question about insurance

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pswift520
Regular Member


Date Joined Sep 2010
Total Posts : 91
   Posted 1/19/2011 6:53 PM (GMT -6)   
I have a friend who has a colostomy. Since he got it he has lost his job and now has no insurance. He is having trouble getting any assistance. He says that if he gets a job that because of his colostomy being pre existing that he will not be able to have the reversal.  I thought that pre-existing was only for a year.  Anyone have any clues as to how this does work if you don't have insurance and then get it, will it pay for you to have a reversal.  I have helped him out as much as I can with extra supplies I have had and given him the name of suppliers to call and get samples, I really don't know what else to do. Any advice would be appricated.
 

Scrap Girl
Veteran Member


Date Joined Jan 2007
Total Posts : 653
   Posted 1/19/2011 10:42 PM (GMT -6)   
I don't know all of the ins and outs of insurance but I will tell you about my experience. We were on COBRA when I got my ilieostomy and then my husband started a new job before I had my second and third operations and I was concerned, too, that they our new insurance wouldn't cover those. He got a job with a large company and with their insurance, pre-existing conditions didn't matter and they covered the second operation and reversal with no questions asked. That's normally the case with big companies, government agencies and public educational institutions. It may be an issue if he gets a job with a small employer. What supplies does he use? I have some I would love to pass on to someone who would need them.

summerstorm
Veteran Member


Date Joined Aug 2006
Total Posts : 6571
   Posted 1/19/2011 10:56 PM (GMT -6)   
i think that the preexsisting thing is gone now. or will be soon, its in the new healthcare bill, i think.

but anyway this is how we were told it works

say your insurance lapses for a week, after your new insurance kicks in, it won't pay for preexsisting conditions for a week. now this was a few years ago when we had a cobra issue. so it may be different now.
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-
No matter what kind of day you are having, take five minutes to sing loudly and dance like a fool!

Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3115
   Posted 1/19/2011 11:39 PM (GMT -6)   
A preexisting condition comes into play when a patient has had a lapse in coverage...which is why every effort should be made to pay for COBRA coverage...but when that is not possible and a person goes uncovered, for any period of time, they usually have to wait the one year wait period until that condition would be covered again. Amounts covered vary from plan to plan but that's a basic explanation.

That's why Scrap Girl had coverage for the preexisting illness...no lapse in coverage.

You friend could contact their local Ostomy Association for help (www.uoaa.org).
Crohn’s dx 1989
some terrible years before my
temporary ileo in 2001
Proctocolectomy w/end ileo in 2008
...wish I knew then what I know NOW!

Scrap Girl
Veteran Member


Date Joined Jan 2007
Total Posts : 653
   Posted 1/20/2011 11:48 AM (GMT -6)   
Actually, my husband's insurance would have taken us regardless if we had a lapse or not. That was never an issue but he works for a company that has thousands of employees.

suebear
Veteran Member


Date Joined Feb 2006
Total Posts : 5698
   Posted 1/20/2011 12:03 PM (GMT -6)   
If he gets a job with a company that provides "group" insurance he will be covered for anything pre-existing. Usually jobs that have group coverage are in the city, county, education, and government arena.

Sue

Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3115
   Posted 1/21/2011 12:27 PM (GMT -6)   
I was under the impression that a group plan cannot deny overall coverage but they can restrict coverage if there was a preexisting condition with a lapse of coverage...there's some 63 day rule that has been explained to me...wow~so complicated!!!

scrap girl~BIG company insurance is usually great...good for you!
Crohn’s dx 1989
some terrible years before my
temporary ileo in 2001
Proctocolectomy w/end ileo in 2008
...wish I knew then what I know NOW!

betsaronie
Regular Member


Date Joined Oct 2007
Total Posts : 318
   Posted 1/24/2011 10:56 PM (GMT -6)   
Each state has different rules when it comes to a lapse in coverage. For instance, in Ohio, where I live, you can have a lapse of 63 days and it will not count against you. Meaning that since I had no insurance for 30 days, when my new insurance started on Jan 1 they HAD to cover all pre-existing conditions because I had not passed that 63 day grace period. If I had passed that 63 days then they can deny me coverage of ONLY my pre-existing conditions for 12 months, or up to 18 months if I had not had group coverage before hand.

In general though if he gets group coverage then they HAVE to cover pre-existing conditions after a wait period ends. So he might have to wait longer to get the surgery but eventually they will have to cover it. I believe that the 18 months is the maximum and typically its only 12. You'll have to check your states grace period, but if he gets a job with group coverage before that grace period ends then the pre-existing coverage starts immediately. Try finding the info for your state on a government website. That's where I figured out how fast I needed to get coverage when my COBRA ended. Plus Ohio has a new HIPPA law that forces insurance companies to offer full coverage to sickos like me if we meet certain requirements which i did. :)
-diagnosed with UC Dec 2006 at 22
-allergic or intolerant to all 5ASAs, sulfa and 6-mp
-emergency transverse colostomy on 9/13/10 from perforated colon
-J-pouch surgery TBD (hopefully in January!)
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