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A way to pay?

Frank007FFrank007 Posts: 12
edited 06/11/2012 - 8:44 AM in Back Surgery and Neck Surgery
I need 2-level cervical ADR very soon. I am unemployed with Cobra coverage that is about to expire. As you know most insurers are still refusing to pay for the surgery. Others now seem to cover it. Aetna is one of the ones that do cover adr as a matter of policy(http://www.aetna.com/cpb/medical/data/500_599/0591.html).A

Unfortunately my Cobra insurer is United Healthcare which does not cover it. I cannot simply purchase an individual policy from an insurer such as Aetna. When I tried I was told that my preexisting condition precluded me from qualifying.

Then I learned of a State of Florida(where I live) HIPAA (http://www.cms.gov/HealthInsReformforConsume/01_Overview.asp#TopOfPage) program for which Aetna is the provider. Apparently I can purchase the “same” policy that is unavailable to me directly as a “Guaranteed Issue Health Insurance plan”. The only difference is the much higher cost. However I have read that companies selling HIPAA policies will simply place what is called an "Exclusionary Rider" on your policy and/or change the preexisting condition clause in the boilerplate of the policy to exclude your prior medical problems. Here is a great article about this: http://www.florida-health-quotes.com/special-risk.html

1. Are they really the same policy? Is there any way I can know ahead of time what is actually covered by my HIPAA Florida Aetna policy before I buy? How can I know for sure if the policy I buy will have any Exclusionary Riders?

The Aetna HIPAA agent could not definitively answer this question. Believe it or not, she told me I would have to purchase the policy in order to then read the details of the coverage! If it turns out that something I need is not covered I have 10 days to cancel the policy and receive a refund. Ten days is not enough time to put in a request for preapproval and wait to see if it’s accepted or denied.

2. Is this a good idea? Am I missing something?



  • You would first need to apply for the insurance. Because of my neck issues when my Cobra ran out went to purchase medical insurance and was deemed uninsurable. Due to the fact I had carried my Cobra to expiration and it was not neglect on my fault the state's have a insurance pool program that they insure resident through. The rates aren't any better, but it is insurance. But first you need to apply to see if you will qualify for the insurance. Don't wait till the last minute as it often takes time to run the applications. On the applications it will ask you about being at the doctor and what not, over the previous year, so don't leave it off. All the insurance companies are automated and basically they can see this information. But first you would need to apply to see if you even qualify for the insurance before looking at what they cover. Good luck.
  • Thanks for the advice. I will do that. Were you able to pay for you r surgery with insurance?
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