Insurance and pre-existing conditions

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mom2acat
mom2acat Member Posts: 556
edited June 2014 in Managing Side Effects of Breast Cancer and Its Treatment

A little back ground before I get to my question. I quit work in November 2008, kept my insurance through COBRA, which expired May 6th. I signed up for, and got approved for, BCBS of Michigan insurance, which has been effective since May 1st.

My former employers benefit  department didn't mail out my proof of coverage for health insurance until May 5th, which I needed to send to BCBS to get my pre-existing waiting period waived. I finally got that proof certificate on May 10th, and that very same day, I filled out the application to have the waiting period waived and mailed in it with the proof of coverage.

My question is; for those of you that have had to do the same thing, how long do you normally have to wait to find out if your application to have the waiting period waived has been approved?

I still have not heard one way or the other; meanwhile, my EOBs for the chemo say that they won't pay because it's a pre-existing condition, and each treatment is in the $3000 range. It just made me sick to my stomach when I saw that. I don't think anyone has even looked at the application for the waiver yet.

I sent them a letter about it yesterday, and also copies of all the paperwork I sent in the first time.

I really pray that this works out; my Medicare won't start til November of this year. I don't know what to do if I can't pay for the chemo; I know there are programs that can help, but they  are for people without insurance. I have the insurance, they just aren't paying right now!

I am also going through a flare up of my IBS, and this is NOT helping!

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  • mrsnjband
    mrsnjband Member Posts: 1,409
    edited June 2010

    I'm not sure how long you should have to wait, but it shouldn't be very long.  But you don't need to have your pre-existing condition waived because you haven't had a lapse in coverage. You just need proof there is not lapse in coverage. It's been a long time since we had to do this, to me the language on the letter was confussing on the wording and made it sound you have had a lapse in coverage. By law you can have 63 days between insurance and not have pre-existing conditions rule to kick in. So I would check this out.  I know it's a pain & time consuming.

    Be sure you keep a copy of any paperwork so you have proof, in necessary.

    You may have to keep on your new insurance and the it as well until they get it straightened out,

    Sorry that you have to deal with this. I hope this is helpful to you.

    Love & prayers, NJ

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  • mom2acat
    mom2acat Member Posts: 556
    edited June 2010

    I did send them proof that I didn't have a laspe in coverage. My COBRA expired on May 6th, and my new insurance was effective May 1st, so there was actually an overlap of coverage for a few days. But the EOBs I have gotten so far with the new insurance say "not covered because of preexisting condition".

    I had my Zometa treatment at my oncologist's office on Tuesday, and I let them know what is going on as well, and they will do what they can on their end to help me.

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  • mrsnjband
    mrsnjband Member Posts: 1,409
    edited June 2010

    I understand that you actually had a overlap of coverage which means that can't deny your treatments. Have you talked to your new insurance people about the problem?  If you haven't, maybe if you can talk to a real person they could resolve the issue for you. 

    Do you have an insurance agent that can help you?  We had a problem once and they helped us. If you don't, maybe you can contact the insurance comissioner of your state.  Or possibly you state reprenstative.  Just trying you give you some ideas. 

    The doctor office can't do anything to help you, the insurance will just continue to deny the claim. The insurance will want to drag their feet hoping you will give up. 

    I know hard this must be to be in treatment and have to fight with the insurance at the same time. Just know you are not the first nor will you be the last to go through this.

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  • mom2acat
    mom2acat Member Posts: 556
    edited June 2010

    I don't have an insurance agent; I applied for my policy online. If I don't hear from them by the end of this week, I'm going to contact our states insurance commissioner.

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  • mom2acat
    mom2acat Member Posts: 556
    edited June 2010

    I decided not to wait til the end of the week to contact the insurance commissioner; I just mailed a letter to them this afternoon; also our state representative. Sent them copies of paperwork to back up my claim too.

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  • karen333
    karen333 Member Posts: 3,697
    edited June 2010

    dear mom 2 a cat,  I don't have any tips, just that i toohave my cobra terminating 7/24, have tried to get medicaid but my social security is $1200, to continue coverage with BC/BS is $1148, My surgery was 8/09 and i just found another lump.  I have an emergency visit tomorrow and don't know how I'll get thru till then, the problems feel overwhelming. karen333

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  • mom2acat
    mom2acat Member Posts: 556
    edited June 2010

    Karen, I would contact your local department of human services office; I went there before I was approved for the BCBS, to see if I could get Medicaid just in case I was denied the BCBS. I didn't qualify either, but I was told the state could help me with the BCBS premiums. I don't know if all states do this, but it's worth asking. I have to spend down my 401K that I cashed out in order to qualify income wise; there wasn't a lot in it, just enough that I over the amount of assets allowed.

    (((HUGS))) I'm sorry you have to deal with this at this time, it's stressful enough to worry about the disease without worrying about how to pay for it too.

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  • mom2acat
    mom2acat Member Posts: 556
    edited June 2010

    Just got a letter in the mail today; BCBS approved to have the pre-existing waiting period waved!

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  • mrsnjband
    mrsnjband Member Posts: 1,409
    edited June 2010

    I'm glad to hear you got your letter with the approval from the BCBS.  I'm sure that is a big relief for you. Now you can put your energy into beating the cancer. 

    Sending love & prayers, Norma

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  • mom2acat
    mom2acat Member Posts: 556
    edited July 2010

    I just got a bill for one of my chemo treatments in May; this was when my pre-existing condition waiver application was still being processed. My last chemo was covered, except for my co-pay. I hope that since the pre-existing condition was waived for me, that the insurance will retroactively pay for the treatments that were done while I was waiting for that approval.

    I sent the bill back to the hospital, with a letter explaining the situation, and asked them to re-bill the insurance company. I also included a copy of the letter from BCBS that said they approved waiving the waiting period for me. 

    The bill was almost $5000! I hope it get straightened out soon, with no hassles; I've had at least 2 other chemo treatments in that time while I was waiting for the approval letter; haven't recieved those bills yet.

    Thank you for the prayers Norma!

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  • karen333
    karen333 Member Posts: 3,697
    edited July 2010

    Dear mon2acat,  Don't you love having to worry about pre-existng condition along with every thing else.  I am waiting to see if I qualify for HealthyNY, but they have a clause that states it may pay for preexisting conditions. What's that mean, depending on how they feel that day.  I'm getting tired and bitter about these insurance companies.  I hope you have no hassles with this $5000 bill, we all have enough on our minds.   Karen333

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  • thriceblessed
    thriceblessed Member Posts: 39
    edited August 2010

    Ladies - Question on switching insurance.  I carry the medical insurance for my husband and myself. Finished treatment this year, although I have DIEP surgery (part I) scheduled for August and part 2 in November.  I'd like to quit work but can't risk not being covered by insurance.  If I quit work, will my husband's insurance pick me up?  Will I be covered fully like I am now, or will any cancer treatments be considered 'pre-existing conditions' and not covered?  How do I confirm I'll be covered before I quit? 

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  • gale1525
    gale1525 Member Posts: 232
    edited August 2010

    You should be covered under your husband plan as you will not have a lapse of coverage, and as far as I know employer policy's are guaranteed issue. Check with your husbands HR to find out for sure and get it in writing. Also instead of quitting your job take a leave of absence as back up, in case of any unforeseen happenings, anyway you are going to be on disability, I would wait until after part 2 of your DIEP and your disability is up before you decided to quit.(or take a leave of absence). In this economy it is better safe than sorry. I don't think you will get disability if you quit or unemployment either.

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