Health Ins Question

[bubbas1]

I am covered under my wifes policy. She is going to ask her Human Resources dept about this but knowing how fast they work it could take awhile for a answer.

Had a tib/fib fracture and had 2 screws put in. Ins is doing good at covering the bills (minus deductable and co/pay). I found out today the screws wont be able to come out until Jan and here is the problem. My wifes work is changing providers Jan 1.

Is this considered a pre-existing condition that dosent get covered by the new provider or do you think they cover it because its a continuation of ongoing treatment?

 

[MadJack]

I am covered under my wifes policy. She is going to ask her Human Resources dept about this but knowing how fast they work it could take awhile for a answer.

Had a tib/fib fracture and had 2 screws put in. Ins is doing good at covering the bills (minus deductable and co/pay). I found out today the screws wont be able to come out until Jan and here is the problem. My wifes work is changing providers Jan 1.

Is this considered a pre-existing condition that dosent get covered by the new provider or do you think they cover it because its a continuation of ongoing treatment?

somebody correct me if i'm wrong but since it's a policy from work you don't fall under pre-existing conditions limitations.

 

[MadJack]

i'll tell you why i think so.

i have a company group policy that i changed to when i moved to indiana. i don't have to worry about the pre-existing conditions with this policy (high blood pressure).

had i gone out on my own and got a policy (not a group policy) i would have to go under the pre-existing condition limitations. FOR 2 YEARS!

what good is that? they'll blame anything on the high BP even though it's perfectly controlled.

 

[THE KOD]

I am pretty sure Jack is right and its a continuation and you should be covered.

I will tell you one thing my wife and I learned. She was in a bad auto accident on Jan 3 and was out of work 8 months.

If anyone out there thinks there is such a thing as long term disability you should think again.

If you have a good record and are a good employee they will carry you for as long as possible.

But after short term disability was used up, 90 days , they told her if she was not back to work
by a certain date , she could file for SSI benifits.

Basically if your hurt, injured, or have a health issue that takes you out for over 90 days , your pretty much on your own.

Insurance sucks.

 

[bubbas1]

I am hoping your right Jack. It makes sense. Just never know how bad an ins co wants to save a few bucks.

Scott..I know for me they immediatly put me on FMLA for 12 weeks. No short/long term disability thru the co. I work for but at least it protects my job for 12 weeks. I should make it back to work with 1 week to spare.

 

[DOGS THAT BARK]

Your condition will be covered with NO pre ex
-only way you would be subject to pre-ex clause is if you went over 62 days without coverage.

In case you have other questions-this might help

q & A on fed HIPAA regulation

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

 

[SixFive]

Your condition will be covered with NO pre ex
-only way you would be subject to pre-ex clause is if you went over 62 days without coverage.

In case you have other questions-this might help

q & A on fed HIPAA regulation

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

yep, the whole reason the HIPAA legislation was started; it just got a lot of bs added on. The portability of insurance, however, is a wonderful protection to the consumer.

 

[Lucy11]

Your condition will be covered with NO pre ex
-only way you would be subject to pre-ex clause is if you went over 62 days without coverage.

In case you have other questions-this might help

q & A on fed HIPAA regulation

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

He/she would have had to be covered for 1 full year without the break of 62 days. If there is a pre-x on the new plan and you only had the other plan for 6 months, that won't qualify to waive the pre-x.

#1 Just because you have insurance through your employer doesn't mean there won't be a pre-x clause in the coverage.

#2 From your explanation, if there is a pre-x clause w/ the new carrier you could cancel that out by supplying the new carrier with a letter of credible coverage from the old carrier. As long as you were covered for a year without the 62 day break, you will be fine.

I work for a major Healthcare carrier so feel free to shoot me any questions as well.

 

[DOGS THAT BARK]

bubbas1 You will be covered trust me.

A: if your previous carrier paid as you said--evidently they did not think your condition was pre existing--

B:-and prob didn't even check as bone fractures are general not something you walk around with for a year--without being treated

 

[bubbas1]

Thanks for the input.

Never had a lapse in coverage so it looks like I will be good to go.