Vegas Free-for-All - I had a delightful conversation with a health Insurance company rep this morning

malibber2

Mar 12, 2014
8:50am

I called the insurance company this morning and asked why they were denying my wife's claims for preexisting conditions because her employer had sent her a letter saying preexisting conditions were going to be covered as of 1-1-14. They hemmed and hawed around for about ten minutes . Then they put me on hold for 20 minutes and finally came back and said we are going to have to "research" this matter and get back to you. The rep said she couldn't tell me now if she is covered or not at this point. So there you go an insurance company that doesn't even know if they are covering preexisting conditions.

Terry Locke

Mar 12, 2014
8:58am

Block User

Working with insurance companies is frustrating. I can only ponder how much $$$ we would have surrendered over the last 10 or 20 years if we hadn't challenged bills. And we're relatively healthy. Shouldn't have to work so hard to clears these things.

forkushV

Mar 12, 2014
10:03am

Block User

Quote

Originally posted by: malibber2
I called the insurance company this morning and asked why they were denying my wife's claims for preexisting conditions because her employer had sent her a letter saying preexisting conditions were going to be covered as of 1-1-14. They hemmed and hawed around for about ten minutes...

So what happened as of January 1, 2014, that changed their policy regarding preexisting conditions? Must have been something wonderful!

malibber2

Mar 12, 2014
10:30am

Block User

It was until Obama f...ed it up. Apparently in one of those Obama executive orders the requirement that employer's policies cover preexisting conditions has been moved forward to a future date. I guess tough shit for me that the employer wasn't smart enough to realize that their group coverage was no longer going to cover preexisting conditions. Obama could f... up a wet dream.

alanleroyII

Mar 12, 2014
11:05am

Block User

Quote

Originally posted by: malibber2
It was until Obama f...ed it up.....

Obama giveth. Obama taketh away.

forkushV

Mar 12, 2014
11:25am

Block User

Quote

Originally posted by: malibber2
It was until Obama f...ed it up. Apparently in one of those Obama executive orders the requirement that employer's policies cover preexisting conditions has been rolled forward to a future date...

I blame the people who whined that provisions of Obamacare needed to be rolled back or delayed. I think that describes you.

malibber2

Mar 12, 2014
11:48am

Block User

I never said it should be rolled back or delayed. I think it should be replaced with something worthwhile, and when somebody tells you that you are covered no backing out of the deal. See you didn't even know Obama could weasel out of the no preexisting conditions deal until I told you. It seems nobody did but those insurance companies.

Dan Svatass

Mar 12, 2014
12:53pm

Block User

It's pretty hard to get excluded under a group plan you get at work these days, but it can happen.

Exclusion Periods for Pre-Existing Conditions

The group health plan at your job cannot refuse to cover you if you have a pre-existing condition. (A pre-existing condition is an injury or illness that started before you joined the plan).

However, some plans have exclusion periods. This means that they will not pay for services for pre-existing conditions for up to 6 months. (If your group health plan has only 1-2 members, it can have an exclusion period of up to 12 months.)

Group plans cannot exclude services for pre-existing conditions in children under age 19.

They cannot exclude services for your pre-existing condition if you have not had any diagnosis or care for your condition in the last 6 months.

They cannot exclude services if you have had 6 months of “credible coverage”. This means that you had health insurance for 6 months and it ended 62 days or less before your new insurance starts.

The exclusion period must be shortened if you had credible coverage for 1 to 6 months.

For example, Mary had health insurance with her last job for 5 months. She got a new job within 61 days. Mary had 5 months of credible coverage. The exclusion period for her new health plan can only be one month.

Source

That's for California. You're in Indiana, right? The only difference for Indiana is that the maximum exclusion period there is 9 months, not six.

Which of these gaps did your wife fall through?

malibber2

Mar 12, 2014
1:15pm

Block User

Your info is old that is from 2013. Your link (Indiana) says in the footnotes:

Quote

Beginning January 1, 2014, the Patient Protection and Affordable Care Act (ACA) prohibits issuers that offer new and grandfathered plans (plans in existence before the ACA that have not made significant changes) in the small group market from excluding coverage for pre-existing conditions.

What they are calming best I can tell is that their policy is no longer a "new" policy as it was described by her employer this fall, but rather it is the same old policy that Obama through an executive order allowed them to grandfather thus they don't have to pay.

She first got the older policy on 6/17/13.

Quote
Originally posted by: Chilcoot
It's pretty hard to get excluded under a group plan you get at work these days, but it can happen.

Exclusion Periods for Pre-Existing Conditions

The group health plan at your job cannot refuse to cover you if you have a pre-existing condition. (A pre-existing condition is an injury or illness that started before you joined the plan).

However, some plans have exclusion periods. This means that they will not pay for services for pre-existing conditions for up to 6 months. (If your group health plan has only 1-2 members, it can have an exclusion period of up to 12 months.)

Group plans cannot exclude services for pre-existing conditions in children under age 19.

They cannot exclude services for your pre-existing condition if you have not had any diagnosis or care for your condition in the last 6 months.

They cannot exclude services if you have had 6 months of “credible coverage”. This means that you had health insurance for 6 months and it ended 62 days or less before your new insurance starts.

The exclusion period must be shortened if you had credible coverage for 1 to 6 months.

For example, Mary had health insurance with her last job for 5 months. She got a new job within 61 days. Mary had 5 months of credible coverage. The exclusion period for her new health plan can only be one month.

Source

That's for California. You're in Indiana, right? The only difference for Indiana is that the maximum exclusion period there is 9 months, not six.

Which of these gaps did your wife fall through?

Dan Svatass

Mar 12, 2014
1:37pm

Block User

Yes, malibber, the information from Kaiser is from last summer.

However, I don't think there's been an extension to the requirement that all employer plans cover pre-existing conditions beginning January 1, 2014. Can you provide a link to such an extension? As best I can tell, ALL employer plans that must cover pre-existing conditions now.

Also, I don't think you understand what you quoted from Kaiser. It says that while certain plans can be grandfathered, those plans also cannot exclude coverage for pre-existing conditions effective January 1, 2014. I think you've misread it to mean the opposite, that they CAN exclude coverage. You're reading it wrong.

Please provide a link stating that grandfathered employer plans have been excepted from the requirement that they cover pre-existing conditions effective January 1, 2014. I don't think such an extension has been made.

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