Insurance questions

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radian23
New Member


Date Joined Apr 2008
Total Posts : 7
   Posted 8/11/2008 10:09 AM (GMT -7)   
I've been trying to find an answer to an insurance question and you guys have been very helpful in the past so here it goes. 
 
Background: Girlfriend was diagnosed with Crohn's disease in a few years ago.  Things have gone up and down and we were able to get her Crohn's disease under control with Remicaid.  Both of us just recently graduated and she was bumped off of Blue Cross Blue Shield June 30th 2008 because of her change in dependent status.  We were planning to use COBRA to continue her health insurance coverage and decided to wait the 60 days before we notifed them (money is always an issue).  She just received a job that offers health insurance coverage with United Health Care that starts on September 1st. 
 
Questions: I was wondering if we would have problem because she has a "pre-existing condition".  Will they still cover her remicaid infusions?  I have looked into HIPPA a little bit but it is all pretty confusing and I want to find out what we need to do to make sure she is still covered.  I guess she is meeting with an insurance agent sometime next week to discuss her health care benefits but I wanted to find out any informaton which may be helpful before she see this agent.  Also would it be a good idea to sign up with Cobra to make sure she has "continuation of coverage" through the months July and August .  She is due for an infusion on the 20th but she says she should be able to hold off until the 1st.  Any information would be much appreciated. 

MikeB
Veteran Member


Date Joined Mar 2006
Total Posts : 1169
   Posted 8/11/2008 10:23 AM (GMT -7)   
Well I am no insurance expert but as I understand it, if your coverage is continuous and you move from one carrier to the next one with no gap ni coverage, the pre-existing condition issue is moot. I would first check with the new carrier and see what their rules are. If there is any doubt the best option would likely be enrolling in COBRA from the date of termination to the new start date.

FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 8/11/2008 11:01 AM (GMT -7)   
I think because the gap would be more than 60 days you may need to elect cobra to have continuation of coverage. If you elect you will have to pay june, july, and august. You can't just pay for August as far as I know. But look into it more because if her state has laws against pre-existing conditions in group plans than you might not need to worry about cobra. You can always call the insurance commission and ask.
26 Year old married female law student (last year!!). Diagnosed w/ CD 4 years ago, IBS for over 10 years before that, which was probably the CD. I am sort of lactose intollerant too but can handle anything cultured and do well w/ lactose pills and lactaid. For crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn. I also have bad acid reflux and have been on PPI's since age 13. I have been through prilosec, prevacid, and nexium. Currently I am on Protonix in the morning and Zantac at night. I also take a birth control pill to allow some fun in my life.


Bane
Veteran Member


Date Joined May 2007
Total Posts : 589
   Posted 8/11/2008 12:49 PM (GMT -7)   
If your coverage is continuous, you shouldn't have any problems. If there's a gap, Crohn's might not be covered. The way my dad tells it to me, even if you've had a gap in coverage and they claim preexisting condition, after you've been insured for a year it can't be called that anymore and they have to cover it. A year is a long time though, so if your coverage does end up having a gap and they stick you with the preexisting condition, you should try looking into some of the assistance programs offered by the company that makes Remicade, and some hospitals even have similar programs.
20, Male, diagnosed over Christmas Break of my Junior year in High School. BEST CHRISTMAS EVAR LOL

(not really)


petittarte
Veteran Member


Date Joined Apr 2006
Total Posts : 686
   Posted 8/11/2008 1:04 PM (GMT -7)   
Every state is different so you should contact your state insurance board and ask them these questions.
Jodi

Remicade and 6MP


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 8/11/2008 1:33 PM (GMT -7)   
Oh and what determines a gap differs by state. For some it is 90 days so then you would be all set. Like others said, call and make sure!
26 Year old married female law student (last year!!). Diagnosed w/ CD 4 years ago, IBS for over 10 years before that, which was probably the CD. I am sort of lactose intollerant too but can handle anything cultured and do well w/ lactose pills and lactaid. For crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn. I also have bad acid reflux and have been on PPI's since age 13. I have been through prilosec, prevacid, and nexium. Currently I am on Protonix in the morning and Zantac at night. I also take a birth control pill to allow some fun in my life.

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