The thread about health care got me thinking about a friend. I’m pretty sure she has diabetes and she’s pretty much agrees that she does probably have it. She’s not treating it. When asked why, she told me it’s because she doesn’t have insurance and will soon have them when she gets a job in January. I thought it was the issue of money, it sort of is, but she told me she doesn’t want to have a "pre-existing condition ". I think waiting until January is a bit too much, but I’m not in her shoes.
Nope. First of all, health insurance that is part of employment seldom has pre-existing condition clauses. Second, and more important, if she is dead she won’t need insurance. Diabetes isn’t something to mess with.
Yeah, insurance connected with work doesn’t usually care about pre-existing conditions. It’s amazing what people will come up with for excuses to not go to a doctor and get their shit taken care of. She’s probably in denial about what it could be doing to her health.
Mine did. I was pregnant when I switched jobs and my new healthcare wanted to exclude my pregnancy as a pre-existing condition :rolleyes:
I fought and won, but still. My sister had some issues as well, that I won’t get into here, but its not unheard off with employer based health insurance.
Actually, in my experience, insurance connected with work ABSOLUTELY often has a pre-existing condition clause that disallows the condition from being covered for a period of 365 days from the first day of eligible coverage. I ran into this when I was diagnosed with Multiple Sclerosis last year.
Some idiot at my last job terminated me when I went into the hospital with my first attack. It took me approx. 8 weeks to recover and go back to work, and they welcomed me back gladly, however the termination had cancelled my health insurance, and by the time I was able to have my insurance coverage reinstated, my MS qualified as a pre-existing condition.
At my current job, I enrolled in our health plan during open enrollment, but because there are records of my MS (and that’s the biggest healthcare need I have - the meds cost about $4,000 monthly, among other issues) I will be paying for (useless) health insurance for a full year before they will cover any MS related treatments. Or migraines…or PCOS…
Employers obtain waivers excluding them from covering pre-existing conditions. Obamacare doesn’t prevent these waivers from being obtained, especially as we’re not being DENIED coverage, simply put off for a year. It also seems to be mainly service industry employers with high turnover, so I can see it from their point of view. Then I think about all the people that work just enough hours in the service industry to earn benefits specifically for the care of their current and established health concerns, and I start spitting fire.
Moral of the story - HAVE established insurance when you get diagnosed with a chronic illness.
Moral #2 - neither you nor your friend are doctors. She’s not likely to die from suspected diabetes, and if she gets ill and ends up with a dreaded pre-existing condition, there are other ways to obtain necessary health care for the year she’d have to wait for it to be covered.
There are a lot of employer policies that specifically exclude pre-existing conditions for a year. Hell, I’ve seen policies that excluded pregnancy for an entire year.
And I think the general fear of not being able to get individual health insurance because of pre-existing conditions spills over into what we think we might or might not have happen to our employer-provided policies.
I can understand the concern about pre-existing conditions. That said, there is a lot she could be doing now - improving diet and exercise, and shelling out $30 for a blood glucose meter and a month’s supply of test strips. The first step isn’t necessarily medication.
Thankfully, under the Affordable Care Act (Obamacare), pre-existing conditions will not be an issue after January 1, 2014. However, that’s still 13.5 months away.
I’m not entirely uncomfortable with her waiting until she has insurance in January or February before getting a diagnosis. The important things would be acknowledging the issue, changing her diet, taking care of herself, and working toward being able to take care of this better (ie, insurance and a diagnosis) as soon as possible. It is somewhat unlikely that it’s going to kill her in the next 2-3 months.
Yep. That’s why it’s such a big deal to have a certificate of continued coverage from your previous employer.
They can’t exclude you if you had insurance already. If you didn’t - you might well be screwed.
In the case of the OP’s friend: she should start acting like a Type II diabetic now even if she’s not going to see a doctor. By that I mean: exercise, VERY strict diet with as few carbs as she can humanly manage. Those are good things to do anyway, but anything she can do to keep her blood sugar down now will benefit her in the long and short term.
Have you consulted a lawyer regarding this? I’m quite sure there are rules about terminating an employee who is hospitalized (as in, you can’t), or at least making COBRA available.
Insurance regulatory affairs guy here - been in the biz over 17 years…
A preexisting condition is defined as a medical condition for which medical advice, diagnosis, care, or treatment was recommended or received during the XX months immediately preceding the enrollment date.
XX months = a maximum of 6. Employer option. Some do, some don’t. Rules for individual coverage vary by state. The above is federal (HIPAA).
If someone was diagnosed/treated for something a year ago, but has not received any treatment in the last 6 months, it is not considered a preexisting condition, by law.
A pregnancy may not be considered a preexisting condition in any circumstance, by federal law. But this does not necessarily apply to individual plans (varies by state) - only employer plans.
This (preexisting condition limitations) is set to “go away” for groups renewing ON OR AFTER Jan 1 2014. But it doesn’t automatically mean it goes away for everyone on that date. The majority of employer plans renew on Jan 1, but not all. Employer groups renewing after that date take effect on that date.
Also, employer plans governed by a collective bargaining agreement MAY be exempt until a new union contract is ratified.
Individual plans, on or after Jan 1 2014 may no longer deny an application based on a preexisting condition.
Regarding terminating employer coverage while you’re confined (inpatient) - this is allowed so long as the termination is legitimate, as in the employee and/or dependent ceased to be eligible under the plan. They will have a COBRA option, but they must apply within the specified time frame.
I’m thinking that the poster who was so terminated might have grounds for retroactive reinstatement of the insurance under the argument that s/he was not offered COBRA in a timely manner. Otherwise anyone dealing with a lengthy hospitalization could be subject to what boils down to a firing in an effort to save health insurance costs.
Retroactive reinstatement would, presumably, solve the issues s/he mentioned with pre-existing coverage etc.
And a lawyer might well get the former employer for wrongful termination as well…
Not to derail the current topic, but I did contact the EEOC and filed a formal complaint. While at first they were sympathetic, the next information I received was to inform me that they were suspending their investigation as they could not find any evidence of any wrongdoing on the part of my former employer.
It’s moot now. I do still have the option to file a civil suit against them, but I don’t have the time or the money to pursue reparations for what seems to have amounted to an ethical issue, rather than a legal one.