Pre-Existing Conditions

macungieman · 04-04-2007, 10:28 AM

Can someone tell me if there is there some middle ground (insurance products) that exists for treatment of pre-existing conditions between group coverage paid for by employers (where the group pool covers most everything) and individual policies where god forbid you have a wart or something and it is excluded.

In my case I have a outpatient procedure that I would like to undergo that costs a few grand I guess but is excluded by current individual policy. Short of changing jobs and getting group coverage (I am self employed for the time being) is there some middle ground.

Would it be foolish to go the cash option anyways.
It might be as simple as expected and get costly in a hurry.
I am new to this subject so forgive my ignorance (if applicable).

healthagent · 04-04-2007, 11:28 AM

I'm sorry but no health insurance company that issues individual plans will cover a scheduled procedure.

macungieman · 04-04-2007, 11:50 AM

John

Can you explain briefly how group plans differ than ind plans. Are group plans paid by employers much more expensive ? I was laid off a while back and was offered Cobra but declined (under the circumstances wished I hadn't). Yes the plan was more costly but not so much so when compared to the treatment (things they will cover) which is so different from one plan to the other.

You probably have better things to do but I am just curious.

Thx

somarco · 04-04-2007, 12:23 PM

Group carriers are required to cover pre-ex as long as you have creditable coverage. If you are a new employee and lack creditable coverage they can make you wait (usually 12 months) before you have full coverage.

HMO's are the exception. Full & immediate coverage.

Individual plans vary from state to state & carrier to carrier, but it is not as bad as you let on.

macungieman · 04-04-2007, 01:12 PM

Thx Somarco

Might there be any helpful PA Producers on the board willing to answer questions to my particular situation, most of which is unrelated to my pre-existing dilemma?

salpro22 · 04-04-2007, 01:42 PM

In my case I have a outpatient procedure that I would like to undergo that costs a few grand I guess but is excluded by current individual policy. Short of changing jobs and getting group coverage (I am self employed for the time being) is there some middle ground.

It would help to know the specific outpatient procedure you are referencing.

As John and others have stated there is no individual plans available that you or anybody else can buy to help reduce OOP expenses on pending treatment. Depending upon the severity of the the treatment, there might be some organizations or charities willing to help.

healthagent · 04-04-2007, 02:03 PM

Imagine calling a car insurance company who you're not with yet and telling them you have damage on your car that you want them to cover. Or call a new homeowners company and tell them you have severe roof damage you'd like them to pay for.

macungieman · 04-04-2007, 02:32 PM

I get it john, but I am not a car. Bad analogy.

There is a long story behind this which I don't want to go into, but because I was not totally on top of my ****, I was not able to get procedure done through the group (Aetna/USDeathCare) I was at one time a member of. If the system was not so layered and user unfriendly we would not be having this conversation.

And please don't try to defend ins. companies. These are the same folks who are screwing Katrina victims down in the Gulf coast. They take your cash and attempt to pay out as little as possible without getting jail time. I know this is a business, but when it comes to healthcare, I think we could be doing better. The focus is not on the patient, it is on the boardroom and my sons chiropractor who has needs to make payments on his Porsche Turbo (lucky bastard). Bottom line is people often don't get treatment because they can't afford it, or are subject to unforeseen events, or even because they are stupid. Whatever the case may be, it is never a good thing.

Now about that PA producer.

macungieman · 04-04-2007, 02:35 PM

SalPro,

Thanks, but I am not indigent.

salpro22 · 04-04-2007, 03:00 PM

There is a long story behind this which I don't want to go into, but because I was not totally on top of my ****, I was not able to get procedure done through the group (Aetna/USDeathCare) I was at one time a member of. If the system was not so layered and user unfriendly we would not be having this conversation.

You have come to the right place then. There are definitely obstacles in the way, but you now have access to talk w/ knowledgeable agents who all have the desire to help people out and protect their familes. If you don't mind me asking, what layers are you talking about?

I know this is a business, but when it comes to healthcare, I think we could be doing better. The focus is not on the patient, it is on the boardroom and my sons chiropractor who has needs to make payments on his Porsche Turbo (lucky bastard).

I agree with you. However, consumers have more knowledge about health care then they ever did before. I can't wait to see what happens in the next few years as HSA's start to pick up and put the power of medical costs in the hands of consumers.

SalPro,

Thanks, but I am not indigent.

It is my pleasure. I am glad to hear that you are not indigent. You should consider yourself fortunate because you have the ability to pay for the treatment you need.

healthagent · 04-04-2007, 03:50 PM

Sorry about the car reference. My point is if individual companies took people without current coverage and had to cover a pre-existing condition or upcoming procedure why would anyone have coverage? Heck, I could cancel my plan today with no repercussions. Anyone gets sick or has an accident? Just get coverage then.

wilkin · 04-18-2007, 01:37 PM

Macungieman-
I am a PA producer, how can I help?