Pre-existing condition/6 month waiting period

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Pre-existing condition/6 month waiting period

Postby joymartin3029 » Sun Jun 16, 2013 6:11 pm

Hi There! Can someone help me understand my new policy. I'm 33yrs old I have had "episodes/flares" over the past 8yrs or so, and my Dr.s have mentioned MS several times but all of my diagnostic tests have come back clear... MRI, CAT scans, Lumbar puncture, ect. They have referred to my flare ups as "gait ataxia, undetermined cause." I have periods where I feel relatively well, but when I experience a flare they are bad... and they are becoming more frequent.

I had been without insurance for a long time and and have not had care. To be honest dealing with the health care systems has been frustrating, exhausting, & expensive. And I still have no answers. Recently I was able to obtain a private insurance policy through my state after being denied by a health insurance company, and I'm considering under going testing again to see if the tests might be more conclusive now that the flares are worse and more frequent.

My policy states that I have a 6 month pre-existing condition waiting period. The letter they sent me says that "I am subjected to a 6 month period where coverage of any pre-existing condition will not be approved."

So does this mean that after the waiting period I can receive coverage for for pre-existing issues? I don't know if I worded that in a way that makes sense... If I go to my Dr. and say "My legs have been bothering me for several years." Or "This is the 4th flare I've had in 6 months." and my Dr. notes this in my records, does the insurance company have the right to deny coverage for any care I might receive even though I've satisfied the waiting period?

Thanks for any insight you might be able to offer.
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Re: Pre-existing condition/6 month waiting period

Postby jimmylegs » Mon Jun 17, 2013 3:26 am

I am not experienced with insurance issues but I think the 6 month limitation is related to the amount of time you've been signed up with this insurer, not the length of time you've been sick.
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Re: Pre-existing condition/6 month waiting period

Postby Ladymac » Mon Jun 17, 2013 6:05 am

joymartin3029 wrote:Hi There! Can someone help me understand my new policy. I'm 33yrs old I have had "episodes/flares" over the past 8yrs or so, and my Dr.s have mentioned MS several times but all of my diagnostic tests have come back clear... MRI, CAT scans, Lumbar puncture, ect. They have referred to my flare ups as "gait ataxia, undetermined cause." I have periods where I feel relatively well, but when I experience a flare they are bad... and they are becoming more frequent.

I had been without insurance for a long time and and have not had care. To be honest dealing with the health care systems has been frustrating, exhausting, & expensive. And I still have no answers. Recently I was able to obtain a private insurance policy through my state after being denied by a health insurance company, and I'm considering under going testing again to see if the tests might be more conclusive now that the flares are worse and more frequent.

My policy states that I have a 6 month pre-existing condition waiting period. The letter they sent me says that "I am subjected to a 6 month period where coverage of any pre-existing condition will not be approved."

So does this mean that after the waiting period I can receive coverage for for pre-existing issues? I don't know if I worded that in a way that makes sense... If I go to my Dr. and say "My legs have been bothering me for several years." Or "This is the 4th flare I've had in 6 months." and my Dr. notes this in my records, does the insurance company have the right to deny coverage for any care I might receive even though I've satisfied the waiting period?

Thanks for any insight you might be able to offer.



Hi there. I feel for you. I know one thing I learned early on is that Insurance can be a problem if someone enters a diagnosis of MS when they do not have the testing to confirm, and the confirmation of that diagnosis must happen at an MS Center. I would first want to make sure that they have not written that and recorded in your system that you have MS. Not until you have been properly diagnosed. This way it doesn't present a problem with insurance. If you have been diagnosed, then keep reading below.

With that said, I don't know if you life in the USA, if you do, they changed the laws about pre-existing conditions. What this means is that you can get insurance, however, it may be more expensive because of a pre-existing condition.

In your Insurance Policy it should describe something like you can't have seen a doctor for the complaints you currently have or receive treatments (including medication) for a specified period of time.

If you get a copy of your actual insurance policy that would be a good start. The second thing would be to get a copy of all your records from your doctor so you can read and see if you need to ask him to take out any mention of MS if you have not been diagnosed yet. Third, this is a big one: For FREE you can go to whatever hospital, etc., you have had your CAT and MRI scan's to the medical records department and request all studies to be put onto a CD/DVD for you and a hard copy of the results of all those studies as read by the radiologists. I started a binder and a file and whenever I have something done I get the CD/DVD that day (you just tell them when you go you need to take one with you) and then when the report is complete you can sign a paper they mail it to you or you can get a copy of that from your doctors office. This way you aren't trying to go backwards to get records. If you have not gone to an actual MS Center, please tell me what STATE you live in and where the nearest 2 major Cities are and I can get you the information in a PM (private message) for the nearest actual MS Center. They are the ones you need to see to sort things out. Also, we have all had stuff done at the local hospital that when we take it into the specialists they all roll their eyes and say that the quality is "grainy" not as clear as theirs. Some can spot something immediately, others want you to have an MRI on their equipment and the cool thing about an MS Center is that you can make the appointment to have your MRI and to see the doctor immediately following. The Neurologist will pull it up on a computer screen right in front of you and explain what he/she is seeing and record right then and there what is what. The radiologists report comes later, but every single MS Specialist Neurologist at a Center likes to read their own and they don't always agree with the radiologist anyways :lol:

So to answer your question, please get your insurance policy in whole so you can read it and then you should go to your docs office and sign a authorization to get a copy of your records (those you might have to pay so much a page after so many pages) and go to wherever you have had studies done like CAT Scans, MRI's and get those in person while you wait put on disc with a copy (hard) of the reports.

Once you have that and have read everything, make notes if there are places where they mention might be ms or if they diagnosed you as MS and then I would be interested in hearing from you as to what you found. You can PM me if you want and not be on the board.

I am willing to help you sort out. I went through this myself. It is a lot of work, but necessary before you can go forward and find out what is going to be a problem with insurance and if you need to have somethings corrected so you can go forward to an actual MS Center to get evaluated under your insurance and when.

Best Regards,
Blessings,

Ladymac
RRMS diagnosed 2006
Tecfidera Started April 2013
:)
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Re: Pre-existing condition/6 month waiting period

Postby Ladymac » Mon Jun 17, 2013 6:14 am

Sorry, one more thing. This helps everyone.....

When you have an appointment with any doctor, have labs, xrays, anything done, if you ask for copies then of the "doctors notes" and the lab results and the films/MRI/Cat Scans on CD they will give it to you. This way you can always stay current and you won't have to go back and pay for records at your DR office.

Especially helpful if later on you need to apply for Social Security. They need to know who, what when where how and why and copies. Keeping a current file is easy to go through and make your own copies including ALWAYS burn a SECOND copy of the CD/DVD for your own file and label them!

Staples has these nice big binder's where you can get the 3-ring disc holders that you slip into the binder to keep your CD/DVD's with all your paperwork together. It also helps to bring the binder with you when you see the specialist so they can see what as been done.

Blessings!
Blessings,

Ladymac
RRMS diagnosed 2006
Tecfidera Started April 2013
:)
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Re: Pre-existing condition/6 month waiting period

Postby joymartin3029 » Mon Jun 17, 2013 7:42 am

Thank you so much for your replies!

The policy I have is through Carefirst Blue Cross, for people who are unable to obtain medical insurance from either employers, are ineligible for medicare or medicade, and/or have been denied insurance from private companies. I only qualified because a private insurer denied my application because of my history of IBS. Completely stupid! But my current policy has my medical information from the last 3 years on file.

When I applied I had to fully disclose everything in order to be approved, but there is no mention of MS in my records. Mostly it has my history of my Gastrointestinal/IBS, fatigue, and overall body pain related complaints.

I guess I'm just wondering how to proceed. I don't want to have all this testing done only to find that nothing will be covered. My policy is expensive enough, I can't afford to pay thousands of dollars for the testing.

I'm in Maryland BTW. Thanks again for your advice & suggestions.
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Re: Pre-existing condition/6 month waiting period

Postby Ladymac » Tue Jun 18, 2013 6:19 am

Hello,

I feel for you with the insurance nightmare. We ALL feel for you with all the insurance nightmares. We are all pretty much on our own to figure out our individual insurance situations. I would like to pass on some suggestions for you:

Here is the link to the Maryland Chapter of the National MS Society: http://www.nationalmssociety.org/chapte ... index.aspx

You will find a host of information and advocacy and you can contact them to have them help you get an appointment with an MS Center (some of the greatest in the world like John Hopkins, etc) in Maryland where the MS Center would get pre-approval for a consult from your insurance company. You just have to explicit that you MUST have pre-approval.

Once they let you know they have pre-approval, ask the Center that they get you to for the pre-approval number. Then call our insurance company and check to make sure they have that pre-approval number.

Now here is the biggest gift of information I can give you. Get a spiral bound notebook. Every time you talk to someone no matter whether it is the Doctors Office Insurance, whatever, write down the Date, Time, Operator ID if they have one, Case number, all information and then write a note to your self what was said etc. If you called and left a message and didn't talk to anyone, still write down the date, time, number you called, who it was, why you called and that you left a voicemail.

When or if they call you back, you notate all the information as above. If you weren't home and they left you a voicemail, still write that all down with date and time and any message.

This is the only way that you can have all the information and credibility to work with the insurance companies and doctors offices because it will make a difference from time to time that you had that information.

Also, always ask for a copy of something to be mailed to you.

I would start with the MS Society of Maryland at the link I gave you above and whatever you do, please do not announce anything to your insurance company until you have been properly tested and diagnosed by an MS Center with a MS Neurologist from that Center. With each phase of testing, do not do it without pre-approval from your insurance company. If they say you don't need pre-approval for something, write down all the information above, wait a day, call back and talk to someone else and get the same information and write their name, id, etc. all down.

The MS Society also has some limited funds that can be applied for if you end up needing help. They are a great resource for you.

Good Luck!

Blessings
Blessings,

Ladymac
RRMS diagnosed 2006
Tecfidera Started April 2013
:)
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