It is currently Tue Aug 22, 2017 2:35 pm



All times are UTC - 5 hours [ DST ]


Our Sponsors





Post new topic Reply to topic  [ 8 posts ] 
Author Message
 Post subject: Pre existing condition
PostPosted: Wed Aug 25, 2010 9:10 pm 
Offline
Average Poster
Average Poster

Joined: Wed Aug 25, 2010 9:03 pm
Posts: 9
I got a letter in the mail from my insurance claims rep. It stated about wanting information about pre existing insurance.

I believe they are telling me that they are placing my suboxone doctor visits as a pre existing condition (addiction) and will not cover any pre existing condition for a year?

my insurance will not cover anything from 6 months prior to insurance coverage and a year after i have insurance.

Has anyone ever come into this situation before?
what is the deal with addiction being a pre existing condition?
should i try to go as many times as i can before i get kicked out?
is this what the reason is that people get kicked out from sub doctors that accept insurance?


Top
 Profile  
 
 Post subject:
PostPosted: Thu Aug 26, 2010 8:45 am 
Offline
Long Time Member
Long Time Member
User avatar

Joined: Wed Feb 17, 2010 10:03 pm
Posts: 991
I suppose if you didn't have insurance before now you could be in some danger of them saying your addiction is pre-existing and they won't cover it. However, I thought there were certain things that Obama's health care legislation covered right away and one of those I thought was that insurance couldn't deny coverage of a pre-existing condition. I thought that was one of the things that began immediately. I could be very wrong on this but you may want to google Obama's health care changes and see what they say.

Cherie

_________________
Criticism may not be agreeable, but it is necessary. It fulfills the same function as pain in the human body. It calls attention to an unhealthy state of things.

- Winston Churchill


Top
 Profile  
 
 Post subject:
PostPosted: Thu Aug 26, 2010 8:48 am 
Offline
Long Time Member
Long Time Member
User avatar

Joined: Wed Feb 17, 2010 10:03 pm
Posts: 991
Sorry...I just looked at it and it appears to only be kids with pre-existing conditions.

_________________
Criticism may not be agreeable, but it is necessary. It fulfills the same function as pain in the human body. It calls attention to an unhealthy state of things.

- Winston Churchill


Top
 Profile  
 
Our Sponsors
 Post subject:
PostPosted: Fri Aug 27, 2010 9:45 pm 
Offline
Long Time Member
Long Time Member

Joined: Tue Nov 24, 2009 7:36 pm
Posts: 879
Location: Wisconsin
Script56 - I have actually had some first hand experience with all of this. In fact, my insurance was cancelled and I was left with nearly $15,000 and no health insurance for a few months due to them deeming my addiction a pre-existing condition. I can provide the entire story if you are still here. I just want to make sure that you are still around before I take all of the time it will take to type out this story.


Top
 Profile  
 
 Post subject:
PostPosted: Sun Sep 05, 2010 2:32 pm 
Offline
Long Time Member
Long Time Member

Joined: Tue Nov 24, 2009 7:36 pm
Posts: 879
Location: Wisconsin
It looks like, as too often happens, Script56 is no longer around - having only posted twice. I hesitate to post answers to people who never will see them, but since I have had a couple of PM requests to tell this story, I'll take the time to do so - hoping that even if Script56 never sees it there are at least other readers who may benefit. At least I hope so.

Here is what happened to me:

I have been self employed pretty much all of my life. I have obtained health insurance through a variety of ways throughout the years. While I was married I was on my wife's plan. When we divorced, I used the COBRA-provided coverage for a while but needed to find something cheaper. The divorce was final in October and the following July I obtained my own policy through Golden Rule Insurance. They had me fill out a rather long form after which they sent someone to draw some blood and ask me a few more questions. My policy was put in place at the start of August. I answered the questions to the best of my knowledge with regard to most of my medical history. However, when it came to a question about drug abuse, etc. I checked the "NO" box. I don't remember the exact wording of the question but in general it asked if I had ever been treated, diagnosed OR WAS AWARE OF drug or alcohol abuse. I had never been treated for drug abuse and in fact NO ONE knew of my drug abuse. It was a very closely guarded secret that I told no one about and no one even suspected me. Of course, deep down, I suspected I had a problem.

Things went along fine for several months until I was involved in a car accident in mid-October. I was actually covered by Workers Comp because I was "working" in a volunteer position when the accident occurred and this was clearly covered by Workers Comp. It was also at this time that my addiction was "discovered" and I was confronted by my family in the hospital. I admitted to the problem and along with treating my injuries from the car accident, the hospital staff worked on getting me into treatment for my drug addiction. About a week after I was released from the hospital for the car accident, I checked myself into an in-patient treatment program. In hindsight this was not a very good decision but that is another story. I did five days of what was basically an in-patient detox. This is where all of the insurance problems started.

As the bills went to my insurance company, they immediately put up red flags and wanted to research through my medical history to make sure my addiction was not a pre-existing condition. They notified me of what they were doing and said they would let me know what they find and decide. It was about a month later (now mid-November) when I was informed that they had determined my drug addiction was a pre-existing condition that I did not disclose to them. It would have been bad enough if they would have said that my bills would not be covered. The larger problem for me was that they were going to treat this as if they knew I had drug addiction in my history when applying for insurance and do what they would have done had they had this information at that time. In other words, they were canceling my insurance retroactive back to August 1! They sent me a refund for my insurance premiums. In other words, they were going to treat this situation as if I never got insurance with them in the first place. I was then to be responsible for nearly $15,000 in addiction treatment. Had the car accident not been covered by workers comp, I would have been responsible for those bills as well - and I'll bet they were $50,000 or more.

I was horrified. I had lost my job due to my addiction. I was facing criminal charges due to my addiction. Some members of my family would no longer talk to me because of my addiction. Many of my friends no longer spoke with me. Basically my life was upside down - plus I was battling the disease of addiction. Now, on top of all of that, I was without health insurance as well.

I was able to get into a state program ran by the state that I live in that provided me with just about the same coverage as what I had with Golden Rule and at about the same price. This took about a month to get put in place and everyday I worried that I would have a heart attack or something and it would bankrupt me without insurance. Anyhow, I did get the state insurance in place. I filed a complaint with the insurance commission office in the state that I am in. They notified the insurance company that I had filed a complaint. I also appealed the decision from the insurance company itself about the pre-existing condition. They then set up a hearing for me and sent me the reports that they had obtained. Of course I was truthful to the people who treated me at the addiction hospital and everything I told them was put in my medical records so there it was in black and white how I had been abusing pain killers for 10 plus years, etc. I really didn't think I stood much of a chance in fighting them but I thought I would at least try. The defense that I used was that I clearly had never been diagnosed with addiction, never had any arrests, never even had much in the way of prescriptions for narcotics that I filled. I told them that I was in denial about my illness (which I was) and that it was not until the medical professionals pointed out to me that I had a problem that I actually realized it. My Sub doctor offered to provide a written statement saying essentially that my diagnosis was not made until late October and that in his opinion I was not aware of my addiction when I filled out their application in August.

Sorry this is getting so long but at least you'll have a good idea of what goes on. I could have appeared in front of the insurance company panel but decided to do a telephone conference call with them rather than drive three hours one way. The panel was composed of employees of the insurance company. This was not a state review. I tried to lay out my case as best as I could. A few on the panel asked some questions - including their medical director. I just answered them as truthfully as I could. I thought that I had did a pretty good job until I was asked about my use of Tramadol. The medical director asked me how I obtained it and for what condition and I told them it was over the Internet and to keep from getting sick from withdrawals. OOOOPPPSSS! I thought later that this answer would sink me. I mean if I was taking Tramadol to keep from going into withdrawal would that not point to the fact that I knew I was addicted? I should have said it was for dental pain or something, but it was too late at that point.

I was pretty certain that they would just side with the original decision and I would then have to take my case to the state insurance commission. To my utter surprise, I got a letter in the mail about five days after my hearing saying they were reversing their decision and would reinstate my insurance!!!! I was AMAZED!!!!!!! I never thought I would win - and still am not sure why I did. I have to wonder if other cases like mine had gone to the state and the state reversed it anyhow? In other words did the insurance company lose some of these cases in the past and figure they would lose with me so they changed it before that happened? Who knows? All I know is I just had to pay back my premiums from August and pay up to the current date - it was now April!!! So I did that and all of my bills were covered and my insurance was reinstated.

This of course brought up some other issues - including the fact that I now had double insurance coverage. Remember that I got the state plan in place so I basically had two insurance companies covering me at the same time. So I had to straighten out that mess. The other thing that really gets me is I tried like hell to negotiate with the four or five entities who were billing me for my treatment. I tried to get them to lower the bills for me since I did not have coverage. Most would not budge. One said if I paid in full within 20 days they would give me a 10% discount. That was until my insurance kicked back in and the bills got slashed by 50% or even more! For example, my in-patient detox bill was around $9,200. They ended up getting about $4,300 from insurance. The doctor that was willing to give me a 10% discount got his charges reduced by about 55%. That is just wrong. If I have to pay out of my own pocket, the charges are $9,200 but if my huge-ass insurance company pays the bill, well then they will get a discount and only pay $4,300. I pay full - they pay half. Is that not backwards? Should it not be the other way around?

In the end, pre-existing condition for addiction is really a huge problem. But it's not only with having your bills paid for addiction-related treatment. The bigger deal is they can actually cancel your entire insurance and not pay for your heart surgery (or whatever) because of your addiction. Many insurance companies will not even insure me now until I have been "clean" for five years. Had that state program not been there, I would not have gotten ANY insurance. I would not have even been able to say - "Just insure me for everything but addiction and I'll pay out of pocket for any addiction" It does not work that way. They will not cover me for cancer or heart problems or trauma from a car accident because I abused pain medication four years ago.

I know this was a very long story. I certainly hope it helps someone since it took over an hour to create. I don't even know what to say about it other than you really have to be careful what you say, what you do, what you disclose - any of it. If there is any way to keep your addiction treatment away from the eyes of the insurance company - that is the way to go. If you have an insurance plan in place and are set with it - you are safe. But if you are in the probationary period or lose your job (and your insurance with it) or for any reason have to get insurance outside of an employer-plan, a history of addiction could really cause problems for you. It certainly did for me and it was only but luck that it worked out. At this point, if I ever lost the insurance I currently have, I would be totally screwed. No one will take me at this point - other than the state plan.

Again, I really hope this helps someone. Let me know if there are any questions.


Top
 Profile  
 
 Post subject:
PostPosted: Tue Sep 07, 2010 3:29 am 
Offline
Long Time Member
Long Time Member
User avatar

Joined: Mon Apr 27, 2009 12:47 am
Posts: 1496
Thank you for taking the time to post your story don. That's some scary shit. Well played on your part though - I bet a lot of people would just give up in the face of that but you fought the man and you won!

I know from my years of being treated for depression - including inpatient hospitalization - how a condition like that can come back to haunt you. I don't know if it is the same everywhere, but in the last two states where I have lived I found that my preexisting conditions could not be excluded if I had been continuously covered for a certain amount of time and that there hadn't been a lapse of coverage greater than 30 days between an old policy and a new one.

This is important to know for people like us when switching jobs or insurance companies. When I lost a job several years ago I had to suck it up and pay my COBRA premiums to continue my coverage until I got a new job and my insurance kicked in - otherwise I would have been s.o.l. with regards to getting my psych issues covered.

_________________
You can't stop the waves, but you can learn to surf.

-Jack Kornfield


Top
 Profile  
 
 Post subject:
PostPosted: Wed Sep 08, 2010 9:47 am 
Yes....thanks donh for posting that. People need to understand how much we are at the mercy of these insurance companies!
If you are one of the fortunate (as I used to be) who works for a large hospital or company, or your spouse does, and can be covered under a great big group policy, you should count your blessings! I carried my family on my hospital's group plan for many years and had pretty good coverage. Of course, it got crappier over the years, but it was still not too bad in terms of out-of-pocket expenses. There were no worries about preexisting conditions or any of that.
While I knew a little bit about all this beforehand.....I was still in for quite a rude awakening when I no longer had that insurance. My husband has been self-employed for 26 years....a small, but relatively successful business with less than 10 employees. A company that size is not required to provide health insurance for its employees (that is very expensive for the company) so I just always carried myself, my husband and all three kids. When that became no longer an option, we had to start looking for alternatives. It has been rough and very, very costly. We pay extremely high premiums for insurance with high deductibles (like $3000 per person) and no preexistings are covered. Our daughters life-long allergies and asthma as well as the mild anxiety she was diagnosed with during puberty are not covered.....at all....not ever. Can you believe that? I figured they'e slap us with a waiting period for the preexistings, but "indefinately"....are you friggin kidding me? Do you know what a hospitalization for asthma costs? Do you know that their maintenance inhalers and meds can cost upwards of $600 a month? No coverage.....all out of pocket.
Our older daughter was born with an atrial septal defect of her heart which was repaired at age 18 and should cause her no further problems in her life, yet she has been declined for every insurance policy she has applied for (she's 23.)
I'm telling you, it's a screwed up situation here. We talk a lot about honesty in recovery. But it's really hard to do that with these insurance companies because honesty will get you NO POLICY! (pun intended!)
The other sucky thing is that if you don't disclose preexistings, you're really just rolling the dice. One of the agents we worked with said that there is a database that the insurance companies use when your application for insurance goes through underwriting. This database will pull up, not everything, but apparently certain 'red flag' type items such as major hospitalizations, prescription histories, etc.
Scary business, isn't it? I'm pretty jaded about the issue of insurance. As donh's story suggests....you've got to be willing to put up a big fight, cause a big stink or whatever to get the coverage you deserve. How they can be that way after all the damn dollars we shove into their pockets via our huge premiums every month, is beyond me!
I know there is the other side of this coin too.....people out there committing insurance fraud, etc....they piss me off too! The whole system is just pretty messed up. I know there is new legislation coming down the line, but for some reason I'm not holding my breath that it's gonna help us out a whole lot!


Top
  
 
 Post subject:
PostPosted: Sun Sep 12, 2010 12:49 am 
Offline
Average Poster
Average Poster

Joined: Sat Jul 31, 2010 8:46 pm
Posts: 21
Very informative information.
I posted on a different tread(I can't find it now)earlier this week. It had something to do with insurance rates going up because of suboxone and perhaps had to do with pre-existing. I want to apologize if I gave any one the wrong information. I just told my experience of switching health insurance providers. I was rather lucky. I was on a state health care plan before getting married. While on that plan I had been admitted to an inpatient treatment facility, seen Suboxone Dr., and wrote out scripts for suboxone. I was given a letter from them giving me a clean bill of health and my new insurance covered the suboxone and the Dr. visits. I don't know if this made a difference at all in this, but the States plan wouldn't cover the doctor visits so I paid out of pocket. They did pay for the detox and a 14 day stay at the rehab center. After that my family paid the cost of sending me to a long term treatment facility where I stayed for 9 months. It would seem to me that even if you paid in cash the insurance company would have been able to get ahold of these records. Or if the fact that the insurance started because of marriage had anything to do with it. I'm pretty clueless to the way these things work. I will count my lucky stars that we have insurance. On the other hand my husband went to the dentist. He had had dental insurance for 1 year before he went. The dental insurance claimed that a root canal and several cavities were pre-existing. How did they know when the cavity started? Oh well.
I just want to apologize to any one that had read my comment and had gotten the wrong information.


Top
 Profile  
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 8 posts ] 

All times are UTC - 5 hours [ DST ]


Who is online

Users browsing this forum: No registered users and 1 guest


You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
Our Sponsors
Suboxone Forum latest topics RSS feed Subscribe to the entire forum
 

 

 
Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

Powered by phpBB® Forum Software © phpBB Group