Pre-existing condition clause with insurance ?s about this

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
sapphireskye
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Pre-existing condition clause with insurance ?s about this

Post by sapphireskye » Mon Jan 02, 2006 2:53 pm

My husband will have his Blue Cross insurance by april. It has a pre existing condition clause for 12 months. He has asthma and high bp so those will not be covered. I suspect he may have sleep apnea also, and am wondering since he has never went to a doctor for fatigue or sleep problems.
So does this mean because this has never been documented or treated, that he will be able to use his insurance to get a sleep study done and get treated if he has apnea. To me I think it could not be considered pre-existing if he hasn't brought it up and we don't even know if he has it or not.
Any advice is welcome. This board has really helped me out so much. Once I become more experienced, then maybe I can add some of my 2 cents.

God bless
Chelle

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Wulfman
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Post by Wulfman » Mon Jan 02, 2006 3:00 pm

Chelle,

It SHOULD NOT be considered "pre-existing" if it has not been diagnosed until then (at the point his BC goes into effect).

Best wishes and Happy New Year.

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sapphireskye
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THanks Wulfman

Post by sapphireskye » Mon Jan 02, 2006 3:04 pm

I am hoping this is the case. I really think it is. And thanks for the advice.

Im off to sleepy land
NIGHT NIGHT
Chelle

HAPPY NEW YEAR TO YOU TOO !!

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Sleeper
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Post by Sleeper » Mon Jan 02, 2006 6:37 pm

That's funny... (well, not funny)

I brought that up with my doctor, about the pitfalls of having that Diagnosis of Sleep apnea and whether it can affect you negatively if you switch insurance/jobs/apply for life insurance...etc.

With regard to health insurance, he said "No, they can't turn you down, that's illegal now..." I guess they can't turn you down but they can deny you coverage, is that it?


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Swordz
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Post by Swordz » Mon Jan 02, 2006 6:42 pm

Sleeper wrote: With regard to health insurance, he said "No, they can't turn you down, that's illegal now..." I guess they can't turn you down but they can deny you coverage, is that it?
So what exactly would be the difference between turning down and denying? I'm kinda thinking thier the same thing, so help me out here!

I'm 23, and almost cried when I got turned down for insurance coverage by Assurant Insurance. They referred me to a state program here in KY, but the deductible was a rediculous 1500k. I'm in college and can't afford that, let alone the 500 deductible and 200 premium BCBS wanted. (Sounds cheap to some, but I don't even make 200 in a month!)

I really need insurance, and its going to get tough this summer when I look into MMA surgery, which runs 15k-25K outta pocket. I just got a bill for a Sleep Psychologist for $400, can you guess how long it'll take for me to pay that off?

Seriously, the healthcare situation in this country (USA) is rediculous. It's crazy that a tax-paying, law-abiding citizen can't afford ANY type of healthcare. Some one want to adopt me on thier policy!?
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Post by kikisue » Wed Jan 04, 2006 4:15 pm

Sleeper wrote:That's funny... (well, not funny)

I brought that up with my doctor, about the pitfalls of having that Diagnosis of Sleep apnea and whether it can affect you negatively if you switch insurance/jobs/apply for life insurance...etc.

With regard to health insurance, he said "No, they can't turn you down, that's illegal now..." I guess they can't turn you down but they can deny you coverage, is that it?
Hopefully this helps - there is a law called HIPPA - requires doctors to ensure your privacy, etc. but it also has a feature called "portability" of insurance. Basically, an insurance company can require a pre-existing clause. However, they have to credit you with any time you had under a previous insurance plan. For example, I was on my husbands Blue Cross until getting a new job in June. I was able to avoid the pre-existing clause by providing a certificate from hubby's BC plan. They are required to provide it to you - it was sent automatically when I went off of his insurance.

It can also reduce the time. Most insurance plans have a 12 month pre-existing clause. If you had prior coverage for 6 months, then they can only keep you from their coverage for 6 months, as they have to credit you with the 6 months in the prior plan.

sapphireskye - you are correct, if your husband has not been diagnosed or treated for a condition before, it is not considered a pre-existing condition. SO, he's best off to wait until his coverage kicks in to see the doctor about it, for insurance purposes. Hopefully that won't be long!

I've probably confused more than helped - if you have specific questions, feel free to PM me and I'll try to help more!

Karen

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sapphireskye
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Thanks Kikisue

Post by sapphireskye » Wed Jan 04, 2006 4:21 pm

We are definitely going to wait. I believe he has like 2-3 months of coverage they will have to take off of his waiting time. It isn't much. But, since his only pre existings are asthma, and high blood pressure, and the fact he had left shoulder surgery at a job for workman's comp (this job really screwed him over, later letting him go over a bogus situation in my opinion). It will be great once he gets his coverage and he can get himself checked out for sleep problems.

Thanks again
Happy 2006