Pre-Existing Condition Insurance ?

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SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 328
   Posted 12/11/2008 6:07 AM (GMT -7)   
Was searching and could not find answer from previous postings. If or when I leave my current job and take another job will I have problem with my health care covergae where the new insurance company would deny my coverage of treatment due to having prostate cancer and saying it was a pre-existing condition?  Thanks!!
 
LIVESTRONG!
Age Dx 37, 7/2008
First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008
Biopsy : 6 out 12 Postive all on right side, Gleason 7 (3+4).
Bone Scan/CAT Scan: Clear 7/2008
Cystoscope: Normal 7/2008
Prostate MRI: Normal 7/2008
Da Vinci Surgery 7/2008
PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
First PostOp PSA 9/2008: <0.01
2nd PSA 12/2008: Praying for <0.01
 


glabers
Regular Member


Date Joined Nov 2008
Total Posts : 31
   Posted 12/11/2008 6:19 AM (GMT -7)   
I have the same question, actually.
Diagnosed:  8/24/08, age-47
Father died of prostate cancer at age 72
PSA 1.5 early 2007, 4.5 mid 2008, all remedies tried & reduced to only 3.2, uh oh.
Biop - 2 positives of 20 samples
Gleason - 3+3
RRP - 11/13/08 via Da Vinci by Dr. David Samadi, Mt. Sinai Hosp. NY
Post op biopsy - 75% of samples positive for cancer, Post op Gleason 3+4
some lymph Nodes tested, all negative
all nerves spared - I'm told
Catheter in for 1 week, using 1 pad a day. 
 
 
 
 
 


Ken S
Regular Member


Date Joined Nov 2006
Total Posts : 120
   Posted 12/11/2008 6:37 AM (GMT -7)   
SHU93, glabers,

In the middle of having adjuvant radiation therapy I switched insurance plans (my wife's group ins. plans) and the only problem was I had to pay the yearly minimum again. I may be wrong but if it's a group plan I believe they cannot exclude you.

Ken
Age 54 (2006)
PSA: 2005 - 3.2, 2006 - 3.7
Biopsy 8/06, Gleason 6 (3+3), T1c
Radical Retropubic Prostatectomy 11/3/06
Memorial Hospital, Pawtucket, RI
Post-Op Biopsy, Gleason 6 (3+3), T2c,
right apical margin positive
CT Scan 1/07, tumor discovered on right
kidney (unrelated to PCa)
Partial Nephrectomy 3/9/07
R.I. Hospital, Providence, RI
IMRT (37 Treatments) 4/23/07 - 6/14/07
PSA: 11/08 - 0.03


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4813
   Posted 12/11/2008 7:31 AM (GMT -7)   
I think the new company's insurance has to take you the way you are.
 
But aren't you past most of the expenses?
Age 53   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Gleason - 6
(biopsy done March 4, 2008-> 2 of 12)
 
06/25/08 - Da Vinci robotic laparoscopy
10/03/08 - 1st Quarter PSA -> less then .01
 

Surgeon - Keith A. Waguespack, M.D.

Las Colinas and Plano Offices

 


glabers
Regular Member


Date Joined Nov 2008
Total Posts : 31
   Posted 12/11/2008 8:56 AM (GMT -7)   
even if the switch is because of a new job entirely, and not the same job & just a new insurer?
Diagnosed:  8/24/08, age-47
Father died of prostate cancer at age 72
PSA 1.5 early 2007, 4.5 mid 2008, all remedies tried & reduced to only 3.2, uh oh.
Biop - 2 positives of 20 samples
Gleason - 3+3
RRP - 11/13/08 via Da Vinci by Dr. David Samadi, Mt. Sinai Hosp. NY
Post op biopsy - 75% of samples positive for cancer, Post op Gleason 3+4
some lymph Nodes tested, all negative
all nerves spared - I'm told
Catheter in for 1 week, using 1 pad a day. 
 
 
 
 
 


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 12/11/2008 9:17 AM (GMT -7)   
I'm not a HR specialist or attorney, but my recollection from dealilng with some of this issue at work is that if you're absorbed into a group health care policy you cannot be rejected - coverage must be extended to all group (work unit) members equally. However, some policies may require a certain period of time to pass before you're allowed to make a claim for benefits as the result of treatment for a pre-existing condition. It's unlikely you'll be denied reimbursement/coverage for prescription medication, such as Viagra or Cialis, etc., even though the medication is related to something pre-existing, and the chances are probably very slim that you'd need more prostate cancer-related surgery within, say, the year following your new employment. You're probably sensitive to this already, but I'll suggest it's best not to disclose pre-existing health issues to a potential employer during the interview/initial evaluation process.

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (getting better, though)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0

 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 12/11/2008 10:50 AM (GMT -7)   
Good point Mavica about the disclosure part...and I don't think a perspective employer can ask the question anyway...although they may. I would think that it depends on the insurance and the company...many companies now are self insured up to a specific limit to reduce the insurance cost before the actual insurance kicks in. If that is the case then the company can dictate pre-existing conditions as well as the time limit before coverage can commence. So theres the rub...by asking the questions of the employer you are in return disclosing your medical condition. Catch 22.
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA Oct 08 <.05


Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 12/11/2008 11:24 AM (GMT -7)   
You can ask the question after you've recieved a written offer of employment (which is binding) but before you accept the position. That way the information can't predjudice the hiring decision, and you can decide based on how good the coverage is.
50 YO
PSA at Dx: 8.2
DaVinci RALP: 10/31/08
Negative margins, no extra-capsular involvement
No follow-up PSA yet (next week).


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4813
   Posted 12/11/2008 11:28 AM (GMT -7)   

A pre-existing condition is a medical condition diagnosed or treated before joining a new plan. In the past, health care given for a pre-existing condition often has not been covered for someone who joins a new plan until after a waiting period. However, a new law. called the Health Insurance Portability and Accountability Act. changes the rules.

Under the law, most of which goes into effect on July 1, 1997, a pre-existing condition will be covered without a waiting period when you join a new group plan if you have been insured the previous 12 months. This means that if you remain insured for 12 months or more, you will be able to go from one job to another, and your pre-existing condition will be covered. without additional waiting periods. even if you have a chronic illness.

Continued here: http://www.healthinsuranceadvice.org/conditions.html


Age 53   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Gleason - 6
(biopsy done March 4, 2008-> 2 of 12)
 
06/25/08 - Da Vinci robotic laparoscopy
10/03/08 - 1st Quarter PSA -> less then .01
 

Surgeon - Keith A. Waguespack, M.D.

Las Colinas and Plano Offices

 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 12/11/2008 12:03 PM (GMT -7)   
Thanks Steve...isn't the internet wonderful...ask a question and an answer is there somewhere.
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA Oct 08 <.05


SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 328
   Posted 12/11/2008 4:20 PM (GMT -7)   
Thanks!! Its a relief!!
Age Dx 37, 7/2008
First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008
Biopsy : 6 out 12 Postive all on right side, Gleason 7 (3+4).
Bone Scan/CAT Scan: Clear 7/2008
Cystoscope: Normal 7/2008
Prostate MRI: Normal 7/2008
Da Vinci Surgery 7/2008
PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
First PostOp PSA 9/2008: <0.01
2nd PSA 12/2008: Praying for <0.01
 


Art662
Regular Member


Date Joined Sep 2008
Total Posts : 54
   Posted 12/11/2008 4:45 PM (GMT -7)   
Concerning insurance. You must have continuous insurance coverage from one job to the next. If you are out of work for a time, Cobra is in effect. You must not allow your coverage to laps more than 63 days or you will lose your pre-existing coverage. also, depending on the state, your coverage may be limited. In Indiana, there are very few group policies that allow treatment for erectile dysfunction. If you are a small business owner like me, there is no coverage available at all of an individual medical policy at any price. Please get out your policy are read the exclusions before you contact a physician if possible.
1979: Organic impotence at age 25 from drug reaction to coumadin.
1979 Half shunt & vena cava clip emergency surgery - 4 weeks in Ohio State Medical Center
1981 IPP implanted - 3 1/2 weeks Baylor U. Houston by F. Brantley Scott
1981 IPP replaced - 10 days Baylor U. Houston by F. Brantley Scott
1985 IPP replaced IPP due to implant shift - 1 week Mayo Clinic by William Furlow
1985 IPP replaced, penile degloving to correct scarring, shortening and cylinder contracture. Suspensatory Ligament procedure - 2 1/2 weeks Mayo Clinic by William Furlow
1989 IPP replaced, repair of Tunica albuginea around corpora cavernosa . Degloving to relive penile shortening - 10 days Baylor U. Houston by F. Brantley Scott.
2000 IPP removed due to fluid loss and possible infection - 6 days Cleveland Clinic by Dr. Karl Montague
2000 IPP replaced - 4 days Cleveland Clinic by Dr. Karl Montague.
2002 IPP replaced, penile degloving to correct penile shortening due to IPP removal for 2 months. Repair of Tunica albuginea around corpora cavernosa - 3 days U of Washington, Seattle Dr. Richard Berger.


coxjajb
Regular Member


Date Joined Nov 2008
Total Posts : 184
   Posted 12/11/2008 5:43 PM (GMT -7)   
SHU93, You shouldn't have an issue. Take a look at
 
http://www.dol.gov/ebsa/newsroom/fshipaa.htm


The Health Insurance Portability and Accountability Act (HIPAA) lays out the rules governing pre-existing rules. As ART66 stated above, you eed to have continious coverage, with no laps greater than 63 days. A wait period imposed by a new plan is not considered in that 63 day gap however. When you leave your current job, your insurance carrier will give you a certificate of prior coverage (HIPAA certificate) that will serve as proof of prior coverage. If your new plan tries to impose a wait period, due to a pre-existing condition, you can present that HIPAA certificate. They must offset the pre-existing wait period by the number of months of prior creditable coverage you had, as per the HIPAA certificate.


Age 50
Pre - Op PSA, 4.3
Gleason 3+4=7
Stage T1C
da Vinci Prostatectomy 8/1/08
No issues with incontinence since day 1 after catheter removal
ED, need a little help from Levitra
First post op PSA 11/11/08, 0.00

Post Edited (coxjajb) : 12/11/2008 5:47:18 PM (GMT-7)

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