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Author Topic: New Year, New Insurance  (Read 1700 times)

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Offline Hellraiser

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  • Posts: 4,136
  • Semi-misanthropic
New Year, New Insurance
« on: January 08, 2012, 09:56:58 AM »
Alright so my insurance benefits kick in on February 1st (I originally thought it would be 90 days from new employment but whatever).   I signed up for it online but they didn't ask about pre-existing conditions at all.  Is this an insurance company that's just ahead of the 2014 change or is the other shoe going to drop after I've used my insurance for the doctor and medicine and they charge me the full price of the bill.  Is anyone familiar with how this might work?  My last insurance asked about pre-existings but then covered them without questioning me.

Offline liketheboat

  • Member
  • Posts: 44
Re: New Year, New Insurance
« Reply #1 on: January 09, 2012, 11:01:51 AM »
it all depends on the insurance carrier. you may still get a questioner in the mail, or they may just ask who your other insurance is thru and requst the information from them. did you have a lapse in coverage? if you did HIV might fall under a pre existing condition waiting period. (usually 6-12 months). sometimes during the waiting period they may cover the cost of an office visit, but deny anything else for pre existing (such as labs, procedures, or Rx). i am going to be going thru a swich of insurance in the next couple of months. since i work in the medical feild i did my research, called up the new insurance, (gave them the group number) and checked that my medications are covered under the drug formulary, and verified that my providers are prefered providers for the insurnace. i may have gone over board, but since ihave been doing medical billing for seven years i have seen what a horror story something like that can be if you dont plan for it and do a little bit of research.
Aaron
Memorial Day 2010 Seroconverted
Labor Day 2010 tested positive
Oct 2010 cd4 359 vl 6,500
Dec 2010 cd4 vl 306
Jan 2011 started Atripla
Feb 2011 cd4 250 vl ud
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June 2011 cd4 293 vl ud
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March 2012 cd4 561 vl ud

Offline Hellraiser

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Re: New Year, New Insurance
« Reply #2 on: January 09, 2012, 11:09:17 AM »
it all depends on the insurance carrier. you may still get a questioner in the mail, or they may just ask who your other insurance is thru and requst the information from them. did you have a lapse in coverage? if you did HIV might fall under a pre existing condition waiting period. (usually 6-12 months). sometimes during the waiting period they may cover the cost of an office visit, but deny anything else for pre existing (such as labs, procedures, or Rx). i am going to be going thru a swich of insurance in the next couple of months. since i work in the medical feild i did my research, called up the new insurance, (gave them the group number) and checked that my medications are covered under the drug formulary, and verified that my providers are prefered providers for the insurnace. i may have gone over board, but since ihave been doing medical billing for seven years i have seen what a horror story something like that can be if you dont plan for it and do a little bit of research.

I was without a job for 2 months (so lapse there) and then it took 3 months for the new insurance to kick in, so all in all I've been without insurance for 5 months.  My former insurance sent me a letter of prior coverage but I don't know if there would be a 2 month window or a 5 month window.

Offline Assurbanipal

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  • Taking a forums break, still see PM's
Re: New Year, New Insurance
« Reply #3 on: January 13, 2012, 09:41:59 AM »
If your insurance is provided by your employer, somewhere there should be a summary plan description (SPD) for the health plan.  If your plan applies a waiting period for pre-existing conditions it should be spelled out in that document.

If it is a large company, there is probably a benefits department where you can call and ask for a copy of the SPD (or just ask the question in a generalized way). 
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline wolfter

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  • Posts: 4,460
Re: New Year, New Insurance
« Reply #4 on: January 13, 2012, 09:55:38 AM »
Sometimes under large group plans, there are no limitations on pre-existing conditions.  I'd contact the HR department and request a copy of the policy information.  I worked 2 different places where my insurnace covered my drugs immediately. 

Best of luck

Wolfie
Complacency is the enemy.  ;)  Challenge yourself daily for maximum  return on investment.

Offline Hellraiser

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  • Posts: 4,136
  • Semi-misanthropic
Re: New Year, New Insurance
« Reply #5 on: January 13, 2012, 10:06:02 PM »
Sometimes under large group plans, there are no limitations on pre-existing conditions.  I'd contact the HR department and request a copy of the policy information.  I worked 2 different places where my insurnace covered my drugs immediately. 

Best of luck

Wolfie

My employer is a massive international corporation so most likely it'll just cover everything immediately since they didn't even ask about pre existing.

Offline osric

  • Member
  • Posts: 54
Re: New Year, New Insurance
« Reply #6 on: February 19, 2012, 03:33:40 AM »
Sometimes under large group plans, there are no limitations on pre-existing conditions.  I'd contact the HR department and request a copy of the policy information.  I worked 2 different places where my insurnace covered my drugs immediately.

This is why we need health care reform. I have an individual plan since I don't have an employer (I'm self employed, which is a fancy way of saying unemployed) and I've been with the same insurer for over eleven years. Now I have to prove my residency every year (group members don't need to do that) which I find insulting. But otherwise I pay my big premium every month and thank ADAP for my meds. My case manager has been adamant that I make sure I keep paying my health insurance since losing my insurance and then trying to get a new plan could be a challenge.

Anyway I figure I paid thousands of dollars to the insurers for a couple of decades when I was in great health that it's payback time and I'd fight tooth and nail If they ever denied a claim or tried to discontinue my coverage.

 


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