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What do you do when you have a pre-existing condition? Just Suffer?

Emj1988EEmj1988 Posts: 45
edited 06/11/2012 - 8:50 AM in Health Insurance Issues
Ok I'm in a messed of situation I pretty sure im not the only one on here that has this sort of problem... Ok basically 3 years ago after I graduated from college I bought my own private health insurance through Assurant Health which is the biggest mistake I have ever made because they are scammers (google "Assurant health scam" and you will know what I mean). A year and a half later I screwed my back up on the job and lately I just got done with the battling of the workcomp insurace settlement. The thing is Assurant Health will not cover my back at all because I was in a car accident about 4 years before injuring my back (I was lucky to survive the crash in my tracker convertible rolling it 2and a half times> I only suffered a cut on my forehead and was completly fine I had no back pain at all until I injured myself on the job.) For some reason that was good enough reason for them to deny it. In my settlement with work comp I comprimised on all future medical bills being paid because I didnt want to go to the hearing and possibly loose since I had a conservative judge.

>I am going back to college again so I can hopefully have a sit down job so I will be back on my parents insurace which is through bluecross.

>Can you buy some type of government health insurance so there is no pre-existing issues. I asked my attorney "what do I do If I need a fusion in the near future since the health insurance companies are going to deny me" and he couldn't give me a straight answer.

>When is Obomas "pre-existing part of the health care bill going to go in effect?" Im guessing Ill have to pay ridiculous premiums if this all works out in his bill.

Please!!! someone help!!! I need to see a doc again for meds and Im tired of the pain!!!

-22 years old
-Grade 1 retrolisthesis, l4-s1 disk bulge @ 2mm and 6mm
-Flat T-spine for 3 vertebrae
-loosing curves in l-spine t-spine and neck
-Severe/moderate shoulder pain I think I might be fibromyalgia.


  • I am sorry you are going through this :hug: Yep that insurance co is a scam. I almost signed up with them for 500.00 a month for me & hubby and then checked into them first and boy am I happy I did.

    any ways....... moving forward.

    In my state ( Pennsylvania ) there is a state insurance I bought that covers ALL pre existing conds. I have to earn ( just me and hubby at home now ) less then 5,000 monthly and I have to work at least 20 hrs a week and I pay 48.00 a month for the insurance :D

    It covers EVERYTHING - eye, meds, dental the works.

    It is for people like you and I who work but have a pre existing cond like an injury or diabetes or something that would make your life better if you had insurance. Oh, you can't have any other type of insurance to get this either. It is called MAWD. I was told all states have it. I would call the welfare office and see if yours does.

    Hope this help :)

    PS: Our posts may get edited, as I don't think we are allowed to post names of Drs or insurances co here lol ;)
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • SpineAZSpineAZ WiscPosts: 1,084
    Assurant is actual a reputable provider of individual insurance. The problems with individual health insurance is they don't cover anything usually within the 5-10 years prior to signing up for the coverage. The plan likely had a provision that if there are any medical records that show care or exam for back pain they would not consider anything for that at a later date. All they'd need to see if "patient complained of back pain after accident, xray in ER was negative" or "due to potential back injury examination and xrays were done" But that shows there was evaluation for back pain.

    This is because individual insurance is solely based on your history and potential claims. Group insurance under employers has a "risk pool" where the hiring of those with pre-ex conditions is not a concern as those who use the insurance will hopefully balance out those who do not.

    You can contact your state department of insurance to see if they have any programs such as PA. I think MA also had some programs for the unisurable.

    The new HealthCare reform act has provisions to aid in removal of pre-ex exclusions in 2014.

    If you were to get a job with a large employer that offered health insurance, and you still have Assurant, you'd likely have no worries about pre-ex in your new employers medical insurance. That is due to a provision in which "credible" coverage that expired no more than 63 days prior (Individual or Group) to starting new Group or Individual coverage results in the insurance company being unable to add any pre-exting exclusions or limitations.

    At this time in the US the most secure type of health insurance is that which comes from working for an employer that offers medical insurance.

    Moreover, it's important to try to join an employer that offers Short Term Disability and Long Term Disability. Once I entered an employer and did STD and LTD claims I decided never again to take a job without STD or LTD. And I vowed to pay for the most generous coverage.

    That paid off in that I ended up being unable to work April 09. STD and LTD have kept me afloat while applying for SSDI (mandatory under LTD as they reduce LTD by SSDI)
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • My apologies, I should have said that MY experience with said insurance co was not that great. Maybe for others they are. I should not have made a blanket statement.

    Once I checked the "fine print" I seen I had been given false info from that specific agent.

    Again, I should have been more specific and not made such a bold statement.
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • The government pre-existing insurance is available for purchase already. Part of the criteria to get it, is you can't have insurance for 6 months. You also can't drop insurance and then use that to buy the insurance.

    The state insurance pools are out already as well. Part of the criteria for getting those insurance is you have to be uninsurable or high risk that your insurance premiums are above a certain percentage of those standard going rate for insurance in your state. I am insured through my state pool program, I will say the insurance is expensive and the deductibles are high. In my state the same group running the state pool program is the same group running the federal program. If I could I would move to the federal program as the rates are much less along with the deductibles. But I can't risk being uninsured for 6 months. Here is a link that might be helpful that you can see if your state has a state program and or whom to contact for the federal plan. http://www.healthcare.gov/law/provisions/preexisting/index.html
  • I am on st disability from work at the present time but am also looking for another josb with less stress. When I get released from my doc, I plan to go back for one week and then give my 2 weeks notice if I get offered this other position. I believe HIPA protects you now if you had continuous coverage for 63 days in between jobs. As far as the st diability on my new job goes, it would not be available for 12 months but hopefully will not need it until after that (if ever) - meeting with Neurosurgeon tomorrow regarding what to do but unless he is insistant that I need surgery, I am going to take a pass - looks like most people are much worse off after surgery and I can learn to live with the pain.
  • SpineAZSpineAZ WiscPosts: 1,084
    HIPAA provides for no pre-ex with new group coverage if the gap is no more than 62 days. So if you go from one employer under which you are covered to another that provides coverage the gap in coverage can't be more than 62 days.

    IF the new employer offers medical insurance only after 6 mo of employment, you'd have to do COBRA from former employer to maintain continual coverage. If not the 6 months would result in a gap in coverage of more than 62 days.

    If you change jobs check on DAY 1 at the new employer as to when medical insurance begins. Many employers are doing First of the Month following 90 days of employment, so COBRA covers you in the meantime and eliminates a gap of more than 62 days.

    DSTEVENSBOB: I had an ACDF in May 2006 and changed jobs in August 2006 as I had recovered sufficiently and knew the new employer would cover me on Day 1 for medical and their STD and LTD had no pre-ex. If you do change jobs ask upon hiring for all plan documents. Sometimes if you can't get STD until 6-12 mo of employment the employer is resistant to give the documents to someone not yet covered. IF so, ask if you can peruse the document just so you have a basic understanding and say "for my financial planner we always want to be aware of benefits" or befriend someone there for a while who can get access to the documents. In my case I had a friend at the new employer and the STD/LTD documents were on line so she printed them out for me.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Post deleted. Solicitation at Spine-Health is never permitted

    Ron DiLauro, Spine-Health System Administrator 09/06/11
  • SpineAZSpineAZ WiscPosts: 1,084
    Usually in the LTD contract there is a provision (often called Recurrent Disability) that states if you become disabled within X amount of months after returning to work you are covered IF disabled for the same or related conditions. The most common is that if you are disabled from the same or related cause within 6 months of returning to work your claim begins again as long as you have proof of disability (even if you are no longer employed with the company under which you had Hartford). Hartford will ask for proof that you are not covered under your new employer so you may have to apply and get denied based on eligibility and then Hartford will consider the claim.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • SpineAZSpineAZ WiscPosts: 1,084
    Look at a copy of the exact LTD policy under which you were covered and then under something like "Recurrent" provision. I've never seen a provision that limits you to returning only to your employer but I suppose it's possible. But that would have had to have been approved by the state insurance department and often they don't like to see wording that discourages positive benefits for the employee/claimant.

    The way LTD is set up is often people do recover enough to return to work but their employer has terminated them, perhaps has gone out of business, no longer has a location where they did before, etc. The insurance company would like to see the person get off of LTD as well, so the 6 mo RTW (return to work) Recurrent provision encourages people to attempt return to work and have a fail-safe if they are unable to do so due to the SAME OR RELATED condition for which LTD was being paid (there must be medical proof of the person's inability to work).

    If you are still within the 6 months you can call Hartford. If they say it must be RTW to your own employer ask them for proof via sending you a copy of the plan under which you were covered. Plans change over time so if starting 1/1/11 it was "own employer" that would be in effect for any employee who goes out of work 1/1/11 or after. Anyone disabled 12/31/10 and prior is not affected by that policy change.

    You really need the exact plan document for your LTD.

    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • SpineAZSpineAZ WiscPosts: 1,084
    Make sure when you get the policy. I hate to be pessimistic but never trust what HR/Benefits or the Ins Co tells you until you see it in writing!
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
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