ANA Discussion Forum
General Category => Insurance => Topic started by: fbarbera on July 10, 2008, 02:32:12 pm
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Hi,
I am wondering if anyone with an AN has had the experience of trying to obtain private health insurance coverage that is not part of a group health insurance plan.
I was diagnosed and treated with Cyberknife while insured by my current employer. If I switch jobs, my understanding is I will be fine so long as my new employer covers me under its group health plan and there is no lapse in coverage. What I am not so clear about is what happens if I decide to become a freelance consultant, not covered under an employer's group plan? I know I can extend my current coverage thanks to COBRA, but what about after that? Will I be able to find private health insurance that will cover my preexisting condition, i.e., ongoing monitoring of my AN?
Would love to hear from anyone with experience dealing with these issues.
Thank you.
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great question... and I'd be curious on that, too. I know, in the past, due to other pre-existing that I have, I've been questioned about life insurance (for personal/own policy)... at that time (a while back), the pre-existing notation was for a year (based on the firm that was doing the life ins policy).
I'd love to know answer to your question as well... will lurk here to see who knows.
Phyl
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During the time period of my husband's treatment we switched in the middle of everything. Husbands former employer was changing to a new company and had no idea what it would be or more important, which doctor's would be covered. This was post main surgery, with residual surgery scheduled. We went from a group insurance covered thru his employer to a private insurance.Blue Cross (Boy, it cost 2 arms and legs) without any hitches. One coverage ended the last day of the month, new coverage started the first of the month. Because there was no lapse in coverage (down time) there was no pre existing clauses, and regardless of his health, the insurance company could not refuse him. In fact he had residual tumor surgery within 3 weeks of the start up of new coverage. I don't know if this varies from state to state.
I was cautioned that it was extremely important that coverage remained continuous. Had coverage laspe, even for a very short time then that would of changed the ballgame totally. Had coverage lapsed then the pre existing clause and the fact that he could of been turned down would of come into play.
Your State Insurance Commissioner, or a trusted Insurance agent should be able to let you know where you stand.
Best to you
Raydean
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During my cobra coverage I tried to get insurance on my own. I tried 3 different companies. Two well known, one smaller. I was turned down by all three. It was very frustrating because the agents all acted like I would get their coverage. Two told me that I might get a 6 month rider on my condition, but be covered after that. I had to give a deposit of one or two months. I got it back though. The smaller company only sent me back half so I had to fight to get back the rest. My neighbor is a supervisor for Met Life, and told me I probably wouldn't be able to get insurance on my own. So I continue with my employers medical which cost me $660 a month with a $1100 deductible. Only saving grace is I met the deductible in 4 months.
mema
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When my husbands place of work switched from Cigna to BC BS of Tennessee July first , I had to fight to get coverage for anything associated with the AN...this even though we were told it would be a seamless transition ...old coverage ended at midnight and a minute after new picked up... over all the new policy doesn't pay as well as Cigna did , but it was determined that anything AN would be cover and not classified pre-existing
AS Raydean said , check with your State Insurance Commissioner
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It is so absurd that a "lapse in coverage" should have all these grave consequences. You'd think we were playing some stupid video game rather than dealing with real people with real health issues. What kind of health care system do we have in this country where if you let an extra day go by all of a sudden your brain tumor is uninsurable? Somehow we have let insurance companies create this absurd and inhuman health care system. Sometimes I am amazed at the the things we put up with.
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It is so absurd that a "lapse in coverage" should have all these grave consequences. You'd think we were playing some stupid video game rather than dealing with real people with real health issues. What kind of health care system do we have in this country where if you let an extra day go by all of a sudden your brain tumor is uninsurable? Somehow we have let insurance companies create this absurd and inhuman health care system. Sometimes I am amazed at the the things we put up with.
We 'put up with it' because insurance companies pay most of the medical bills in this country and they have rules we agree to abide by when we sign up for a policy. I don't believe that our health care system is anything close to 'inhuman'. That's a bit of an exaggeration. Sometimes absurd? Absolutely. Not covering some preventative measures but then covering expensive surgical procedures that result from a lack of preventive medicine is definitely absurd. Happens all the time.
I'm no fan of insurance companies. I don't work for or hold any stock in insurance companies - but it's up to the policyholder to read his or her policy language and know what is covered and what isn't and what the 'rules' are, so to speak. If you rely on your health insurance to pay most of your medical bills and know that allowing your policy to lapse for ONE DAY will invalidate your coverage, it is essential that the policyholder do whatever is necessary to guarantee that the coverage is not allowed to lapse...ever.
It's always easy to rant about our health care system - the best in the world - and figuratively shake our collective fists at insurance companies. Unfortunately, I've often noticed that the people complaining the loudest simply haven't held up their end of their 'bargain' with their insurance company and/or never looked at or tried to understand their policy limitations and exceptions until their claim was denied. I'm the first to admit - from experience - that our health care system has definite flaws and the health insurance business is sometimes inconsistent and poorly regulated. I've had a few hassles with my insurer but always made sure I knew what my policy stated about a specific charge, procedure or whatever before I picked up the phone and dialed their Customer Service number to protest something. I usually 'won'. Many folks simply won't take the time and just complain to others instead of where their complaint might actually do some good for them - to the insurance company.
I believe a government-run health care system ('universal coverage') would be far worse with no real recourse for the average citizen who might be dissatisfied. I think a 'single payer' system (an unaccountable government bureaucracy) would end up giving us rationed care and few choices as to what doctors or hospitals we can employ. The taxes needed to pay for medical coverage for over 300 million people would be astronomical and we would very likely be far less satisfied than we are now. That being the case, I'll grumble about our health care/insurance system along with everybody else, but I have no real desire to trade it for a 'universal' system run by government that I think would be far worse in many respects. Of course, this is simply my opinion and I could be wrong - but I doubt it. :)
Jim
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in my case I was told by the insurance rep that they told people that serious things were going to pre-existing
status and that many people just accepted it and didn't fight them ... a ploy to get out of paying some claims ...
I went in fighting and had our PR person working with me as her husband with heart issues also got a notice
he would not be covered...
Also in my case we were not given a policy or choice to go over ...just told this is how things were like it
or lump it ... either take what was given or go out and get insurance on our own... the coverage we now have
would be almost double to buy ourselves without group rate...but fought and for most part won ...
as for universal health care ...have a friend in England who says that although she doesn't have big medical bills ,
the wait to see anyone about anything other than simple illnesses is often so long that the patient is in bad
shape before anything is done... she has lupus and when new problems come up may have 3 months or
so to get in to a specialist that her rheumatologist recommends
No good answer in my opinion... if you think you have been wronged by the insurance company don't give up the
fight to get things worked out ... if you don't challenge them they assume you are totalay happy
I am not as unhappy as I was but still not super happy about our change
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It is so absurd that a "lapse in coverage" should have all these grave consequences. You'd think we were playing some stupid video game rather than dealing with real people with real health issues. What kind of health care system do we have in this country where if you let an extra day go by all of a sudden your brain tumor is uninsurable? Somehow we have let insurance companies create this absurd and inhuman health care system. Sometimes I am amazed at the the things we put up with.
I believe this is just one of the reasons HIPAA (health insurance portability and accountability act) was put into place. As long as you remain covered, without a single day lapse in coverage, your insurance and existing conditions are usually covered (under the terms of your new policy benefits) without being termed preexisting when you move to another group coverage policy. This is actually an improvement from previous years prior to HIPAA where an employer could find out you had a medical condition, penalize you by firing you or denying you insurance and you became instantly uninsurable. Because of HIPPA...the portability part makes you able to change jobs and insurance without being penalized. Otherwise, you could be stuck working at the fish hatchery or cell phone store all of your life for fear of losing your insurance or being denied because you previously had been diagnosed with a brain tumor. ;) While extremely expensive, I admit I paid for COBRA insurance to cover a two day gap from a previous employer's insurance plan until the start date of my next employer's plan. Peace of mind was worth the $800 (8 years ago) because an accident or illness would have cost more.
Unfortunately a lapse in coverage is just that. No coverage. If your house burns down or you are in an auto accident and your insurance has lapsed, you are stuck. It always pays to know your rights and the terms of coverage because insurance companies may try to tell you otherwise. Getting things in writing never hurts.
Private insurers have more of an opportunity to exclude you or charge you higher rates because they are private, not group policies. You are specifically seeking them out to insure you and they tend to be more choosy as to who they will insure and under what terms.
Also know that each human resources department chooses the policy and benefits for the company. Just because two companies next door to each other offer Blue Cross and Blue Shield and charge you the same out of pocket per pay period, the actual policy may look very different. My policy may cover something yours does not, or co-pays or deductables may vary, depending on the agreement your employer signed with the insurance company. Just like ANs, no two are alike.
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I believe this is just one of the reasons HIPAA (health insurance portability and accountability act) was put into place. As long as you remain covered, without a single day lapse in coverage, your insurance and existing conditions are usually covered (under the terms of your new policy benefits) without being termed preexisting when you move to another group coverage policy. This is actually an improvement from previous years prior to HIPAA where an employer could find out you had a medical condition, penalize you by firing you or denying you insurance and you became instantly uninsurable. Because of HIPPA...the portability part makes you able to change jobs and insurance without being penalized. Otherwise, you could be stuck working at the fish hatchery or cell phone store all of your life for fear of losing your insurance or being denied because you previously had been diagnosed with a brain tumor. ;)
Couldn't have said it any better myself, oHIo.
I also agree with Jim and Soundy. I never realized the "freedom" I had here in the U.S. until I read all the posts by patients in Canada who have to wait months and months for a surgical date. I wonder if Denise (denisex2boys) is still waiting ???
Jan
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There can be no direct comparison made between the States and Canada, not only because of private vs. public, but also because of the population size. Don't forget that we are only about 32 million (I think?) spread very thinnly across the country. The number of doctors and specialists is less as well (not to mention all the specialists that pack and leave for the States, because they can make so much more money there). Given this, I would say we are very fortunate to have access to top notch services, even if it means that waiting times are longer. And you are never left waiting if you are faced with a life-threatening condition.
Needless to say, I am always dumbfounded by the complexities of private insurance and I am amazed that you guys are able to figure it out so well!
Marianna
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Needless to say, I am always dumbfounded by the complexities of private insurance and I am amazed that you guys are able to figure it out so well!
Marianna
I have yet to figure mine out ... and it gets worse every day :-\
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Don't get me started on preex mess. The one time I had to go off of group coverage and get an individual plan, I thought I would go nuts. It was definitely a learning experience and I've worked for insurance companies for 10 years now. Long story. I kept COBRA for as long as I could which was very expensive, then ended up back on group coverage. Again, long story not worth going into. But when trying to get an individual plan, I applied to BCBS. When I received the information and exclusion letter I was floored. The average person wouldn't have understood the letter to begin with. The exclusion letter included icd-9 (diagnosis) codes only with no descriptions. After reviewing all the codes, I was being excluded for conditions that I as a nurse had never heard of. In short, if you've had a particular diagnosis, the exclusion can include just about anything within that same body system. When I questioned the letter, I was told that most people signed the exclusion letter because they basically had no other option. With preexisting conditions, if you've been diagnosed or treated for a condition within a year prior to getting the individual coverage or if there had been a lapse in coverage of greater than 60 days, they aren't required to cover any treatment for this condition for 365 days. At least that's the way the plans worked at the companies I've worked for. If for whatever reason you lose a job/group coverage, you have 60 days in which to apply for COBRA.
site regarding COBRA:
http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html
From what I've found in general, the larger the company, the better the insurance benefits. Every individual needs to understand what coverage they have but unfortunately most don't until they need it.
I do consider myself very fortunate to have had good coverage while being treated for this AN.
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I agree TOTALLY with you, Jim.
You said everything very well.
Lacey
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Are you guys talking about problems with coverage BEFORE treatment or AFTER treatment?
I can understand an insurance company being reluctant to insure an individual that has an AN prior to treatment, but post treatment bills should hopefully be somewhat more limited.
You've got me worried.
I have Aetna HMO as an individual. It's getting very expensive. So I was thinking of switching at some point after surgery (maybe 3-6 months or so after). I didn't realize that I might have some problems doing that. I'm single. So I can't get on a spouse's coverage. I also can't get onto a group plan at work because I'm not in the Union and won't be able to get in for several years at a minimum.
Suppose I did get married, would I still have trouble getting insurance via my wife's group plan?
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Are you guys talking about problems with coverage BEFORE treatment or AFTER treatment?
I can understand an insurance company being reluctant to insure an individual that has an AN prior to treatment, but post treatment bills should hopefully be somewhat more limited.
You've got me worried.
I have Aetna HMO as an individual. It's getting very expensive. So I was thinking of switching at some point after surgery (maybe 3-6 months or so after). I didn't realize that I might have some problems doing that. I'm single. So I can't get on a spouse's coverage. I also can't get onto a group plan at work because I'm not in the Union and won't be able to get in for several years at a minimum.
Suppose I did get married, would I still have trouble getting insurance via my wife's group plan?
wcrimi:
There is no definitive answer. There are a couple of factors involved; how long since your surgery, your prognosis and, most importantly, what the company's policy is regarding 'pre-existing' health conditions. That can be discovered via their website or through an agent, but you must see the policy language in writing before making a switch - and be certain you understand the 'legal' language, which can be (purposely) confusing. I understand that there are many 'groups' that accept anyone as a member (no specific job or professional position required) and offer health insurance at the 'group' rate. Just a suggestion but because health insurance is both expensive and necessary, something you may wish to look into. I'm sure other folks will have more ideas about obtaining health insurance that avoids the 'pre-existing' obstacle.
Jim
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Thanks Jim. All I can do is pray I have a successful surgery and can go back to work in a couple of months. Perhaps I can look for a new job with coverage and get into a group plan that way.
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I would like to add another string to this important discussion. IF you are a person and considering either Cyberknife or Surgery but have not decided which, does the problem of having a pre-existing condition after Cyberknife but NOT after surgery make a difference? That is, a big enough difference when contemplating future issues with insurance companies? With surgery, assuming it is successful and following MRI scans are clean, one does not have a pre-existing condition to worry about, right? However, with Cyberknife, you need to follow up with MRI's forever with the small prospect of salvage surgery if the tumor begins to grow. So you do have a pre-existing condition. What are your thoughts?
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I don't agree that there is much distinction between radiation and surgery in this regard. Radiation does mean watching closely at first, to verify that the treatment has worked, but that is basically over in a couple of years.
Once you are 3 or 4 years past radiation treatment, your chance of regrowth is about the same as for surgery. It happens occasionally with both treatments, sometimes as much as 20 years later. CMP on this site just had a second surgery this year, following a surgery in 1988. It is probably a good idea for all AN patients to have a checkup from time to time for the rest of their life.
Steve
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The original question was regarding being covered from a group plan to an individual plan. Maybe I missed the post that directed an answer that way. Most replies were changing from group coverage to group coverage, with or without a lapse in between. Has anyone inexperienced changing from group coverage to individual coverage? I'd like to retire early and I am researching my potential insurance costs. If I go from my current group coverage (Blue Shield California) to individual coverage and stay with BS CA, will I still have to deal with preexisting conditions?
Thanks in advance for your insights.