DCIS and insurance

DiannaLJones

DCIS and insurance

DiannaLJones

Before I was diagnosed with DCIS in late September I was considering changing jobs because I travel away from 3 days per week. My medical insurance is employer sponsored, and has paid very well so far. Will I ever be able to find another job without being told I have a preexisting condition if I have to file a medical claim. I do not know who to ask or who to trust in the answer. The thought of not being able to work at home is impacting me more negatively than the diagnoses.  Please answer if anyone knows. I have been told as long as there are no breaks between insurance companies,  a new company would pay.

mbordo

Dianna-

I have changed insurance *twice* since I was diagnosed in March.  Our insurance coverage is a group policy, through my husband's employer.  The first change was when his company was bought out, so we had to assume the parent company's benefits (they were not very good!).  About 4 months later, my husband made a job change (not only were the benefits bad, so was the new management!).  He was very clear with the HR rep where he was interviewing that I was in the middle of cancer treatment, and we needed to make sure there were no "hiccups" as far as insurance was concerned. (I had a stage of reconstructive surgery scheduled for 3 weeks after he started @ the new job...) They expedited our cards to us, so my PS could get pre-approval for my procedure.

I'm not sure if the laws vary from state-to-state? I am in CA, and as long as you have continuous coverage, you *cannot* be denied group insurance.  Only if you have a lapse in coverage (always get COBRA for transition periods!) can they label you "pre-existing".  Getting an individual policy would probably be either impossible (until you are several years out from diagnosis) or very expensive.

I hope some of this is helpful!  DO you know anyone who works in the HR or benefits field who could tell you the law for your state?

Mary

DiannaLJones

I really appreciate your answer, I am so glad your coverage paid. Thanks, Dianna

chessiegirl

I was just diagnosed on Wednesday with DCIS.  I am in the process of applying for two other jobs.  If I should get one of the jobs, what will happen with insurance?  I live in VA.

Gulfwater

I am 99.9% sure if it's just a matter of changing from one employer group to another employer group with no lapse, pre-existing conditions do not come into play.  Years ago it did, but a law was passed . . . .  So no more problems going from empoyer group to employer group.  If there's a lapse (again employer group to employer group), I'm not sure.  That may still not be a problem.  But I'm not quite so sure about that.

But if you're talking about private insurance (insurance policy you pay for yourself for you and your family), that is a whole other story.  Those laws vary from state to state.  You have to be very careful.  Never let insurance lapse in that case.  In Illinois where I am, you can simply be denied if you have any of a whole list of medical conditions.  Needless to say cancer / DCIS is one of them.  I was lucky.  I was diagnosed with DCIS just six months after getting my private insurance policy.

Mary D.

Bren-2007

We live in VA.  My boyfriend started with a new company in Sept.  There is a 90 day wait for his medical insurance benefits to begin.  Any pre-existing condition for which he was treated in the prior 12 months will only be covered by up to $500 for the entire first year.  It depends on your employer.  

COBRA coverage is the way to go, and it's the law that if you are currently covered through your employer and quit or are fired, they must offer you COBRA coverage. 

If you are underinsured or uninsured Virginia has the Breast and Cervical Cancer Screening program which is free.  Medicaid also covers all treatment of breast cancer for the uninsured or underinsured.

Hope this helps,

Brenda in VA

determinedmom

Usually COBRA is very expensive. In FL as long as you have continued grp coverage there can be no pre-existing clause. Perhaps check w/ your state's Insurance Commissioner to verify the laws in your state just to be safe.



You have enough to worry about as it is, this shouldn't have to be one of them.



Best wishes,

Jeanne

Lucy1234

I had the a similar thing but im in the UK



I gave my boss my resignation after getting a new job.

I had to give four weeks notice and was due to start my new job on the 5th of November. A week into my notice period I found the lump and the following week was told it was DCIS.

Its a large area so I have to have a mastectomy and re-con.

In the UK if you start a new job you have to complete a three month trial period, in that time you are not paid sick.

Luckily my area manager let me retract my notice (even though he knew why!)



Is that the case in the US or are you automatically covered for sick?

Gulfwater

Generally, when you leave a job (and therefore the mostly employer-paid group health insurance plan), you can get COBRA for up to 18 months.  That means you can continue in the same plan, but you pay the full premium for the same insurance which is almost certainly high.  That can be for no more than 18 months.  These days generally when you start a new job (with group health insurance),  there's generally a waiting period (maybe up to 90 days) before it begins . . . so COBRA.

Mary D.

Smalls

I would like to ask a question?  I have a seperate cancer insurance policy.  I bought this years ago and have faithfully been paying my premium each month.  Now they are giving me a difficult time about paying my claim.  I was diagnosed with DCIS, grade 3 in Feb. and had a mastectomy in March.  I have been on the phone going round and round with these people. My medical inusrance people have been great.  This other company that is carrying the cancer policy is just unbelievable.  I am about ready to take the next step.  I have not gone public with the name and all the details.  I want to talk to my lawyer and get advice first.  I would like to know if anyone else has encountered this problem.

Thanks

Gulfwater

I have BC/BS private insurance.  Had no problems with them paying for what they should.  I did have to watch for mistakes (usually coding mistakes made by the providers) and see that they were corrected. 

Some insurance carriers more than others will give you a (very) hard time about paying claims.  I believe it's not too unusual. 

Mary D.

snherrington

It has been explained to me that as long as you never go without coverage you are not considered pre-existing.  I know that with most jobs you have to complete your 90 day probation period before you are insured.  My advice is if you are leaving a job to take another be sure you ask all of the right questions, such as when your coverage will begin and if it is 90 days then take out Cobra from the job you are leaving.  The premiums will be a little high but definately worth it versus the cost of medical bills.

Stacey H.

snherrington

You need to read all of the fine print in your policy.  I have a cancer policy also... which I had only had for 2 years before I found I had cancer.  I had a stage 5 cancer with mets. in the liver.  My policy requires that I send them an itemized statement from my doctor and copies of my EOB's when I send in a claim.  I don't know what kind of policy you have but some have a maximum that they pay for each year and some have a total maximum for life.  Mine has a maximum for each year.  I have been through with chemo for 2 years... but I was her2neu+ so I receive Herceptin treatments every 3 weeks for the rest of my life.. Technically even though it is just a maintenance drug it is still classified as a chemo so I get paid every year and I get paid for mileage.  If you have done everything that they require and they have not paid then you should definately seek legal assistance... you could also have your doctor write a letter explaining your diagnosis and prognosis.  Good Luck and I hope you get everything straightened out.  Like we haven't been through enough already to be fighting with insurance companies...

God Bless!  Stacey H.