Psycho-Babble Social Thread 221712

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applying to new insurance- need help hok

Posted by Dr. Bob on April 23, 2003, at 8:23:40

In reply to applying to new insurance- need help , posted by hok on April 23, 2003, at 0:11:13

> My old insurance is about to run out and I have to apply to Blue Cross/Blue Shield for new coverage. I'm wondering what exactly I have to tell them about my past mental condition. In reality, I have been seeing a psychiatrist since age 15, however, she has always put down "adjustment disorder" as the diagnostic code. I have just recently, in the past couple of months, started seeing a new psychiatrist who has actually started to put "Major Depressive disorder" as the code.
>
> What exactly, if anything, should I report as a pre-existing condition on my application? I'm really concerned about them hiking up the premiums if I tell them too much about my mental heath history. Any suggestions or similar experiences? I could really use some help on this.

 

Re: applying to new insurance- need help hok Dr. Bob

Posted by judy1 on April 23, 2003, at 11:49:59

In reply to applying to new insurance- need help hok, posted by Dr. Bob on April 23, 2003, at 8:23:40

my initial feeling is to deny any pre-existing mental disorder (especially if you feel it will affect your premiums, and it will prevent you seeking help for one year for a specific illness). my insurance keeps physical and mental claims separate, but i do know that insurance companies share information on their clients- usually more in the range of how much money you have cost them and usually that applies to catastrophic illnesses. if your pdoc is covered by the new insurance and you are fortunate enough to live in a state that identifies major mental disorders (like California), then you will have no problems. will your pdoc be covered under the new insurance? if so, ask his/her opinion about the new insurance and how you should approach this. best of luck-judy

 

Redirected: applying to new insurance- need help

Posted by Dr. Bob on April 23, 2003, at 17:44:19

In reply to applying to new insurance- need help hok, posted by Dr. Bob on April 23, 2003, at 8:23:40

Re: applying to new insurance- need help

Posted by canwetalk on April 23, 2003, at 12:02:54

In reply to applying to new insurance- need help , posted by hok on April 23, 2003, at 0:11:13

Yes I can see your concern. My suggestion to you is talk it over with your psychiatrist and let him know your concerns. Perhaps he may have other patients who had similiar situations.

Insurance companies can be funny about "pre-existing condition." I do feel your psychiatrist could help you with this. Perhaps another way of phrasing it instead of what he put down. If in the past you had listed what it was and everything went smoothly for you why not list it the same way.

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Re: applying to new insurance- need help hok

Posted by Janelle on April 23, 2003, at 14:11:59

In reply to applying to new insurance- need help , posted by hok on April 23, 2003, at 0:11:13

I was in a similar situation - I had Blue Cross/Blue Shield Insurance, but for some reason and I forget what it was (I think it was because I was coming off COBRA and went directly to BC/BS I did NOT have to indicate any pre-existing conditions)

However, the premiums for BC/BS kept skyrocketing (so what's new?!!) so I went to another company and spoke in detail to the agent who was a very nice man whose wife is BiPolar and he told me that I really should disclose my condition on the application - that they would probably NOT reject me but rather waiver me out for depression & anxiety, which is exactly what they did - when I got my policy there was a separate page stating that they would not cover anything relating to these conditions for as long as I had the policy. Argh.

I did put through some claims for those conditions and sure enough I got letters telling me I was not covered for those conditions.

I eventually dropped that policy because it also began to skyrocket, even with a high deductible.

Now I'm without health insurance, which freaks me out. I do have coverage for the mental disability part but not for anything else. I will be going to a low cost clinic (yuck) but g-d forbid I have to go to the hospital - I'm screwed. I have seen what hospital bills cost and eeeeeeeeeeek.

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Re: applying to new insurance- need help Janelle

Posted by Snoozy on April 23, 2003, at 15:52:25

In reply to Re: applying to new insurance- need help hok, posted by Janelle on April 23, 2003, at 14:11:59

Hi Janelle-

some states have "high risk" health insurance pools, generally for people who can't get health ins. on their own. That might be worth looking into.

How are you doing with the drowsiness?

Snoozy

 

Re: applying to new insurance- need help hok

Posted by noa on April 24, 2003, at 8:29:35

In reply to applying to new insurance- need help hok, posted by Dr. Bob on April 23, 2003, at 8:23:40

Hok,

The HIPAA web site provides the information you need, along with what you will need to know from your STATE health insurance commisioner's office.

It will depend on a few things.

First, is the insurance you are losing a GROUP plan?

Have you had continuous coverage (see below)?

Are you now enrolling in an INDIVIDUAL plan or a GROUP plan?

Why are you losing benefits and have you used up your COBRA option?


Here are some helpful links at the HIPAA site:

If it is a GROUP plan, you are protected under these federal rules in that you cannot be charged higher premiums based on pre-existing conditions, or answers on the health questionnaire.

http://cms.hhs.gov/hipaa/online/420102.asp

But in an individual plan, it is possible.
http://cms.hhs.gov/hipaa/online/620181.asp

BUT, your state may provide protection.

As for being DENIED coverage on the basis of pre-existing conditions, or having pre-existing conditions excluded from coverage, whether you are protected under HIPAA (and remember to check State rules which could be even more protective, depending on the state) it depends on whether you are coming from group coverage, and have continuous coverage with no significant breaks.

Am I HIPAA-eligible for individual coverage?
http://cms.hhs.gov/hipaa/online/620321.asp

It will take you through a series of questions to determine if you are a "HIPAA eligible individual".

Description of HIPAA eligible individual:
http://cms.hhs.gov/hipaa/online/modules/terms.asp?record=010481

"If you are HIPAA-eligible, also called an eligible individual, you have the right to get individual coverage without preexisting condition exclusions.

General Rule
You are HIPAA-eligible if ALL of the following are true at the time you apply for individual coverage:

You have at least 18 months of continuous creditable coverage without any significant breaks
Your most recent coverage was under a group health plan
You are not eligible for coverage under another group health plan
Your most recent health coverage was not cancelled because you did not pay your premiums or because you committed fraud
You are not eligible for Medicare or Medicaid
If you were offered COBRA, Temporary Continuation of Coverage (TCC), or State continuation coverage, you purchased and exhausted the coverage
You did not accept a conversion policy or a short-term limited duration policy"


What is guaranteed availability of individual coverage?
http://cms.hhs.gov/hipaa/online/620021.asp

I am also copying the text of this one here, but do see the link because it has a link to State info:

"Under HIPAA, guaranteed availability of individual coverage means that if you are HIPAA-eligible, you cannot be denied the right to buy individual coverage, regardless of your health history. In addition, a preexisting condition exclusion cannot be applied to your coverage.

The particular coverage you are entitled to buy will depend on how your State has chosen to apply the HIPAA requirements.

In some States, you may be entitled to buy any individual policy sold in the State
In some States, you will only be able to buy specific policies identified by the insurance issuer
In other States, you may only be entitled to coverage through the State's high-risk pool
Click next to find out what your State does."

Can I be charged more because of my health condition?
http://cms.hhs.gov/hipaa/online/620181.asp

The answer they give is "maybe" because HIPAA doesn't regulate premiums. BUt they do urge you to check the State laws.

And other questions are at:

http://cms.hhs.gov/hipaa/online/620001.asp

Regarding what pre-existing conditions exclusion periods, and "continuous coverage":

From: http://cms.hhs.gov/hipaa/online/430271.asp

"In group health plans, a preexisting condition exclusion period cannot be longer than 12 months, or 18 months if you are a late enrollee. The length of the exclusion period must be reduced by the number of days of continuous creditable coverage* you have.

Note: Contact your State Insurance Department to find out if your State has stronger consumer protections regarding the length of preexisting condition exclusions."

* From http://cms.hhs.gov/hipaa/online/tellmemore/570001_content.asp?record=570021

"Continuous creditable coverage includes most kinds of health benefits, but does not include any coverage you had before a significant break in coverage of 63 or more full days in a row."

Ok the way I understand all this is that if you have had continuous health insurance coverage, with no breaks of 63 days or more, the exclusion period for pre-existing conditions is reduce by the length of continuous coverage. Since pre-existing condition exclusion periods are maximum 12 months (if you enroll immediately when eligible or during an open enrollment period) or 18 months (if you enroll some time after becoming eligible), if you have at least that amount of time of continuous coverage, ther should be no exclusion period.


 

Re: applying to new insurance- need help hok

Posted by Bill L on April 24, 2003, at 15:04:02

In reply to applying to new insurance- need help hok, posted by Dr. Bob on April 23, 2003, at 8:23:40

Do you currently feel depressed? If not, then I would not say anything about the depression. If they later say that they checked with your doctor and he said you had "major depression", tell them that it's not really true and that you just had anxiety. If they ask about meds, you can say that the meds are just for anxiety.

But they might not check with your doctor. Don't even give them your pdoc's name. If they require your family doctor's name, call him first yourself. Tell your doc that you think that the condition you have/had is just anxiety and not depression. Ask him if he is willing to tell that to the insurance company if they ask.

 

Re: applying to new insurance- need help

Posted by hok on May 6, 2003, at 14:18:05

In reply to Re: applying to new insurance- need help hok, posted by noa on April 24, 2003, at 8:29:35

I was tabling this issue for the last couple of weeks and am now finally having to readdress it. Hopefully the new HIPAA act will allow me to get some sort of behavioral health coverage without waiting for the pre-existing condition period to end. Thanks to all for your input, especially yours Noa.

HK


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