Reversal and insurance

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Rodd
New Member


Date Joined Mar 2010
Total Posts : 2
   Posted 3/21/2010 4:57 PM (GMT -6)   
Thank you for allowing me to post here. It is great that places like this can be found.

I had an emergency colostomy on January 6 2010.

My surgeon is about ready to schedule my reversal. (Yay!)

Does anyone ever have an issue with their insurance on this? The first operation was obviously emergency. I guess I am paranoid that maybe the reversal is TECHNICALLY elective.

Am I worrying over nothing?

Another concern, though hopefully it won't be an issue : I work for a VERY small company (2 employees), and we end up changing insurance EVERY year, because the prices go up so much. Let's just say I haven't had my reversal by the time that happens in September. Would this be considered a pre-existing condition, and I'd NEVER get a reversal? Would a new insurance company not cover my supplies ?? (appliances etc.)

I'm being paranoid, hopefully. But I can't help it. I won't stop worrying until after the reversal actually happens. Haha. This whole thing has been so life changing.

Any answers will be appreciated.

--Rodney

summerstorm
Veteran Member


Date Joined Aug 2006
Total Posts : 6571
   Posted 3/21/2010 5:49 PM (GMT -6)   
as long as you keep insurance, there are no preexsisting clauses, IF your insurance lapses though, you will have to deal with that. So, keep cobra.
Thats how it has been explained to us anyway, my husband changes jobs alot, he keeps getting better offers, lol.
Anyway, as for the surgery, i dont know about that, i dont think it would be considered elective, i know for my ileo i had to get preapproval for them to pay.
UC for 8 years, before finally kicking its butt and having a permanent ileostomy April 17 2007! 
-I have gone to find myself, if i get back before i return, keep me here-


Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3115
   Posted 3/21/2010 6:14 PM (GMT -6)   
Yes, what summerstorm said is correct...as long as you have not had a lapse you won't have to worry about your 'pre-existing condition'...we are a small company, too, and usually change every year or so and I've never had a problem.

The doc's office will have to get pre approval, but you shouldn't have an issue...I was approved my 'elective' proctocolectomy which is a pretty major surgery that I wanted...but could have lived without...ya, right!!

Good luck w/your surgery...the reversal is way easier to recover from than the first one:) you'll do fine!

Oh, welcome:)
Crohn’s dx 1989
some terrible years before my
Proctocolectomy in 2008


Pitz
Regular Member


Date Joined Jul 2007
Total Posts : 84
   Posted 3/22/2010 10:14 PM (GMT -6)   
I had my colectomy & ileostomy last year two days after starting my present insurance. I had my takedown in January of this year with the same insurance and it was covered. I did call them beforehand, though, just to verify it was covered. As far as the lapse in insurance, you CAN have a lapse, but if it is more than 63 days, any pre-existing condition(s) will not be covered. Make sure to carry COBRA if you leave a job without any other insurance in place.

06/2002 - diagnosed w/ulcerative colitis
06/02/09 - colectomy w/ileostomy
01/23/10 - ileostomy takedown; ileorectal anastomosis


Liza D
Regular Member


Date Joined Apr 2009
Total Posts : 166
   Posted 3/23/2010 10:23 AM (GMT -6)   
I was worried about the same thing- my colectomy was also emergency. I called my insurance company before the reversal to make sure it wasn't considered elective. They said everything was in order and it wasn't elective. That's just my insurance. I would check. Also, with the supplies, check and make sure your supplier carries the new insurance if you get to that point. Health Insurance is a horrible obstacle, but the more you ask questions and the more you know, the better you'll feel.

Good luck!!
UC (Pancolitis... 90%!) December 2001
Arthritis (2003)
Upper GI Ulcer (2006)
Osteopenia (2008)
Depression/Anxiety (2002)
J-Pouch May 2009

Check out my blog: shlookshlies.blogspot.com/


summerstorm
Veteran Member


Date Joined Aug 2006
Total Posts : 6571
   Posted 3/23/2010 10:48 AM (GMT -6)   
since the new bill passed there are no longer pre exsisting condition clauses.
UC for 8 years, before finally kicking its butt and having a permanent ileostomy April 17 2007! 
-I have gone to find myself, if i get back before i return, keep me here-


Allison77
Regular Member


Date Joined Feb 2005
Total Posts : 421
   Posted 3/23/2010 3:23 PM (GMT -6)   
Cobra? please explain???

-Allie
RX Crohn's 1999, over 30 surgeries, 3 strokes, permanent colostomy and rectum removal.
 
"The most unfortunate thing that happens to a person who fears failure is that he limits himself by becoming afraid to try anything new."


Rodd
New Member


Date Joined Mar 2010
Total Posts : 2
   Posted 3/23/2010 5:21 PM (GMT -6)   
Thanks for the replies

Actually the pre-existing conditions part of the new "law" doesn't go into effect until 2014.

And Cobra.. well.. if it were affordable, that would be great. LOL. I couldn't afford to make the Cobra payments if I switched jobs.

(For the person who asked, Cobra is basically a program that by law, you have to be allowed to pay for your insurance on your own, if you leave a job for whatever reason. But this cost is pretty unaffordable for the average person). For me, it would be close to $400 per month. Absolutely NO way I could come up with that. I make $13/hour and pretty much live paycheck to paycheck.

Hopefully nothing will come up to make it a problem! haha.

I was just basically wondering if anyone had ever heard of an insurance company NOT paying for the reversal surgery. (Since I suppose it COULD be argued that it is technically elective surgery, unlike the original operation that was emergency and necessary)

Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3115
   Posted 3/23/2010 5:24 PM (GMT -6)   
cobra is where, if you've separated from your employer, you have the option to continue benefits from that employer and pay the premium yourself, to continue benefits without interruption. that WAS very important for those who have preexisting conditions.
Crohn’s dx 1989
some terrible years before my
Proctocolectomy in 2008


Probiotic
Veteran Member


Date Joined Mar 2007
Total Posts : 2832
   Posted 3/23/2010 5:25 PM (GMT -6)   
Hey, I would gladly pay $400/month for a few months, even with a credit card and minimum monthly payments, if it saved me $60-$100,000 for surgery- a tiny tradeoff. But of course, one should also investigate beforehand with the provider that they have pre-verified that insurance would authorize the coverage for the operation.
"In order to save the village organ, we had to destroy remove it" -- Medical proverb. 
 

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