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Daughters Dilemma

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sherry randle

Junior Member
I live in Texas. I have a 38 year old daughter. My daughter was diagnosed in 2001 with a Prolapsed Mitral Heart Valve at the time of delivery of her baby. Since this time, my daughter has had gastric bypass surgery and has since developed an acute dependency on alcohol and prescription drugs such as Vicadin and Zanax. My daughter developed congestive heart failure and pneumonia last month. My daughter does not wish to pay for health insurance at all, so therefore she is not getting adequate medical care and has been told that she needs to have surgery to correct the leakage of the mitral valve in her heart. Can we still obtain insurance to cover this surgery for my daughter and if so, how?? Who should we contact?? I will accept any advise you can possibly give me.
 
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cbg

I'm a Northern Girl
Is your daughter employed, and if so does her employer offer health insurance? Is she married, and if so, is her husband employed and does his employer offer health insurance and if so, does it offer health insurance to dependents?

It will be much, much easier for her to obtain health insurance through an employer's group health insurance plan than through any other method.

If either her own or her husband's (assuming she has one) employers offer health insurance, then no less often than once per year the insurance carrier MUST allow any eligible employee and (if dependents are covered) any eligible dependents to join the health plan during what is called an Open Enrollment period. During Open Enrollment, eligible employees and any eligible dependents MUST be allowed to join the plan. They cannot be turned down for ANY reason. (Note: if she is married and looking to join her husband's plan, he MUST either join the plan or be covered already on the plan. Barring COBRA, which does not apply here, under no circumstances will a health insurance plan add a dependent without the eligible employee being covered as well.)

However, that does not guarantee that any pre-existing conditions will be covered. Not all insurance plans exclude pre-existing conditions, but if the hypothetical plan we are talking about does, she could be excluded from coverage on any conditions for which she has been treated during the lookback period. At the Federal level the lookback period is 12 months; your state MAY have a shorter one. From what I know of Texas law I wouldn't count on it. Your state insurance commission will know.

At the end of twelve months of coverage, all pre-ex conditions will be covered. A pre-ex condition cannot be excluded for longer than 12 months. (18 months in some, very limited circumstances).

There is no guarantee when an Open Enrollment period might be. While many employers offer Open Enrollment during the month of December for a January 1 coverage date, the only thing that is required by law is that an Open Enrollment period exist, not when it happen. It is generally tied to the benefit year. Traditionally the benefit year runs either January-December or July-June, but it can legally be any 12 month period the employer wants.

The employer is not under any circumstances required to allow an existing employee to join the plan outside of an Open Enrollment period. The ONLY times an employee is guaranteed entrance to the health insurance plan is at the time of their initial eligibility (usually at some point within 90 days of hire) or during Open Enrollment. In fact, if the employee's share of any premiums is taken out pre-tax or if pre-tax is an option, then the employer is prohibited by law from allowing any new enrollments to the plan outside of those two points.

If she (or her hypothetical husband) is not employed and/or her/his employer does not offer health insurance (or his employer does not offer health insurance to dependents) then it's going to be extremely difficult, if not impossible, for her to obtain health insurance. Many (if not most or even all)states (I do not know specifically about Texas) offer a plan that is available to hard-to-insure individuals. Often it is through Blue Cross Blue Shield but as I said, I have no specific knowledge about Texas. I can offer no information about potential premium cost. Talk to your state insurance commission. They should be able to tell you what options exist.

The only other suggestion I can offer is that she look into whether or not she qualifies for Medicaid.
 

cbg

I'm a Northern Girl
After re-reading your post it occurs to me that you may be asking whether or not you, as parent, can obtain now any insurance that will cover your daughter as your dependent. The answer to that, sadly for you, is no. I cannot conceive of any situations under which a parent could obtain medical coverage for a 38 year old daughter. MAYBE if you had obtained coverage for her when she was a minor AND she had been diagnosed as being incapable of self-care you might have been able to keep such a plan in place, but even if you could find an insurer willing to establish such a plan now, which is HIGHLY unlikely, the cost would be prohibitive.

Any arrangements you make with your daughter to help her with insurance costs is between you, but at this point I don't see any way she can avoid applying herself for any insurance to cover her current situation.
 

rmet4nzkx

Senior Member
sherry randle said:
I live in Texas. I have a 38 year old daughter. My daughter was diagnosed in 2001 with a Prolapsed Mitral Heart Valve at the time of delivery of her baby. Since this time, my daughter has had gastric bypass surgery and has since developed an acute dependency on alcohol and prescription drugs such as Vicadin and Zanax. My daughter developed congestive heart failure and pneumonia last month. My daughter does not wish to pay for health insurance at all, so therefore she is not getting adequate medical care and has been told that she needs to have surgery to correct the leakage of the mitral valve in her heart. Can we still obtain insurance to cover this surgery for my daughter and if so, how?? Who should we contact?? I will accept any advise you can possibly give me.
Quite frankly, your daughter has more serious issues than insurance. Your daughter has problems with substance abuse and compliance with medical treatment in general. So you will have difficulities getting insurance as CBG described.

Is she on disability?
She was diagnosed with MVP following the birth of her child, then rather than getting that repaired, she has GBS which is still a risky proceedure with other implications for someone with a chronic heart condition, compounded by the substance abuse. While you don't mention it, I would also assume she has depression and due to her noncompliance she has some nuturtional and other health issues. While she was a candidate for surgery before, has she been recently assessed for the risk? Is the substance abuse problem in check and how is her weight? Is she able to care for her child?
 

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