Anyone have UnitedHealthcare (UHC)

[MoltenStorm]

If so, maybe you can answer a few questions for me.

1) Is it the Insurance Company or the Employer that decides whether or not to have a Pre-existing Condition Clause?
2) Does UHC have one?
3) If so, what is it for HIV?

Note: If the answer to number 1 is the Employer, please disregard numbers 2-3.

[otherplaces]

I'm no big expert on this, but I've had to deal with it.  It is the insurance company, but the employer chooses the group plan, and the pre-existing condition is part of the plan they chose.  They're usually six months to a year depending on the plan.  If you had any type of coverage it can be applied to offset the pre-existing condition.

For example I had absolutely horrible catastrophic health insurance when I was diagnosed.  When I joined the group plan at my previous job there was a pre-existing condition, BUT since I had had coverage for 5 years (even though it was crappy coverage) it made the pre-existing condition clause go away.

If I recall correctly you were using ADAP.  I assume you will stay on ADAP until your pre-existing condition time is up and then you're home free. 

It's all a pain, but once you get it ironed out....well, we all deserve good health insurance.

take care,
brian

[gerry]

The insurance company is the one that establishes the pre-existing condition clause.  Pre-exisiting condition clauses are not illness-specific.  they apply to any illness that has been diagnosed previously on members who have had a lapse in creditable insurance coverage longer than 63 days on the date that the new insurance coverage commences.  If they are not clear whether or not a condition is pre-existing, they can clarify it by asking for medical records or documentation of diagnoses on specific dates from providers.  Not sure what UHC imposes but I've seen pre-existing periods of 6 months to 12 months.  You could call the insurance toll-free number and ask a general question about their pre-existing condition period without revealing who you are.

[redhotmuslbear]

I've been under UHC for the last 20 months, and I recall a 12-month pre-existing condition period being mentioned.  Then again, I had unelapsed creditable coverage again that period from my prior employer, so labs didn't raise a concern initially; and I've been off meds while on the plan.

I will note that UHC is very pushy about "condition management" for people with chronic illnesses including HIV.  A woman called me three times in two weeks back in May to schedule an intake phone interview for their case management program.  I ignored the first two calls, then on the third I asked what condition she was referencing -- I'm on a small dose of an ACE inhibitor for blood pressure, so maybe that was it.  The woman said that only the nurse could discuss medical information with me, so I set an interview for two days later.  When the nurse called, I headed her off with the same question, and she indicated HIV with some concern that I didn't appear to be on meds---wanting me to remain a healthy worker for my employer, UHC wanted to be certain I was aware of 21st Century treatment options    ... wait!.... an insurance company want me to know how to rack up more expenses?.... I was in disbelief, and I explained my situation with being tracked as a longterm non-progressor off meds.  The nurse ended the call after the requisite "we just want you to know we're here" lines.

Cheers,
David

[aztecan]

Hey Molten,

If you were on ADAP prior to going on your employer's plan, it probably won't count as creditable insurance.

That said, your ADAP should continue until such time as your insurance kicks in and starts paying for the meds.

Pre-existing condition clauses vary and depend on the plan chosen by your employer. It doesn't vary by disease or condition, just that one existed before signing on.

As David noted, if you are already insured and just switching coverage, the pre-existing condition clause shouldn't apply.

One thing I always check out when switching insurance is what their medication coverage is like. There are wide differences between plans and some require you mail-order your meds if you are on maintenance drugs - like ARVs.

HUGS,

Mark

[MoltenStorm]

I called today, and they said there is no pre-existing condition clause, so Woohoo! Thanks though for the information guys.

[otherplaces]

Hot diggity Molten,  that must be some effin' GOOD insurance you got there!  Congrats!!