health insurance for pre-existing coverage

[pete123]

health insurance for pre-existing injury

What is the name of your state? Pennsylvania

I am 26 years-old. I hurt my ankle at 17 years-old lifting weights in my high-school weightroom. In non-medical terms, I shattered a bone in my ankle which required arthroscopic surgery. At the time, I was covered by my father's health insurance, i.e. Blue Cross and Blue Shield. I was dropped at 23 years-old and haven't purchased a health insurance policy since. I am self-employed. In essence, I still have an ankle condition and am a candidate for ankle replacement. I am looking for the most efficient and economical healthcare solution for the long term (i.e. health insurance for my pre-existing injury) and I want to use the surgeon of my choice from possibily another state. Should I pursue legal assistance with this matter and if so, how could it benefit me? If I buy my own health insurance policy w/Blue Cross and Blue Shield, would my condition still be considered pre-existing?

Thanks!

Pete

 

[cbg]

This is not a matter for which you need legal assistance. This is simply a matter of doing your shopping carefully. Whether this condition will be considered pre-existing will depend on what policy you buy, not the carrier you buy it from.

It will also depend on how long ago you last had treatment for it. Under the law, a condition cannot be considered pre-existing if the last time you had medical treatment for the condition was more than one year ago. In some states there is an even shorter look-back period; for example, in my state if the last medical treatment for the condition was more than six months ago, it cannot be considered pre-ex. Off the top of my head I don't know if PA uses a different standard than the Federal, but you can always call the state insurance commission and ask.

Not all insurance carriers, and not all insurance policies, include a pre-ex clause. How long have you been without insurance? Do you have available insurance through your employer?

 

[pete123]

I am self-employed and a part-time college student. I have been without insurance for three years total. I was under my father's insurance until I was 23, then they dropped me because of age and haven't purchased a policy since. I am now 26.

I haven't had treatment for my ankle since 1995, which was arthroscopic surgery. I thought pre-existing meant something you accrued in the past, no matter how far back. Now I know

Now that I'm aware (thanks you to this site and your help) I should be able to get insurance without having to worry about what I thought was a pre-existing injury. So when I apply for insurance, am I obligated to tell them that I have this problem or not? Because when my policy permits, I am going to start seeing doctors right away. I already know that I am a candidate for ankle replacement, so I know it's going to cost a lot.

Also, if I wanted to choose my surgeon, no matter his/her location, what type of medical insurance do I need to look for? If this question is inappropriate for you, whom should I ask? Is there some sort of online/offline medical insurance repository that you're aware of?

I am very thankful for your help!

Pete

 

[cbg]

Pete:

If there is a question on the application for which a truthful answer would mean telling about this injury, then do so. If there is not, you do not need to volunteer it. As I said, under the law as it stands now, if you have not had medical treatment for this condition for more than a year, then by law they cannot consider it pre-ex. This has been the law for approximately 10 years or so (I don't remember the date it became effective) so it's possible you're still thinking of the days before this law was passed. Just answer whatever questions they ask truthfully.

If you want to be able to use any surgeon you want regardless, you want an indemnity plan. Nowadays they tend to be less expensive (as a self-employed consultant it's the kind of policy I have myself) but you pay more out of pocket. Traditionally there will be a deductible and you will pay a percentage of the balance - generally but not always 20%. If you use ANY form of network plan (HMO, POS, PPO) there are going to be SOME restrictions on who/what locations you can use.

I'm more than happy to answer these questions for you. If you have any more, don't hesitate to return.