Denied insurance do to sleep apnea.

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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roster
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Post by roster » Tue Aug 12, 2008 3:13 pm

Anonymous wrote:.......... They also asked what side efect of it was..
Only one: You fill so good you kill insurance agents.

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Snoredog
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Post by Snoredog » Tue Aug 12, 2008 3:14 pm

this is an example where being honest doesn't pay, having the diagnosis is worst than the disorder. I say what they don't know won't hurt them.

If I was signing up for insurance I wouldn't list anything, not even hypertension, let them diagnose and find it out for themselves.
someday science will catch up to what I'm saying...

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dreamchick
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Post by dreamchick » Tue Aug 12, 2008 3:53 pm

Rooster:

Yes and no. Cobra (The Consolidated Omnibus Budget Reconciliation Act) is Federal and was put in place by the US Department of Labor. You can read all about it here http://www.dol.gov/dol/topic/health-plans/cobra.htm.


Now, states do regulate the insurance in each state. Some states like NJ and CA have better laws than other states that said, pre-existing condition laws are federal.

You always have to check out your own state laws to make sure you are getting insurance from a company that is allowed to sell in your state. Go the State website for details.

The feds passed the pre-existing clause so that insurance companies could not flatly deny coverage to people like us forever.

"The most comprehensive of all the pre-existing condition laws, is a federal law that was passed in July of 1997. The HIPAA, or Health Insurance Portability and Accountability Act , limits the amount of time and specific circumstances under which coverage for pre-existing condition coverage and be lawfully denied to a beneficiary. Under most pre-existing condition laws, coverage for a per-existing condition can be denied for a maximum period of twelve months (eighteen for late enrollees).

Federal pre-existing condition laws help protect consumer's health benefits by limiting exclusion periods, lowering the chances of losing existing coverage, providing protection when an insured changes jobs, and a number of other benefits. There are also certain medical conditions that cannot be denied coverage under pre-existing condition laws, including pregnancy, children under 18 who have been adopted, and the like".

To read more...here is a link for you.

http://www.bad-faith-insurance-claims.c ... -laws.html

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roster
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Post by roster » Tue Aug 12, 2008 4:05 pm

dreamchick wrote:........
You always have to check out your own state laws to make sure you are getting insurance from a company that is allowed to sell in your state. Go the State website for details.

.......
Chickie,

Is it correct that an application that contains false information or that omits information about diagnosed conditions can later be legal grounds for the insurance company to cancel the coverage and deny all claims?

Thanks.

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graygables
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Post by graygables » Tue Aug 12, 2008 4:31 pm

We are self-insured. A few weeks after my now 12yo was born (normal, healthy pregnancy, normal birth, normal everything), she started having gastrointestinal issues that required a few hospitalizations and LOTS of doctor's visits and specialized formula. Her claims were denied as having a "pre-existing condition". When asked how a healthy newborn could have a "pre-existing condition", I was informed that my uterus/body was obviously NOT the best environment for her and she was somehow flawed in utero. There was NO getting through to these you-know-whats. When we recently switched insurance, we were told that they had checked my girls' medical records and since they'd had colds, there would be no coverage of anything to do with the upper-respiratory system, including the throat. Just for the record, there would also be no coverage for office visits or prescriptions with a $6000 per person deductible ($18000 per family) and $500/month. Ummmm. No.

Don't even get me started...

I hope you get it sorted out and I'm sorry it's a mess for you. Self-employment in America sucks which is why I'm closing my business and am looking for a job right now.

Guest

Post by Guest » Tue Aug 12, 2008 5:26 pm

My new plan is to find some one to marry for health insuarance. If she needs a green card it will be a win win.

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sleepycarol
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Post by sleepycarol » Tue Aug 12, 2008 5:43 pm

When we had Teamster's Insurance (had it for 28 years) and had a problem and called our state about the problem was told that since Teamster's carried their own plan they did NOT come under the normal regulations. Sorry!!!

Good grief it seems like you can't win no matter what you do!!
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I am not a doctor or other health care professional. Comments reflect my own personal experiences and opinions.

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dreamchick
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Post by dreamchick » Tue Aug 12, 2008 6:31 pm

rooster:

Yes, you are correct. Omitting facts or misrepresenting them is considered insurance fraud and could result in the retroactive cancellation of your health insurance policy. In some cases, physicals are required in order to obtain health insurance, but this is certainly not a universal policy.

If you are having problems with pre-existing condition then here is a site to check out. It is Insurance for pre-existing conditions. http://www.healthquote360.com/Individua ... itions.php

Know your rights. Because insurance matters are regulated by each individual state, there may be certain resources and provisions in place to help you find and keep insurance coverage. Find your state’s life and health insurance information by checking out InsureMe’s state articles.
http://www.insureme.com/content/state/

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dreamchick
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Post by dreamchick » Tue Aug 12, 2008 6:33 pm

graygables:

What state are you in can you get insurance for your children from the state?

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roster
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Post by roster » Tue Aug 12, 2008 8:50 pm

Insurance seems to be a good business. You collect money (premiums), you give no money (benefits) back.

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Re: Denied insurance do to sleep apnea.

Post by JB91361 » Wed Aug 13, 2008 6:15 pm

I just went through this song and dance myself. I also live in California.
Here's how you want to do it (if you have pre-existing conditions and want to remain covered for those conditions):
1) Elect to have COBRA coverage, and keep it for the 18 months until it exhausts.
2) If your employer is home-based in CA, you can extend COBRA using "CAL-COBRA" for I think another 18 months.
3) Once COBRA (and CAL-COBRA) is exhausted (and you MUST exhaust these options first), you can apply for an individual "HIPAA coverage" plan from most major employers (I went with Aetna). The insurance companies don't advertise these plans because they basically don't want to sell them, but Federal law requires them to offer it. It isn't cheap, but it's your only option to avoid pre-existing condition clauses. Ask for "HIPAA Plans" when you inquire.
In all cases, YOU CANNOT LET YOUR COVERAGE LAPSE for more than (I think) 61 days between plans or all bets are off. Also, miss a payment, and they drop you and don't have to reinstate you.

[Disclaimer: This is how I think it works, and I'm not an insurance or legal professional....Do your own homework to be sure.]

Good luck....

Guest

Re: Denied insurance do to sleep apnea.

Post by Guest » Wed Aug 13, 2008 6:40 pm

I was denied also, but finally got insurance with Aetna (Florida) but the catch is that they uprated me by 50% so I am paying $650 monthly for health insurance and I have a $1500 dedictable so I really don't go to the doctor very much. I am just using it for catastrophic protection

jcdenton22
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Re: Denied insurance do to sleep apnea.

Post by jcdenton22 » Tue Jul 21, 2009 7:41 am

these people helped me when i needed insurance http://www.cheap-insurance.biz

drubin007
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Re: Denied insurance do to sleep apnea.

Post by drubin007 » Tue Jul 21, 2009 8:02 am

As has been said, I am sure it varies by State, and also has been said, our health care system sucks ass....

That all being said, my 2 cents to add.

When I lost my job (a year and a half ago) cobra was cost probihitive (I think it was like 1200 a month for the family?)
it was not an option... as I type this, I am thinking it might have been when I lost the job before that, maybe about 2 years earlier? hard to keep track In any event, tried to get private insurance on me and the family...
the wife was denied because they said she had lupus. We were like she has what? (No clue she was diagnosed, did not even know she had it). Apparentally there is 2 kinds of it, the not so bad kind and the really bad kind... As luck would have it, she has the really bad kind. Long story short, she is (in the words of the guy who sold me insurance: "uninsurable"). No Insurance company will write her any type of policy except for a group plan. She is perfectly healthy, fine and nothing wrong with her (She is sensitive to extended periods of Sun, and this is South Florida, but she manages). She has only had 1 "flare up" which made for a bad weekend where she prayed for a fast death, and she is on meds she seldom takes, but because of that diagnosis she cannot or will not ever get private insurance. now that I have been diagnosed with OSA I guess I am in the same boat... great... before I got the job I have now, I had disaster insurance on me and the kids, wife was flying blind and hoping to stay healthy... Now if we need insurance again it should be interesting... (and I am not giving up my love for riding sportbikes either!)

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Post by jdm2857 » Tue Jul 21, 2009 9:08 pm

dreamchick wrote:

As the laws exist today, you can never be without insurance again or they can exclude coverage for your sleep apnea for the next 12 months.

Pre-existing condition limitation: For the first 12 months following the enrollment date of your coverage, they will not pay for: Conditions for which medical advice, diagnosis, care or treatment was recommended or received during the six months before enrollment. As well as, conditions for which during the last six months there are symptoms, which would cause a prudent person to seek medical advice, care or treatment.
This is an excellent description of insurance rules in New Jersey. Every state has different rules, so these may or may not apply to you.
jeff