health insurance issues

[al1975]

What is the name of your state? Colorado
I am finishing graduate school this month and my school health insurance will end. Unfortunately, I found out recently that I have developed a cataract in one of my eyes. Cataracts usually develop in people much older than me. It may have been caused by a blow to the eye. It has developed quickly to the point that I can't really see out of my left eye. My current insurance covers cataracts because they are considered an eye disease. I have not told them about it however (I found out through the local LensCrafters) because my policy ends this month and it is non-renewable. I am afraid to tell them because they might communicate my preexisting condition to whatever insurance agency I apply to for health coverage and I could be denied. I need to have coverage in case I need surgury. If an insurance agency knew about my eye, do you think I would be denied coverage? Can I be denied even though I have had continuous coverage? Is there any way that anyone could find out about my cataract through Lenscrafters? I'm just scared that I will be left high and dry next year, even though I have tried to everything right. Thank you for taking the time to help me out.--Ali

[cbg]

Your current insurance carrier is not going to be in contact with whatever new insurance carrier you end up with. Insurance carriers do not pass information back and forth about their insureds. For one thing, unless they had a release signed by you giving them permission to do so, it would be a violation of HIPAA. But even before HIPAA, that simply did not happen. I worked in the sales office of a national insurance carrier; you can trust what I tell you.

If an insurance agency were to know about your cataract, what they would do about it would depend on several factors. My experience is in group insurance; my response is based on group insurance. Individual insurance may be different; I cannot respond to that.

Off the top of my head I don't know if the insurance you had through the school will be considered creditable for purposes of pre-ex. But EVEN IF a group health insurance carrier through a potential employer were to consider the condition pre-existing, under the law the MAXIMUM length of time they can exclude it under a pre-ex clause is 12 months. There will NEVER be a time when a condition can be considered a pre-existing condition permanently and coverage denied altogether.

Not all insurance carriers even apply pre-ex clauses. Some of them will cover every condition from day one. You have to read the policy.

If you are completing an application for insurance; if there is a question to which a truthful answer will mean revealing your cataract and you fail to disclose it, that is insurance fraud and if caught (which can happen) can result in claims being denied and your insurance cancelled. If it is group insurance through your employer, it can also result in your employment being terminated. So it is NOT a good idea to try to hide the condition from the insurance carrier.