Insurance / Pre Existing Condition

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JennInPA
Regular Member


Date Joined Sep 2009
Total Posts : 228
   Posted 12/11/2009 7:28 AM (GMT -7)   
I'm confused as I've never been through this and now that I lost my health insurance I'm freakin out. Is it true that now that I have a pre-existing condition that no insurance will cover my Lyme related costs in the future? So when I get a new job, it won't be covered???
“You must be the change you wish to see in the world.” -Gandhi

http://lymeactually.blogspot.com/


JennInPA
Regular Member


Date Joined Sep 2009
Total Posts : 228
   Posted 12/11/2009 7:31 AM (GMT -7)   
one more thing. When I applied for Medical Coverage through the state, they told me I don't qualify because my unemployment is too much. But they asked if my Lyme medicine was "health sustaining" meds? I didn't know the answer. I mean I feel like they are but.... I dunno.
“You must be the change you wish to see in the world.” -Gandhi

http://lymeactually.blogspot.com/


JELAINEP
Veteran Member


Date Joined Sep 2007
Total Posts : 2017
   Posted 12/11/2009 9:49 AM (GMT -7)   
Hire a lawyer ASAP. In the end, it's the only way anything is going to get done anyway.

Usually when you start a new job you don't have to fill out a health questionaire for medical insurance... it' just "Yes, I want Coverage" -or - "No, I don't". Therefore, no pre-condition issues..... BUT BUT BUT - read the policy and if you don't understand it, talk to someone at your job who handles the health benefits.

If you fill out a medical questionaire and have to answer questions about LD, chances are you'll either be denied all coverage or you'll be covered except for anything LD related.

I consider my LD meds. to be life sustaining..... I also think that question is odd, icky, and maybe illegal. I'd question them on that one... eeewwwww.
Never doubt that a small group of thoughtful, committed citizens can change the world... it's the only thing that ever has.-Margaret Meade

JennInPA
Regular Member


Date Joined Sep 2009
Total Posts : 228
   Posted 12/11/2009 10:27 AM (GMT -7)   
He wanted to know if my meds were life sustaining because then I would qualify for medical coverage regardless of my income. I just wonder who makes the decision wether it's life sustaining or not.
“You must be the change you wish to see in the world.” -Gandhi

http://lymeactually.blogspot.com/


Willowrose
Veteran Member


Date Joined Oct 2009
Total Posts : 699
   Posted 12/11/2009 1:40 PM (GMT -7)   
Probably your LLMD could substantiate that your Lyme meds are life sustaining. That doesn't sound like a question for the patient. Would your doctor support that?

Rose
I have Lyme; it doesn't have me.


Dagger
Veteran Member


Date Joined Apr 2008
Total Posts : 1522
   Posted 12/11/2009 2:29 PM (GMT -7)   
The insurance companies act like Lyme is a simple, easy to cure illness UNTIL it's a pre-existing condition. Then every single problem you have becomes Lyme related and they won't cover it. I had a problem with this a long time ago.

I have not had any trouble with pre-existing conditions when I've started new jobs, like JelaineP said, they just asked whether or not I wanted it. I did run into trouble when I worked for a small company and they wanted to switch insurance companies. The new company would not cover any Lyme related claim for the first year. The agent was pretty nice, he looked up the symptoms of Lyme and said that basically, they would not cover ANY medical claim I had in the first year since it could all be blamed on Lyme. I told me boss I'd have to leave the company if he switched companies. Fortunately, we were a small company and my boss needed to have four employees to get the group rate. Without me, they'd lose the group rate anyway so they wouldn't save any money by switching.

Unless you are trying to get private insurance, you should be ok. You may find it difficult or impossible to get life insurance or short term disability insurance though.

rcenters
Regular Member


Date Joined Oct 2007
Total Posts : 259
   Posted 12/11/2009 6:16 PM (GMT -7)   
Actually, I have a question about pre-existing conditions as well. I was reading something that the lookback period for group health is like 6 months...does that mean if you have had something for a very long time and have not seen a doctor about it for more than 6 months, that it won't be considered a preexisting condition that they can exclude?

JennInPA
Regular Member


Date Joined Sep 2009
Total Posts : 228
   Posted 12/11/2009 6:56 PM (GMT -7)   
ohhh rcenters, I wonder! I hope someone can answer that!! Because it's only been 4 months for me.
“You must be the change you wish to see in the world.” -Gandhi

http://lymeactually.blogspot.com/


rcenters
Regular Member


Date Joined Oct 2007
Total Posts : 259
   Posted 12/12/2009 6:57 AM (GMT -7)   
Here is what I was reading:
http://www.bad-faith-insurance-claims.com/pre-existing-conditions-law/

But the way I understand it this only applies to group plans...individual ones are different and every individual plan I applied to has asked for things up to 5 or 10 years ago and if you have anything they will simply decline you to begin with.


In my own case I am wondering because I have a lipoma that needs removed and I will be able to go on a group plan in 6 months. If it's a pre-existing condition that can be excluded, then that technically means I can't get it done for 18 months(since they can exclude pre-existing conditions for 12 months). On the other hand though, I last saw a doctor about this in Nov 2007, and that's more than 6 months ago. I, of course, know that I have had it and any doctor would know that it has been there...so what I am wondering is whether the fact that I haven't seen a doctor about it in more than 6 months constitutes a legal loophole that means they can't make me wait 12 months.

+Lyme
Veteran Member


Date Joined Apr 2009
Total Posts : 1304
   Posted 12/12/2009 8:15 AM (GMT -7)   
Maybe all group policies are different, but I've changed jobs 3 times and never had to answer to pre-existing conditions. 
 
 As others said above, I had to accept it when it was offered or I would have to answer to pre-existing and other questions later.  I've been treated for depression for years and it has never come up w/ new policies. ANd they've always covered my same Dr and my meds.
 
If you decline insurance coverage at first, and then later ask to enroll, I guess they think that some health issue has popped up and you are needing health coverage for it.
Bit 1972: Acute and chronic tonsillitis, UTI, miscarraige, appendicitis, hypoglycemia,  chronic neck pain w/ crushed vertibrae, chronic severe back pain, mitral valve prolapse, depression, resolution?
 
Bit Mother's Day 2007: Lyme, Babesia microti, hypothyroidism, EBV, HHV6, Parvovirus B19, low adrenals &misc other hormones, depression, anxiety, more of the above.


rcenters
Regular Member


Date Joined Oct 2007
Total Posts : 259
   Posted 12/12/2009 10:06 AM (GMT -7)   
No, I don't believe you will ever have to answer questions on group policies...but when you go for treatment they would deny your claim, is what I guess would happen.
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