Freaking out about insurance coverage!

chanchan · 10-03-2005, 03:10 PM

So I was planning on changing my insurance this month because we have open enrollment. Over the weekend, I was talking with a friend of mine who was in a battle with Blue Cross. Blue Cross was not processing her claim because they said it was for a pre-existing condition and it wasn't covered. Now, I'm terrified that if I switch I won't be able to have any coverage for anything they think is related to PCOS. I don't know what to do. Has anyone else had this problem? Will I be forced to stay with the horrible HMO I have now?

nicole47 · 10-03-2005, 04:23 PM

If I understand the law right, so long as you do not have a gap in coverage, they cannot deny you based on a pre-existing condition. So as long as you switch directly to the new coverage (or buy supplemental outside insurance during the transition period, if there is one), you should be ok. That's why it's important to keep up health insurance coverage with no gaps.

StarsHallowGirl · 10-03-2005, 04:29 PM

As long as it's group insuracne through your work they cannot deny you coverage for any pre existing conditions. If it's individual unfortently Blue Cross will deny you any coverage with PCOS.

yania · 10-03-2005, 04:55 PM

Basically if you have a job, and then u have have the insurance through them, and u quit or term it or what ever, and u start at a new company and in three months get the coverage or what ever that case may be, is that if you started your insurance 6 months ago, and u go to another gruop insurance, they will say that you have a pre existing clause. You just have to send them or fax them a letter from your prior insurance company saying what dates to when you had their coverage, and thent he new insurance will waive your pre existing clause. Now if you go through a private insurance, most of the time, you will still have the pre existing year to wait out.

VivC · 10-03-2005, 05:06 PM

You can only be w/o insurance for 59 days before they can start yelling pre-existing. So if you switch jobs, I'd COBRA a month if your new insurance doesn't start for 3 months.

BTW, I have BCBS, and I've had no problems with PCOS being covered (my insurance is through my employer). I also think the state you live in might have an impact - in MD, insurance companies are forced to cover a lot more.

Jashobeam · 10-04-2005, 03:01 PM

I also had BCBS and they didn't deny any of our claims. We have recently switched to United Healthcare and have not had to file a claim yet, so I have no idea what they are like yet.

Jen K · 10-04-2005, 03:06 PM

I know very little about this subject (being from Canada and all...), but just wanted to say how bad I feel that you ladies have to deal with this. What a lousy system of healthcare you're dealing with.

Best of luck,

Jen K

Jashobeam · 10-04-2005, 03:23 PM

Quote:

Originally Posted by Jen K

I know very little about this subject (being from Canada and all...), but just wanted to say how bad I feel that you ladies have to deal with this. What a lousy system of healthcare you're dealing with.

Best of luck,

Jen K

I just paid $11 for over $200 worth of medical tests. DD's shots cost about $1 each. Doctor visits only cost me $10 to $20. DH's denal is fully covered at no cost to him. I'm very pleased with how much we pay, how fast I can see a specialist, etc. DD's pedi noticed something strange with her hips (new Pedi, being cautious) and said DD needed an xray. Within 2 horus or so we were admitted, had the xray done and within a day or so we had the results back (no problems at all, she was fine). That's my idea of how things should go. Each insurance company is different (we've subscribed to at least four since being married), and there are some that just are not worth dealing with. Others are great. U.S. cysters need to do their research on companies (as my Mom is doing now) especially if they are buying from a company not dealing with their work's insurance company. The last one my Mom had was horrid. Her and my Uncle signed up and both were outraged at the company's policies. Both are searching for a new company. You just have to be aware there are bad ones out there.

Countrygirl81 · 10-04-2005, 03:44 PM

it also depends on your employer.. like walmart.. refuses as many claims as they can!!! ive gone round and round with my job and insurance companies an the insurance company tells me they can only approve wat wally world allows them

guineapig · 10-04-2005, 06:30 PM

We have the best insurance in our state, through the government, and they won't pay anything even remotely fertility related, won't pay for the Ring or most pills for that matter, or weight control / nutrition either. (yet they'll pay Viagra and non-medical-related abortion Grrr). I had to sing, dance, and scream last week just to get them to pay for Singulair, an ALLERGY medication! We have to meet a yearly $1000 deductible each person before they'll even pay for labs etc. Stupid insurance! But I know the importance of it--my younger cousin didn't have it, and she was diagnosed with breast cancer. She got treatment because her stepmother was the a very high administrator of the hospital, but now she has 100k of medical bills.

Unfortunately, I found out 3 years ago when I lost my last job, when you have PCOS, it's not always possible to just go out and "buy" insurance that's not employer-related (like those flyers in the mail for $79 per month for BCBS). I got denied in 4 states, couldn't even get "break leg / flu" insurance coverage, and had to move in with mom to afford to continue COBRA. Finally worked for the school system and got group insurance--they can't deny you that, but they can refuse to cover conditions up until a year into your NEW insurance unless you have a letter from your old company (or COBRA) that you had insurance before this new one.