Lupus Support Group

I think that is complete BULLSHIT how insurances can deny full coverage for a prexisting condition.. I was in the same boat when i was pregnant with my 3rd son.. My insurance wouldn't cover me at all.. So I had to pay cash. But I didn't pay it fuck that. What are they gonna do put it on my credit? I just sad... I'm sorry I'm RAMBLING.. As far as what your going through I'm not sure if they will cover it.. Hope it all works out for you..

Hugs

make sure you follow all the rules for PPO like some require you have a referral from your GP, i know all this sucks big time!

I am sorry you are having to deal with all of this. I was not aware of the pre-exsisting condintions, I thought they got rid of that? I was on my husbands insurance until he lost his job, then got onto my insurance thru my work and they are covering me. it is all confusing and frustrating, they really need to make our health insurance better. I hope things work out for you.

hugs,
paige

I am from Canada and we don't have to go through the things you do. I do wish you luck and hope you are covered for nuerologist. Gidget I can't believe you where not covered for having a baby. That is horrible. hugs

Hi Allison,
PPOs should allow you to see anyone you want to see if they are in the network without needing a referral....And, if you have health insurance already I believe they cannot deny you seeing a dr. because of pre-existing conditions. I think that has been outlawed. They cannot deny you health care any longer they can only make your premiums so high that a person couldnt afford them. I have a PPO and have pre=existing conditions...My husbands insurance company has changed carriers several times and I have never had a problem seeing my dr.s. We have always had to have a PPO because of my health. Im pretty sure that the HEPA law keeps insurance companies from being able to get any records, past and present, to see what conditions you have had. You may want to look into this.
Hugs
Melissa

Actually, I don't think that Melissa is right on this one. Despite the HIPA laws, insurance companies CAN get your records because they require you to SIGN A WAIVER saying they can look at your records or you won't get insured. Remember, they have to look at your records to pay for your docs too.

Yes, you absolutely CAN BE TURNED DOWN for a pre-existing condition. You become what is called "an uninsurable" in the insurance field. The only way to get around that is to be married to or work for a VERY LARGE GROUP (like City of Los Angeles in my case). Large groups have so many members that it balances out the loses for pre-existing. Even so, many of the large companies have a pre-existing "period", usually 6 months or a year where if you go without treatment for that ailment, they WILL cover you. Some will set up your policy where it will cover everything BUT the pre-existing condition.

CA tried to work around this issue with a High Risk Insurance pool, but they had so many people want it that the waiting list was several years. And the rates were high back then.

Now to answer the original question: has a note been made in ANY DOCTORS' charts saying that you have this neuro problem? Pre-existing isn't defined as whether you've seen the specialist or not, it's whether you had the symptoms BEFORE signing on to the policy. So if your rheumy put "numbness in legs" or whatever, then it's a PRE-EXISTING CONDITION.

Lately, even people with secure insurance that was in place prior to becoming sick are finding insurance carriers DROPPING THEM for ridiculous reasons. The insurance commission has been looking in to this. Several years ago, a number of the large insurance companies pulled up stakes and LEFT CA because they did not want to cover the number of sick people in that area.

The only good news is that when you get SSDI you become eligible for Medicare and that covers most of your medical, although prescriptions are a problem if they aren't generic. But Medicare is better than nothing.

And for the record, HMOs require referrals. PPO usually do not; HMOs keep the costs down by making everything funnel through a primary care doc whose job it is to KEEP YOU from going to see specialists unless you REALLY NEED them. And it works to a large extent; there are plenty of people who jump right to specialists when there is no need to. To get an HMO to work for you, though, you have to be willing to push for your own needs and not wait for everything to come to your feet. You need to call after referrals, nag your docs, etc. You will eventually see the doc you need, but it takes tenacity some times.....

Tracy

tracy,
Thanks for correcting me...I certainly dont want to give out false info. Now that I think about it, Clark is with a large company and I am married. Until then, my parents had to keep me on their insurance from when I was a kid. I did think that they changed the insurance though that no one could actually get denied. I really dont know much about insurance but am VERY lucky that we have good insurance....I feel for people who do not....Clark does pay alot of money for ME.I did not know that insurance could look at your past records....Hmmm. Learn something new everyday....
Hope everyone has a nice 4th of july.
Melissa

Yep, it's pretty awful that the people who need insurance the MOST can't get it. But I think we all forget that insurance is a BUSINESS. They are betting that they will take in more money from you with your premiums than they will have to pay out in medical care. And taking a patient with a pre-existing condition is basically a sucker bet for them. They WILL lose money. But if the company is large enough, it will average out against people who are NOT sick.

These days, ANYTHING can be a pre-existing condition. They are turning away people on anti-depressants! ANY NEGATIVE HISTORY will prevent you from getting insurance. I remember my doctor didn't want to write LUPUS on my chart because the insurance company would see it. But these days, they see everything. I've tried 5 times to get them to approve Tri-Luma for the spots on my face. Lupus is partly a SKIN disease and this is something for the skin! But they claim (the insurance co) that it's "cosmetic." Well, doing a breast reconstruction after breast cancer is cosmetic too. I have found that if you fight long enough, you'll win with the insurance co.

Tracy

I have put muscle weakness on her symptom sheet. So I think a neurologist is out right now. My rhumy appts are only 30 dollars with a discount. She usually only does the inexpensive testing. I do have insurance through my husband and it is a large group I just don't have the previous coverage.