Pre-existing Conditions and Health Insurance

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indigosunrise
Regular Member


Date Joined Nov 2007
Total Posts : 479
   Posted 11/7/2008 1:25 PM (GMT -6)   
I am considering a job change...the one I am at now is way too stressful!  sad
 
My main concern is, with having Crohn's, does anyone know if it can be considered a pre-existing condition?  A friend of mine said that insurances cannot do that anymore but I was wondering if anyone here has heard differently?
 
Thanks so much!

Jen77
Veteran Member


Date Joined Mar 2006
Total Posts : 2170
   Posted 11/7/2008 2:09 PM (GMT -6)   
They can do that if you go without insurance for 90 days. At least that's the way it is here where I live. DH has switched jobs in the past and we had to wait the 90 days before the insurance kicked in, which was fine. Scary though I know!
~Jennifer
 
Diagnosed with Crohn's Disease 2/06 after sever GI bleed. Has been suffering since 1998. History of rectal fistula and gallbladder removal. Taking Asacol, Questran, Toprol XL (for high blood pressure). Tapered off prednisone a month ago!


MAG102886
Veteran Member


Date Joined Jul 2008
Total Posts : 674
   Posted 11/7/2008 2:49 PM (GMT -6)   
The only type of insurance I was able to get was through the state (welfare basically) and I had to fight like hell to get it. Any other insurance company I tried would not cover anything that had to do with my crohns, dr's visits, meds, hospital stays ect until I had that insurance for 1 year, then they would cover it...because it is a pre-existing condition.  My employer doesnt offer medical benifits until 2 years of employment, but once I get it I will be fully covered under them.  I guess it just depends on what insurance your employer offers. But having Crohns is a pre-existing condition, at least thats what every insurance company has told me.

Dianogsed with Crohns at 16, 21 yrs old now.
Surgeries:2 Bowel Resections, Gallbladder Removed.
Current Meds: Humira (bi-weekly), 20mg Pred, Levbid, Nexium, B12 injections.
 

Judy2
Forum Moderator


Date Joined Mar 2003
Total Posts : 9287
   Posted 11/7/2008 2:51 PM (GMT -6)   
If you're in the US they can't do that. You get a certificate from your current employer verifying that you've had continuous coverage, and the new employer's insurance can't invoke a pre-existing condition clause. Some places do still have a 30, 60 or 90 day wait for all employees, though. They just have to treat everyone the same as long as you have continuous coverage.

It's a federal law.
Judy
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Avascular necrosis in both shoulders is my "forever" gift from Entocort.
Colazal,  Remicade, Nature's Way Primadophilus Reuteri. In remission since April, 2006.
"My life is an ongoing medical adventure"
 
Co-Moderator UC Forum
Please remember to consult your health care provider when making health-related decisions.


Chronicallyill
Regular Member


Date Joined Apr 2008
Total Posts : 195
   Posted 11/7/2008 3:07 PM (GMT -6)   
I couldn't imagine not being covered. I live in Canada and we just buy life insurance. Also the gevernment gives assitance to those who don't make enough money for medical. I don't have to pay for any meds unless its something crazy that the government won't cover. I don't ever have to worry about hospital stays either. I think I am very lucky and hope your situations get better with your employers and all :)
Age:22/6"1'/138lb - Diagnosed: 2001 @ age 15 now 22
First time mom as of March 8th 2008
Past drugs: Pentasa, Flagyl, Budesonide, Prednisone, tons of Antibiotics, Didrocal
Past herbal remedies and vitamins:Probiotics, Omega 3&6, Prenatal vitamins, B12, Calcium, iron, vit C, vit D, vit E, Selenium, mineral drops
Current drugs: Valtrex, Warfarin, Prednisone :(, 6mp :( NOT WORKING
Problems:Fissure and Tags on rectum, blood clots, ChronicUTI's, Osteopenia, Ulcers in my decending Colon
No surgeries....yet. Gone through 5 G.I.'s
Procedures: 3 colonoscopies, 1 upper endoscopy, 2 barium swallows, 1 biopsy of the fissure and tag (chron's affected)


JAB
Regular Member


Date Joined Nov 2003
Total Posts : 322
   Posted 11/7/2008 3:13 PM (GMT -6)   
What Judilyn said. I had to provide proof that I had insurance on the previous job in order for the preexisting clause to be waived on the new job.

AlwaysRosie
Veteran Member


Date Joined Jan 2005
Total Posts : 8616
   Posted 11/7/2008 3:15 PM (GMT -6)   
Hi Chronic . . . my relatives live in Canada and they say that they still have to buy supplement medical insurance to help cover their medical expenses. Not sure if that is based on income? They are just average folks. But they do have to wait a l-o-n-g time for things like radiation and surgery. They were on a list and had to wait until their turn came up. Then they had to make a three hour drive, each way, to get radiation treatment, every day.

It also seems that it depends where, in Canada, you live. Because some Canadians on the Lupus forum sound like they have really good health care.

I sure agree, though, that things are way too expensive here.

Blessings!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

Co-Moderator - Lupus Forum

UCTD, Inflammatory Arthritis, Diverticulosis, (recent dx - Sjogrens, Crohn’s 4/08)

Clickable Links:  Lupus Resources    Lupous.Org   Lupus Criteria (4 of 11)   Lupus Chapter Locator


mj8dokken
Regular Member


Date Joined Dec 2006
Total Posts : 145
   Posted 11/7/2008 3:37 PM (GMT -6)   
It is a pre-existing condition, but group insurance through your employer can't refuse you for it.

Bad flare May '06 resulted in CD diagnosis
 
Asacol: 2400 mg/day; Prednisone: 1.25 mg/day; Entocort: 9mg/day; Metronidazol
Started seeing a Naturopath-Castor Oil Packs, Liquid B Complex, Floragen, Ribes Nigrum, Herbal GI, Chlorella
 
"Life isn't about how to survive the storm, but how to dance in the rain"


Roni
Veteran Member


Date Joined May 2003
Total Posts : 2480
   Posted 11/7/2008 4:41 PM (GMT -6)   
AlwaysRosie said...
Hi Chronic . . . my relatives live in Canada and they say that they still have to buy supplement medical insurance to help cover their medical expenses. Not sure if that is based on income? They are just average folks. But they do have to wait a l-o-n-g time for things like radiation and surgery. They were on a list and had to wait until their turn came up. Then they had to make a three hour drive, each way, to get radiation treatment, every day.

It also seems that it depends where, in Canada, you live. Because some Canadians on the Lupus forum sound like they have really good health care.

I sure agree, though, that things are way too expensive here.

Blessings!

In Canada, you only need med. insurance for prescriptions and semi-private or private hospital rooms and some rare blood tests. Everything else is 100% covered by govt. No paperwork or waiting involved on our part, we just show up with our provincial health card and get treated. It's sooooooooo awesome.

My relative just had thyroid cancer and had surgery within three weeks of diagnosis. She also started radiation without waiting.
 
Another relative just had non-life threatening cancer and had surgery within 3 weeks also.
 
There may or may not be a wait, but they won't make a serious life-threatening illness wait, and if they do they can get sued if seomthing happens to the patient.
 
Chronically ill, if you just bought life insurance for yourself, I hope your insurer told you that if you die or get sick from ANYTHING that can be related to crohn's or its medications, you WILL NOT be covered. I know because I have people in my family who are insurance agents and I've looked very heavily into getting life insurance for myself.
 
 

Post Edited (Roni) : 11/7/2008 2:53:10 PM (GMT-7)


Jenn4dex
Regular Member


Date Joined Mar 2006
Total Posts : 487
   Posted 11/7/2008 4:51 PM (GMT -6)   
If there is a probationary period before benefits kick in at your next job, make sure to pay for COBRA in between so that there is no GAP in insurance or you will be denied for crohn's. 30 days is the max of a gap you can have. Been there, done it all.....
Jennifer
Diagnosed Crohns 1/06
CD of Terminal Ileum
Taking Pentasa. Adverse reactions to Remicade. Also take Forteo Injections, Actonel, Calcium and Vitamin D, B12 injections.


Keeper
Veteran Member


Date Joined Jun 2008
Total Posts : 1058
   Posted 11/7/2008 4:58 PM (GMT -6)   
Some added insurance in Canada also covers things like dental, physio, chiro, massage, acupuncture, eyeglasses and so on. My coverage is for 70% of those expenses up to an annual limit - usually something like $200 for most things, but more for some dental stuff. That insurance costs more than the premiums on the regular health care plan - last I recall it was about $130/mo.

Zanne
Veteran Member


Date Joined Apr 2005
Total Posts : 3763
   Posted 11/7/2008 5:28 PM (GMT -6)   
I don't know if this still applies, but when my husband changed jobs, we signed up for COBRA, but didn't have to pay for it if we didn't use it. Since it was only for 30 days until the new company's insurance kicked in, I was able to avoid going to the doctor and I pre-filled all my Rx's. It would have been cheaper in the long run than having a gap in coverage, but we ended up not having to pay for it at all. But this was years ago, so my info is old.
Suzanne

CD 19 years offically, 29 unofficially. 3 resections '93, '95 '97
Symptoms constantly but all tests show only minor ulcerations. Currently having multiple episodes of gastritis with no known cause.


Prednisone, 6MP,Prevacid, B12 shots, Bentyl, Xifaxan.....


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 11/7/2008 7:57 PM (GMT -6)   
Zanne is right. The amount of months you can gap varies by state I think but the usual is 90 days. You have 90 days to elect your COBRA. If you do elect COBRA you have to pay for it from the day you left your job and it covers you retroactively. So, if you will be covered under the new plan in less than 90 days don't pay for the COBRA unless you wind up needing it. If you need one $200 med it might be cheaper to pay out of pocket than a $600 COBRA payment. But like others said, don't gap because that is when you can be flagged with a pre-existing condition. Some states make it illegal for group insurers to have pre-existing condition clauses. If that is the case then you do not have to worry. Hope that helps!
27 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.


patientspiders
Veteran Member


Date Joined Jul 2005
Total Posts : 729
   Posted 11/8/2008 8:41 PM (GMT -6)   
My only tip here, Indigo, is to make sure that you have a statement of "Credible Coverage" from your current insurance. Take that statement, and make 50 copies of it!!! I'm serious. Going into a group plan with crohn's more than likely means that they're required to cover you if you follow allow the rules listed in the other posts. The thing is... that doesn't mean they won't fight you every step of the way. I had Healthlink for a couple years through my employer. They covered me, but I had to prove "credible coverage" every 3 months or so. Healthlink would just mysteriously "lose" my paperwork, and tell me that a Remicade treatment wasn't covered because it was pre-existing or some other line of nonsense. I must have faxed my Credible/Continual Coverage sheets to them 25 times. Not exaggerating. EVERY time I had a claim over a couple hundred dollars I'd have to go through the same dog and pony show.

So... get your statement... and make LOTS of copies!!! And keep good notes (i.e. names and id numbers of insurance personnel that you speak with). Good luck!
27f, dx'd CD July '05 after 6 fistula/abscess surgeries
(miscarried at 13 weeks, now waiting to heal before trying again)
Stopped Humira August 22nd, 2008.
Went Gluten-Free, noticing some definite improvement.
Started LDN October 27th, and already LOVING IT.

"Our greatest fear is not that we are inadequate, but that we are powerful beyond measure."


indigosunrise
Regular Member


Date Joined Nov 2007
Total Posts : 479
   Posted 11/10/2008 3:46 PM (GMT -6)   
Thanks everyone!

Yikes! It just scares me. I guess I will wait and see what happens...I never worried or cared a whole lot about health insurance until I got sick.
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