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Obama insurance question about preexisting - help

Posted: Jan 7, 2013

Well, I'm not a member of many message boards, but am a transcriptionist and post on the MT site some. This has to do with the Obama health law.

I'm not stating my political views here, just a question. My husband started going to the doc last year for his back right before or when his insurance (Blue Cross) took effect. He had not had insurance prior to that (at least not in a few years). The doc never did xrays or anything, just gave him prescriptions and took history and symptoms. So about several months later (about October or November of 2012), the doc orders an MRI (which shows multiple problems, may need surgery, etc.). Referred him to a neurosurgeon for a consultation. Went for that. The neurosurgeon ordered a CAT scan also, which was done. This was all under assumption insurance would cover. They come back and say they will not cover the MRI because it was preexisting and he didn't have have insurance cover within a certain time period before. So we have to pay it all. They went by the doctor's records that he had sent to the insurance company.

So we called the insurance company and they said yes, it's preexisting, we have to pay, final word. My husband goes back to the doctor and he says that the Obama law prohibits preexisting and they will have to pay for it. Appeal, I suppose. Is this doctor correct? I thought that would not go into effect into the next year or two. I don't know a lot about this kind of stuff. Does anyone know what we can do to possibly appeal this and get insurance to pay (especially if the preexisting condition can no longer be a reason for insurance not paying)? Or are we responsible for the whole thing as the insurance company insists? It is definitely our fault for not checking into this further before going and getting the MRI, etc., but we just assumed and since they took the insurance info and all . . .

Any kind advice is appreciated. :)

Thanks,

Broke MT :|

;

It really depends on your state - Obamacare user

[ In Reply To ..]
If you live in a state that is telling the President to shove his healthcare bill, then you're likely out of luck.

I live in Pennsylvania. I have coverage through the Affordable Care Act for pre-existing condition. I pay $280 a month for Blue Shield, decent insurance (80/20).

The first place you want to check is with your state or go to the Presidential website and you can likely get information there. Or try to google pre-existing condition and your state and see what you come up with.

Good luck. I hope your husband is okay.

Insurance - anon

[ In Reply To ..]
Most insurance companies require there not be a lapse in insurance coverage, especially for preexisting conditions. If you had a lapse for longer than 60 days, yes you will probably pay for it and through the nose. Obamacare is really about insurance companies not denying you from obtaining insurance in the first place for preexisting conditions, but you really need to have a continuation of care for companies to pay.

We pay $1000 per month each for just our premiums just so we will not be denied down the road or being covered in case anything happens, not just paying for insurance when we need it and not when we do not. I wish that were so. We could have purchased a house with that.

You can always try appealing.

Thanks - Broke MT

[ In Reply To ..]
Thanks. You're right, I do believe. We did call Blue Cross back and she said the preexisting thing takes effect in 2014. She did say that his doc could write a letter saying that this particular back issue is different from what he had gone for back then, which was more muscular, etc. I mean, he's 51 years old, and there's a million things that can be wrong with a man that age's back over the years who does a lot of physical labor and active. Anyway, so hopefully the doc will write a letter and she said that we could appeal, which is what we are going to try to do.

Wow . . . $1000 a month. Insurance prices are crazy. Can't afford to have it, can't afford not to. And then when something major comes up, they never want to pay. Thanks for the info! Hope you have a good week! :)

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