Insurance Agent Forum

[pentagon]

I have just recently purchased the "Plan 100" from Golden Rule including the prescription card.

I was reading through the brochure and noticed on page 27 under "General Exclusions and Limitations"

Covered expenses will not include, and no benefits will be paid for any charges which are incurred:

(AA) For treatment of mental disorders, ... except as expressly provided for by the policy

I have an anxiety disorder and would like my insurance to cover these expenses. I purchased the "prescription card" as well to help with the cost of medication, but this being a mental disorder I am not sure if they will cover anything at all now. Does anyone here know anything about this? I guess I will have to call them if no one knows.

Thanks!

[healthagent]

What state are you in?

[healthagent]

In MD this is the mental benefit clause:

"All diagnoses or treatments of mental disorders, as defined in the policy, including substance abuse, will be limited to a lifetime maximum benefit of $3,000 (not covered in Saver Plans, subject to state variations). Covered expenses for outpatient diagnosis or treatment of mental disorders will be further limited to $50 per visit. As with any other illness or injury, inpatient care which is primarily for educational or rehabilitative care will not be covered."

Saying that, I'm quite familiar with Golden Rule's underwriting and normally your anxiety would be "ridered" or excluded. Did you note on the application that you had anxiety and were on medication? And if you did, check your policy since you might have rider that you didn't even notice.

[somarco]

The Rx card is an added expense that I would never put on a GR policy. Plan 100 is fine just like it is.

I have to agree with John. If you listed anxiety & your meds on the application then chances are good the condition is ridered so no coverage. Other carriers will cover anxiety with as much as a 50% surcharge to your premium.

Did your agent assist in completing the application? Did you fully disclose everything to your agent and to GR?

[pentagon]

Florida

I am not on medication at the moment, but would like to be. I did not list this on my application, because I have not been officially diagnosed, nor have I ever taken the medication.

I wasn't sure about the prescription card addition, I am new to health insurance and I applied for insurance over the internet, so I did not speak with an agent. Is it easy to have this prescription card removed from my policy? I don't completely understand what it even does...could someone enlighten me? I was under the impression that it would bypass my $1500 deductible on medications...but I'm probably wrong.

Thanks again.

[salpro22]

Originally Posted by pentagon

Florida

I am not on medication at the moment, but would like to be. I did not list this on my application, because I have not been officially diagnosed, nor have I ever taken the medication.

I wasn't sure about the prescription card addition, I am new to health insurance and I applied for insurance over the internet, so I did not speak with an agent. Is it easy to have this prescription card removed from my policy? I don't completely understand what it even does...could someone enlighten me? I was under the impression that it would bypass my $1500 deductible on medications...but I'm probably wrong.

Thanks again.

Out of curiousity, how do you know you have an anxiety disorder because you have not been diagnosed? BTW, there are alternative treatments for anxiety depending on the severity of the condition.

[healthagent]

Originally Posted by pentagon

Florida

I am not on medication at the moment, but would like to be. I did not list this on my application, because I have not been officially diagnosed, nor have I ever taken the medication.

I wasn't sure about the prescription card addition, I am new to health insurance and I applied for insurance over the internet, so I did not speak with an agent. Is it easy to have this prescription card removed from my policy? I don't completely understand what it even does...could someone enlighten me? I was under the impression that it would bypass my $1500 deductible on medications...but I'm probably wrong.

Thanks again.

Once you get your policy, if you go to a doctor and request anxiety medication Golden Rule will most likely immediately rescind your coverage and refund any premiums you paid. You do indeed have a condition that you didn't make Golden Rule aware of whether you've seen a doctor or not - so basically you don't have a policy. You absolutely cannot get insurance and plan on using it to seek treatment on a condition you didn't note on the application.

[K-Dub]

What John just said is completely true! Why do so many people self diagnose themselves? They see something on TV and say, I've got that!

Another thing....drugs are not good for you! I'd recommend what SalPro said and do the alternative method. Go outside, look at the sunshine, smile...sure beats taking meds that kill you! Of course all this is just my opinion!

[somarco]

You can ask GR to remove the Rx card if you are still within the 10 day free look (or whatever FL requires) period.

Q 23 (on the GA application) asks:

In the last 10 years, has any applicant had any KNOWN INDICATION, signs, symptoms, diagnosis or treatment of:

. . . . mental, emotional or behavorial disorder.

Either you answered that question truthfully, or you did not.

Sounds to me like there was a material misrepresentation of the facts.

FWIW, you can go back to GR and plead your case and maybe they will place a rider on the plan retroactively. Most likely they will suspend coverage until you have a diagnosis.

Or . . . you can apply to another carrier with FULL DISCLOSURE and they will reject your application pending a diagnosis.

Did you misunderstand the question on the application, or did you intentionally choose to manufacture an answer to get coverage? A good agent (and we have one on this board from FL) would have helped you through the process, assuming you were honest with him. You do not pay extra for the services of an agent. You may have made a big mistake by submitting a false application, or you may be able to work it out by paying for your treatment out of pocket.

[healthagent]

Well, I don't want to get into whether or not someone needs medication. There are physiological, not just phychological, mental/nervous disorders that need to be treated with medication.

When you fill out any application there's a question about whether or not you're having any symptoms:



The answer to this question should have been yes. Here are your options:

1) You say nothing and think you'll just get away with seeking treatment for a condition you didn't note on the app. 100% chance your policy is rescinded.

2) You call Golden Rule and tell them the truth. They will cancel your policy and hold off on re-issuing it until you get a formal diagnosis.

3) You apply to another insurance company and tell the truth and they won't underwrite you until you get a diagnosis.

You cannot diagnose yourself with a medical conditon - you're not a doctor. If you know something's not right you simply need to see a doctor first - not run off and get health insurance.

[James]

Originally Posted by pentagon

Florida

I am not on medication at the moment, but would like to be. I did not list this on my application, because I have not been officially diagnosed, nor have I ever taken the medication.

I wasn't sure about the prescription card addition, I am new to health insurance and I applied for insurance over the internet, so I did not speak with an agent. Is it easy to have this prescription card removed from my policy? I don't completely understand what it even does...could someone enlighten me? I was under the impression that it would bypass my $1500 deductible on medications...but I'm probably wrong.

Thanks again.

First thing is to find out if you even have a true Anxiety Disorder! If you don't need meds or treatment then everything is fine, if you do then you have a dilemna. Myself, I wouldn't take any medicine if I could live without it. What makes you think you do?

[pentagon]

Thanks for the replies.

I didn't get health insurance specifically to cover expenses for this, in fact the medication appears to be pretty inexpensive so I may just see a doctor and purchase it myself and see if it even makes a difference. I wasn't even aware that I possibly had a disorder until recently. So, assuming I didn't even know I had this and then got insurance...how could they still deny coverage if I later found out I did have it?

But, no, I don't know that I have this, I haven't seen a doctor about it yet. I may never even see a doctor about it.

[pentagon]

Also, could I call them up and tell them I forgot about this when I was filling out my application? Would they let me change it and then make me go get a diagnoses on my own dime or what?

My plan is not effecitive for another week, if that makes a difference.

Thanks again

[healthagent]

If you plan on seeing a doctor about your condition you'll need to immeditaly call Golden Rule.

This is what happens:

A: You see your doctor about your condition.
B: The doctor office claim is sent to Golden Rule.
C: Golden Rule claims says "Wow...already seeking treatment for something not noted on the application?"

And it goes downhill from there. First of all, your health comes before anything. If you feel something might be wrong you need to see a doctor. But you'll need to get a diagnosis or a clean bill of health before you can obtain health insurance.

So your choices again:

A: You're not going to see a doctor about it and just keep the policy.
B: You're going to see a doctor and you need to call Golden Rule today.

[salpro22]

I didn't get health insurance specifically to cover expenses for this, in fact the medication appears to be pretty inexpensive so I may just see a doctor and purchase it myself and see if it even makes a difference. I wasn't even aware that I possibly had a disorder until recently. So, assuming I didn't even know I had this and then got insurance...how could they still deny coverage if I later found out I did have it?

It sounds like you have researched anxiety and are familiar with the costs of the medication and have thought about getting around the insurance company. DO NOT DO THAT!!!!!! As John and a few others noted, your policy will be rescinded, and that WILL effect future decisions from other insurance carriers. A reputable agent would have explained how the claim's review process works, so you would know that you are dancing with fire if you do not include something on an application.

Also, could I call them up and tell them I forgot about this when I was filling out my application?

Client: Mr. Insurance Carrier, I forgot to include that on the application, but I have all of the anxiety medications memorized as well as the costs associated with the medications.

Carrier: REALLY? Thank you for your business and good-bye. Your check is in the mail.

I am not trying to beat you up about this, but you are in a predicament. I would recommend that you first visit a professional who is trained to diagnose mental disorders. Personally, I would recommend seeing a Psychiatrist or Psychotherapist trained in using the DSM-IV and other tools. Most people visit their primary physician and although many physicians have training in mental disorders, the vast majority don't, so do you research.

Once you have an answer, then you will have a better idea as to your alternatives. I also highly recommend that you find an agent in your state. We do have one in this forum down in your area who you can contact.

[healthagent]

Agreed. You see a regular doctor and say you have anxiety or panic attacks and while he's looking at his watch he'll likely say: "Here's Lexapro now get out. NEXT PATIENT"