PRE EXISTING CONDITION HEALTH COVERAGE?
Question by hairyford2:
pre existing condition health coverage?
i have just received notification that my health insurance premium will drastically increase in 2009. i am self employed, so im not part of a group plan. ive checked quotes on the web to compare to the higher rate. if i switch plans i can save $ 175 a month. the problem is i have a pre existing condition, about ten years ago i broke my leg in a automobile accident. to repair the break the physician put a long piece of metal down the center of the bone. its still in there. i assume that this qualifies as a pre-existing condition.
are supplemental plans available that would cover just this condition? if so are they affordable? who offers them?
any info or recommendations would be appreciated.
thanks
i have no ongoing problems with the pin, nor do i see a physician about it. but i was told by my physician that they like that the pen is removed. if i was ever to break that leg again it could cause complications to repairing the break. the pen is inside my bone, not on the outside. what would happen if in ten years i break the leg and my medical bills are ten fold because of the pen? would the new insurance cover me?
my physician specifically stated that he wasnt advising me to have the pin removed and that it posed no problem staying where its at. he stated that he was “informing me of possible outcomes”. i have put off having the pin removed because i lead an active physical life. the surgery kept me down for three months last time. i just cant be down for that long. and besides, the pin isnt causing any problem and i was told that it wouldnt cause any problems in the future. my surgeon released me fully.
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Answer by Insurance Pickle.com
It’s a pre-existing condition, but if you have no ongoing problems or you do not see a physician in regards to it you might not even have to put it on the application.
I have a plate in my arm, but it’ll always be there and I do not ever have to see a physician in it’s regard so it would never affect insurance and mine is brand new.
So, if you do not see a physician for it then the insurance company would not be out any money covering you therefore it’s no huge deal. However, if you are disabled because of it then it’s a huge deal.
You can use the tool on my site to look at plans….just click the pickle on the home page. It requires no personal information to use and works instantly in most states.
Answer by stephenweinstein
Due to the HIPAA law, if you had health insurance continuously for the last 18 months immediately prior to the begin of your new coverage, then it will cover your pre-existing conditions.
Answer by debijs
~~I do not know of any insurance that will cover your leg. More than likely it will be excluded as preexisting for a certain period of time with the new insurance.
Since you are self employed, if there are at least 2 partners in your business (like you and your wife or any other partner) and you live in HI, NV, WA, CA, or OR, you can qualify for group insurance through your own business with www.costco.com It is very reasonable and great insurance.
Of course with group insurance there is no preexisting clauses.
Our agent is Lisa and you can reach her at 1-800-611-9057 ext 2206
We have been very happy with her work and the insurance for our business.~~
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What do you think? Answer below!
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Individual Insurance Carriers may or may not exclude this as a preexisting condition, since you have had no problems in the last 10 years. Carriers only require medical history in the past 5-10 years. However, I would recommend disclosing the condition, since they would have to specifically exclude as a preexisting conditon or cover your leg.
If the Insurance Carrier excludes the condition, you can obtain a) a low cost Supplemental Benefit plan that pays cash benefits in case of Accidents or b) Mini-Medical plans that pay benefits for Hospitalization, Surgery, etc. Most plans have a 12 month exclusion on pre-existing conditions, but then it would be covered.
1. HIPAA specifically states continuous GROUP coverage to eliminate the pre-exisitng waiting periods. However, some individual companies allow individual insurance to apply. You will need to check with the new company for their rules.
2. You might want to consider staying with the current company, but changing your plan. For example, do you have office visit copays? How often do you use them? If you only go to the doc twice a year, removing the office visit copay can drastically reduce your premiums (I sound like a commerical). And if you go that route, you still get the contracted rate for any office visits ($ 50-$ 100, with no lab work. You can call your doc and ask the billing person)
3. Do NOT lie on the application. You will get caught and eventually they will just terminate your policy anyway.
4. Typically there is an 18 month limit on pre-exisitng exclusions. Assuming you don’t lie on the app and the approve you without exceptions, they will cover the leg. For example, if you had cancer 10 years ago and 5 years from now you get cancer again, its not excluded.
5. Supplemental plans aren’t going to do you a lot of good here
6. I would get the pin removed before switiching plans. They don’t like to hear about upcoming claims in underwriting
It’s going to be up to the carrier. You WILL have to disclose this on the application, and odds are, they’ll put an exclusionary rider on the policy for this. These riders do NOT expire with time, like they do with group policies.
My suggestion, for the $ 200 a month, you should schedule to have the pin out in the next year, and keep the current plan. Once the pin is out and you’re fully healed, THEN you can shop out for a new plan.
You’re not going to find a supplemental to cover “preexisting conditions.”
You said “i was told by my doctor that they prefer that the pen is removed”. If that is an accurate statement no new coverage will cover the leg for anything, it will be an exclusion or even a decline for not following the Drs. advice. Get it taken out with your current coverage and get new coverage next year.