mild case. Take care and let us know what happens. Good luck

to both of you. Love, Fran

June 6, 2004

oh brother, I thought the only way they could deny was if you hadn't had any

ins. coverage?? Geepers... I'm sorry to hear you have to go thru this

[ ] insurance nightmare

> hi to all, first of all welcome to everyone new, and WAY to GO Janet!!!

congratulations!! get your disability is wonderful news!!!

>

> ok, I am currently stuck in insurance hell. My hubby's company decided to

chg insurance plans. Could not find a " group " plan for the 3 people wanting

coverage in this small company so we were all forced to find individual

plans and the company will still pay a nominal amt of the premium. Ok, no

problem...called up Anthem, applied, the Agent said due to the fact we were

coming off a group policy and due to my PA being so very mild, should not be

a problem getting me covered. WELLLLLL, not so much was he right. He was

stunned as was I when 10 days later they denied me, and suggested I seek

High Risk Health Care coverage offered by my state. Unbelieveable. I did not

know they could turn you down if you were coming off a continuous group

policy. Fortunately, my Rheum was willing to write a letter saying due to

limited symptoms he is not willing to Dx me as a PA patient ....of course

that was my dx code for the last several mos, BUT, he says clinically I

don't necessarily fit the bill and my Tx has been ultra conservative. God

love the man!!! NOW, we appeal and wait. WORST case scenario...I have to be

untreated for 12 mos in order to reapply and not have P or Pa count as a pre

x condition.

>

> nice huh?

>

> annie and the pugherd

>

June 6, 2004

thanks...that is what I thought too!!! It was my understanding for such a long

time, that if you came off group coverage as long as the break was less then 53

days the most they could do was penalize you for 12 mos before they would cover

costs for the pre x conditions.

oh well...I sure hope this appeal works. this is so frightening to me!! I can't

imagine going without coverage or treatment!!!

annie and the pugherd

[Annie, you might want to give your State Insurance Commissioner a call.

Sometimes people who work for insurance companies don't know what they're

talking about. A simple call to your insurance commissioner will either confirm

that your insurer was within their rights to deny you coverage OR will get you

the insurance we think you deserve! Best of luck. Kathy F.}