What happens to people with pre-existing conditions? Are there any options when an insurance plan won’t cover? What does one do?
Hmm…In some cases, how would they know it was pre-exsiting?
Consider something that comes and goes…
- Jinx
Sometimes, the insurance will cover pre-existing conditions after a while, just not right away. Also sometimes you can continue to be carried on a prior employer’s insurance for a while (known as COBRA) in the US. Aside from that, people are just S.O.L., or “trapped” in a current job.
Well, if I recall correctly, when my husband and I recnetly bought life insurance, we were asked if we knew we had things like heart conditions, diabetes, cancer, etc. We could lie and say “no” and eventually get busted (unless we totally changed doctors someone might figure out we knew ahead of time), or we could fess up and see what they charged us.
IIRC, every time I’ve changed jobs, I’ve had similar questions asked of me.
Plus, with the life insurance we had to have blood drawn but that was mostly testing for HIV and diabetes (they did a fasting draw).
I had to provide proof that I had coverage for my pre-existing condition up to the switch date when I changed insurance for the new company to cover me. I also had to have a proper qualifying event (I left one job and had hubby’s insurance cover me after that) and sign some papers stating that my previous insurance hadn’t been cancelled by the provider.
Different policies have different rules for when they will cover pre-existing conditions. The states also have laws about what they require insurance companies to cover.
Cobra can be quite expensive to carry for any appreciable length of time but you would need to balance that against the cost of treatment for your condition.
not only the cost of the treatment of the condition, but some companies will make your waiting period longer to cover the condition if you have a lapse in coverage.
In the US, if you are covered by an employer’s plan, the maximum length of a pre-existing condition exclusion is 1 year from the date coverage begins and a pre-existing condition is usually defined as a condition for which a reasonable person would have received treatment during the six month period ending on the date coverage begins.
This exclusionary period can be shortened if you can show that you had virtually uninterrupted coverage from a previous employer’s plan up until the date of coverage by the new employer’s plan. This continuous coverage needs to have been for at least a year to avoid any sort of exclusionary period.
For private/non-employer insurance, the insuarnce companies are bound by state law but generally may exlude pre-existing conditions forever. They may also have very broad definitions of pre-existing condition (much broader than the definition set forth above).
Finally, for private/non-employer insurance, if the insurance company thinks that your conditions (which are not pre-existing) are too expensive to cover, they can cancel your policy and then, so long as employer insurance is not available to you, you will, from then on, always have a pre-existing condition for which coverage is not available. Medicaid will rapidly become your only option.
Moral of the story: It is very expensive to be chronically ill in America and it can destroy your savings and your dignity. If it can be avoided, it should be.
Sorry I can’t give better news.
Btw, Mynn, if you really have employers ask you about pre-existing conditions, and if such conditions have ever kept you from getting a job (or keeping a job), you should speak to an attorney. You may have a claim under the Americans with Disabilities Act as well as Section 510 of ERISA. Such questions have become very taboo in an employment setting–almost like asking if you are black in a phone interview.
In Illinois, IIRC state law prevents insurance companies from refusing to cover pre-existing conditions provided there has ben a lapse of less than 60 days since the condition was covered by another insurance plan.
In practice, it’s pain in the ass to prove you were covered. Once I changed employers, and even though the new employer started coverage right away WITH THE SAME INSURANCE PROVIDER AS THE OLD EMPLOYER (BCBS), they made me provide them with a copy of my Certifiate of Coverage. And it was for allergy medication, for chrissakes! They picked up that it was a preexisitng condition becuase the prescription was a refill.
It’s not hard to prove at all. Under the terms of HIPAA, your previous insurance carrier is required to furnish you a copy of what’s called Certificate of Credible Coverage. Don’t throw it out!
Robin
I know, and I do hang onto things like that. It just seemed silly to have to provide it to the same organization that issued it in the first place. A huge waste of Claims Dept. time and mine, if you ask me.
And let’s not get into how every time I se my ortho doc about my leg, which I injured 6+ years ago, I get an 8-page questionnaire in the mail basically asking me to describe everything about the nature and cause of my injury and swear that I’m not going to sue anyone or receive any lawsuit proceeds. The statute of limitations was up 4 years ago, anyway; I couldn’t sue anyone now even if I wanted to.
I’m not positive on this score … it might be family history and or pre-existing conditions … and even so, it would have been after I’d gotten and accepted an offer and was going through the pre-employment paperwork.
The only insurance I’ve done lately is filling out life insurance forms, asking about our pre-existing conditions (maybe family history, I’ve slept since then). When I hired on to my current employer, there may have been questions, but again, it was part of the ‘done deal’ phase … offer letter sent and formally accepted. Plus we were doing both health and life insurance at the same time, so I don’t recall what questions would have been with what.
Okay.
An insurance company might have units dedicated to certain groups. Just because you kept Blue Cross doesn’t mean that they transfer records from one unit to the other. They have to drop you from the old policy and sign you up for the new policy. It’s a pain, I know, but that’s how it works.
As for the injury, what’s probably triggering that questionnaire is the diagnosis. An injury or accident diagnosis flags the computer that there might be third-party (i.e. auto, homeowner’s, commercial, whatever) liability involved. There is no way to get it to stop once and for all unless your doctor stops using an accident diagnosis. (Let’s say you hurt your knee. Instead of using, say, 836.0 for injured knee, use 717.9, which describes an old injury, and which keeps the insurance company happy.)
Robin