pre-existing conditions

[ctom]

my husband has been diagnosed with barret's esopogus and is considering having an operation done to remove his esopogus. our hmo will not allow him to go out of area if they feel there is a qualified dr. in our area. as we see it there is not and they still will not approve an out of area dr. this surgury is only being considered until we get advice from some specialist at jefferson university and john hopkin's. we are self employed and are considering getting a different health plan which is not a hmo. can they deny us insurance because he has barret esopogus. note he does not have cancer and they keep a watch on him by scoping him yearly. surgury has just been recommended to prevent cancer but at this time is only being considered. if we get approved for another health insurance can they refuse to pay for the surgury w/i the 1st year.

 

[ALawyer]

This is not a definite answer but it appears that as you are not covered under an ERISA plan, unless you have some state law that provides specific rights, the new carrier can apply any underwriting criteria it wishes and any waiting period in permitted in its policy.

From the perspective of a health insurer, you are someone they do not want to cover as your participation in their plan will almost guarantee a very substantial loss. I am sorry, but that is they way it is. They are in business to make money, as are you.