Insurance question...

[Theben]

What constitutes a "medical precondition" in the eyes of insurance companies? I need to go to the doctor to get some things taken care of.

[rah]

A condition that has been previously diagnosed and one that you continue to have or possible to have again.

Example. You have previoiusly been diagnosed with a heart condition. You change insurance companies. Your new company MAY decline to cover any treatments related to your pre-existing heart condition.

In most of the US, if you change jobs and you're covered by a group policy moving to another group policy, they will usually accept pre existing conditions and cover them, but not always.

Another reason not to go to a doctor, because then problems can not be diagnosed and you can truefully claim no pre-exisiting conditions.

[Q Classic]

rah

[Japher]

I changed jobs when my wife was 7 months pregnant

Apparently insurance companies do consider pregnancy a pre-existing condition or precondition. Fortunately, with wifey going part time, Stanford kept her insured. Also, my new company's insurance allowed preconditions aslong as there was no break in coverage and since wifey never lost coverage they didn't care.

[Zkribbler]

BTW: The concept of "preexisting condition" is an American concept.

The rest of the industrialized world views the purpose of health coverage to protect the sick. US insurers wish to insure the healthy and ignore the sick.

[Provost Harrison]

Backwards healthcare systems

[Pekka]

So wait.. if you have a condition, and for some reason you have to change insurances.. there is a possibility for the insurance not covering this condition later on?

So basically, you are ****ed, no matter what you do? And the point of the insurance was what?

[KrazyHorse]

Originally posted by Pekka
And the point of the insurance was what?

To make money for the insurance company.

[Spiffor]

This is fricking amazing.

Very interesting. I'll use this tidbit in the healthcare debates I'll be having in France. Thanks

[Spiffor]

Originally posted by rah
Another reason not to go to a doctor, because then problems can not be diagnosed and you can truefully claim no pre-exisiting conditions.

This is simply frigging amazing. Really.

[Imran Siddiqui]

Theben, what you are describing is pre-existing condition exclusion. The way it works is this. If you recieve treatment or diagnosis for a condition within the 6 months before you join your job, a new health plan may deny coverage for that health condition if you did not have continous coverage (without a 63 day break in coverage) before that for 12 or 18 months.

Basically, the new plan may assign a 12 month (or 18 month if you joined up under special enrollment.. ie, if you lost coverage somewhere else and joined under a family member's plan) pre-existing condition exclusion. HOWEVER, this 12 months is offset by any creditable coverage you had before. Any coverage you had after a 63 day break in health coverage (creditable coverage) is used to offset this 12 month exclusion.

So the question is when did you get coverage with your current employer and what were the dates of your previous insurance... and did you have a 63 day break in coverage?

If you had more than 12 months continuous coverage without a 63 day break in coverage, you can prevent pre-existings by showing your current insurance a Certificate of Creditable Coverage, which you can get from your previous employer/insurance.

Oh, and if you were curious, this stuff (HIPAA) is part of my job .

edit: Oh, almost forgot, to ENFORCE a preexisting condition exclusion, they have to tell you, specifically, which condition they are excluding and for how long when you join up. If they didn't, they are in violation of ERISA, and are not allowed to exclude that.

[Imran Siddiqui]

Apparently insurance companies do consider pregnancy a pre-existing condition or precondition.

IIRC, they aren't supposed to.

[Spiffor]

Imran: how can one possibly get a break from health coverage?

[Imran Siddiqui]

Originally posted by Spiffor
Imran: how can one possibly get a break from health coverage?

When you don't have any health coverage. It happens quite frequently, especially when people switch jobs or when kids get too old to be covered on the parents' plan.

[Theben]

Originally posted by Spiffor
Imran: how can one possibly get a break from health coverage?

Break IN health coverage, i.e., you lose your insurance from one carrier and don't get insured by another until later. The time in-between is the 'break'.

Like if ones loses his/her job.