View Full Version : Pre-existing condition
05-26-2008, 11:04 PM
Did any of you have a change in insurance between the time of diagnosis and surgery? My husband is wanting to take a new job but we are trying to determine how to be absolutely sure we won't jeopardize Carter's treatment. From what I've read about pre-existing conditons insurance companies can deny claims for a conditon that was diagnosed in the last six months prior to the change in insurance anywhere from 3 months to 18 months in some cases. We are worried that if we switch to another group insurance plan we could be in a "waiting period". Although we don't have a surgery date yet Carter will be in the age range for surgery in September and I'd hate to have to prolong the agony of waiting!!
05-27-2008, 12:32 AM
I'm pretty sure that if you prove that you had insurance and NO GAP in coverage (by providing a "certificate of creditable coverage" to the new insurance, they will have to cover you. The could deny coverage if you didn't have insurance when he was diagnosed, AND if you have a gap between coverage. (I think!)
05-27-2008, 07:52 AM
Ditto to what Candice said. If you are going to have a gap in coverage, it is good to fork over the dough for the COBRA benefits (if available). This way, the pre-existing condition should be covered.
05-27-2008, 10:35 AM
Going through this w/ Emily right now. We switched insurances and I didn't think twice on it. Sent in the Cert of Credible Coverage, etc....After 8 million questions on Emily's condition, they are covering us all, except Emily and will re-evaluate her after her NS appointment (post-op) in August! YIKES! I'm freaking a bit.
That being said- I 'believe' if you are obtaining insurance through an empolyer, they will cover everyone-- Christian is self employed and so it's just us....no employer.....
05-27-2008, 01:47 PM
Thanks for the responses! That helps.
Jennifer that was my other thought that what if we switch insurance after the surgery he will still need follow up care for a long time and I don't want to get caught in some kind of loop hole. I hope your insurance covers Emily, I'm sure it's scary.
05-27-2008, 02:20 PM
We switched employer provided insurance companies one month after Austin's surgery. We put the cranio surgery on his pre-existing conditions, and all of his follow-up care to date has been taken care of by the new insurance company.
05-28-2008, 10:18 AM
I know my mother had multiple health issues and she was told when she lost her job recently due to it being shipped overseas (gotta love our country) that she would either have to pick up COBRA or have her conditions be pre-exhisting whenever she got a new job. She took the COBRA so when the insurance kicks in on her new job, she will be covered then. (She has COPD, T2 Diabetes, HBP, HC)
I hope to God not to have to ever do this with Christina because her eye exams will be every 4 months and MRI's once a year for who knows how long.
05-28-2008, 10:51 PM
One option if available to you is...
If the new employer offers the insurance with the same company you have now, pick that insurance. E: If you have BCBS now and the new employer offers BCBS or HAP, take the BCBS.
It depends on the insurance carrier as to what they consider pre existing to be. Some are more laid back than others. PPOMs and HMOs are much more strict as to what they consider pre existing and it did not always matter whether or not there was a gap in insurance. If it were me, I would call the insurance company offered by the possible new employer and ask them what they would do in your situation. You do not have to give a name or anything. Just tell them that your husband may be switching jobs and taking on the insurance. Give them your son's info and ask if it would be covered. OR, tell them you are thinking about switching insurances ans ask them to send you their regulations for pre existing conditions.
I do not want to scare you, but it does not always depend on whether or not there was a gap in insurance coverage. Make sure you get all the info you can before switching. I used to work with billing in a medical clinic and have had to tell people that treatment wasn't covered due to a PEC. It sucks, but each company has their own rules. It is not impossible to switch insurance, you just have to do your homework first.
05-31-2008, 06:38 PM
Thanks Angi! We did contact the new insurance company and they said they do not impose pre-existing conditions.
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