Pre-existing condition

[tbreymai]

Ohio
I was insured at the time of my diagnosis. Shortly there after I left my job and was uninsured until my current coverage began, which was a span of approximately 6 months. I was unaware of the insurance laws for pre-existing conditions until I received my first statement from the insurance company denying payment because of my "pre-existing condition". I was under the impression that insurance companies could not deny coverage for a "pre-existing condition" if the patient was insured at the time of the diagnosis. Unfortunately, I found out that there is a federal law that gives the insurance company the right to deny coverage if the patient went for a period of more than 60 days without insurance coverage. Is my understanding of this law correct? Is it true that my insurance company will not ever pay for any procedure related to my "pre-existing condition"? My condition is one that I will suffer from for the rest of my life, it may even take my life. Because of this, will I ever be able to attain health insurance coverage that will cover expenses related to my condition? It upsets me to know that, if I simply would have known of this "federal law" I could have continued coverage through the COBRA option with my last employer until my current coverage began. Do I have any options? Or am I stuck paying for insurance that doesn't cover what I need it to pay for? If I have to continue paying "out of pocket" I won't be able to afford to continue my current treatment. If any one can offer some assistance, I would be eternally greatful.

 

[cbg]

I'm a little confused by what you mean by "your understanding" but it is NOT correct that if you have insurance at the time of diagnosis, all future insurances are prohibited from calling it a pre-existing condition. It IS correct that a Federal law exists which gives an employer-sponsored group insurance policy the right to call a condition pre-existing for a period of up to one year if you had a gap of 62 days or longer between the end of one plan and the beginning of the new plan.

It is NOT correct that the carrier will NEVER pay for this condition. When you have been insured with them for one year, they will at that time pay for any covered procedures for that condition. (They will never pay for any covered procedures for that one year.) This is part of the same Federal law; as long as you signed up for coverage when you first became eligible for it, the LONGEST that any condition can be considered pre-ex is one year.

Because of this, will I ever be able to attain health insurance coverage that will cover expenses related to my condition?

Yes. The pre-ex condition clause will not stay there forever.

It upsets me to know that, if I simply would have known of this "federal law" I could have continued coverage through the COBRA option with my last employer until my current coverage began.

That's why you ask question BEFORE you make final decisions instead of acting on assumptions that have no basis in fact. This is why COBRA exists - to prevent this from happening.

Do I have any options?

Yes. You have the option of waiting out the one year period until your insurance will begin coverage for that period. You WILL have to pay out of pocket for that year; however, the same law that gives the carrier the right to call this condition pre-ex, also places a limit on the time frame.

If it had been less than 60 days since you received your COBRA notice, you would have had the option of going back and picking up COBRA retroactively. However, if it's been six months since your old coverage expired, that option is no longer available to you.

 

[tbreymai]

Thank you

I truly appreciate your feedback. After contacting ny insurance company and the HR director at the company I work for, I got absolutely no where. I am glad that there are forums such as this one where you can get advice from true professionals. Thanks again, it's good to know that there is hope for my situation.

 

[Betty]

I'm a little confused by what you mean by "your understanding" but it is NOT correct that if you have insurance at the time of diagnosis, all future insurances are prohibited from calling it a pre-existing condition. It IS correct that a Federal law exists which gives an employer-sponsored group insurance policy the right to call a condition pre-existing for a period of up to one year if you had a gap of 62 days or longer between the end of one plan and the beginning of the new plan.

It is NOT correct that the carrier will NEVER pay for this condition. When you have been insured with them for one year, they will at that time pay for any covered procedures for that condition. (They will never pay for any covered procedures for that one year.) This is part of the same Federal law; as long as you signed up for coverage when you first became eligible for it, the LONGEST that any condition can be considered pre-ex is one year.

Because of this, will I ever be able to attain health insurance coverage that will cover expenses related to my condition?

Yes. The pre-ex condition clause will not stay there forever.

It upsets me to know that, if I simply would have known of this "federal law" I could have continued coverage through the COBRA option with my last employer until my current coverage began.

That's why you ask question BEFORE you make final decisions instead of acting on assumptions that have no basis in fact. This is why COBRA exists - to prevent this from happening.

Do I have any options?

Yes. You have the option of waiting out the one year period until your insurance will begin coverage for that period. You WILL have to pay out of pocket for that year; however, the same law that gives the carrier the right to call this condition pre-ex, also places a limit on the time frame.

If it had been less than 60 days since you received your COBRA notice, you would have had the option of going back and picking up COBRA retroactively. However, if it's been six months since your old coverage expired, that option is no longer available to you.

Very good post!