What are the chances of being denied?

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jenlong
jenlong Member Posts: 13
edited June 2014 in Employment, Insurance, and Other Financial Issues

Hi

My husband and I are about to move back to the states in April. While over here in Germany I've been diagnosed with bc. That was in 2007. What are the chances that insurance companies will turn me down? I have no clue on how this works. My husband will be covered through is job by Blue Cross Blues Shield. Will they cover me? Any experiences? Thx.

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  • lago
    lago Member Posts: 17,186
    edited January 2011

    I'm not sure if they can refuse you. If you had continuous coverage I don't think they can but if not they can refuse to cover a precondition. That won't change till 2014.
    -----------------------------------------------------------------------------------------

    Here is what passed under Obama's health care reform in 2010:

    * Children age 26 and younger will be able to remain covered under their parents health insurance plans (this is increased from past age limits which were anywhere from age 22-25).

    * Medicare recipients will receive a $250 rebate to help in closing the "doughnut hole" (with the goal being to close the doughnut hole completely by 2020).

    * Health insurance companies will be banned from excluding coverage for pre-existing conditions for children.

    * Adults with pre-existing conditions will be eligible for coverage into high risk health insurance pools until future health care exchanges are up and running.

    * Health insurance companies will be prohibited from levying annual limits and lifetime limits on coverage.

    * All new health insurance plans must provide coverage for preventative services with no out of pocket cost (all health plans will be forced to comply by 2018).

    * Those companies that offer health benefits for early retirees ages 55 to 64 will receive assistance from a temporary reinsurance program.

    * All new health insurance plans will have to comply with new regulations that lay out an appeals process for when health insurance claims are denied.

    * Small businesses that employ less than 50 people are eligible for a tax credit equal to 35% of their health insurance premiums (this increases to 50% by 2014).

    Source:  http://www.csmonitor.com/Business/Christian-Personal-Finance/2010/0325/What-Obama-s-new-health-care-bill-means-for-us 
    See source for changes for 2011-2014

    --------------------------------------------

    Right now I am on my states high risk pool insurance. It's not cheap but it's bettter than nothing. Check here to see if your state will be participating. If not then I think the federal government offers something. Once you have been on some kind of insurance for a  year then I think  your husband's employer can not refuse the precondition.:

    http://www.cobrahealth.com/statehighriskpools.html 

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  • Bren-2007
    Bren-2007 Member Posts: 6,241
    edited January 2011

    If I went on my DH's insurance, I would have a 12 month wait.  He has BC/BS and it would be considered a preexisting condition.

    I hope that isn't the case for you.

    Best of luck to you,

    Bren

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  • jenlong
    jenlong Member Posts: 13
    edited January 2011

    Thanks you guys for the info...

    Well, this sounds pretty confusing. Aren't Obama's plans gonna be 'reversed' because the republicans have more power now? I thought I read they wanna get rid of his health plans?

    Jen

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  • lago
    lago Member Posts: 17,186
    edited January 2011

    jenlong Republicans have more power in the house of representatives but not in the senate. It has to pass both so right now I doubt it will be reversed. Of course if in the next election the republicans take the senate majority then it might be reversed.

    Jenlong you should call the insurance plan and ask. There is always that state/federal high risk insurance. Expensive but trust me cheaper than not being covered. That's why I'm on it. If you need help let me know. I used to deal with insurance in a dental office back in the late 80's. This is why I know some of the issues and how it works. 

    BINVA, Not sure if that's true of every BC/BC plan. Typically you need to wait 12 months for preexisting only if you have been out of insurance for any length of time within a year. If it's continuous you should be OK. My husbands new company has BC/BC PPO and it doesn't seem to be rejecting precondition from what he can see. But since jenlong has been out of the US system I do believe the precondition would apply. She would need to check with her husbands insurance.

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  • jenlong
    jenlong Member Posts: 13
    edited January 2011

    Hi lago

    Sorry had problems with my computer. Well, in the meantime my husband made a few phone calls regarding insurance. For roght now it doesn't look too good. He called about the corbra plan, but I'm not qualified. I'm really worried now about not gonna be able to get insurance. You offered to help me out, I 'd really appreaciate it! What would you recommend?

    Thanks

    Jen

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  • lago
    lago Member Posts: 17,186
    edited January 2011

    Have you called about the highrisk pools: http://www.cobrahealth.com/statehighriskpools.html

    I'm on it right now since my husband's insurance won't kick in for several months. What state are you planning moving to? Have you contacted the American Cancer Society. They may be able to lead you to some sources as well: http://www.cancer.org/

    Let me know what I can do. PM when you get a chance so I don't miss your post. OK I need to take off for a doctor's appointment right now. Hang in there we will figure something out.

    What exactly did they say? They wouldn't cover you at all or wouldn't cover the pre-condition for at least a year?

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  • jenlong
    jenlong Member Posts: 13
    edited January 2011

    Hi there

    Yes, we did call Cobra. The problem ist that we are coming from Germany. In order to get accepted you would have to have been insured in the states first.

    And I don't qualify for the high risk pool plan because I've been insured for at least the last 6 months.

    We are gonna move to Arizona. I read about portability plans but they would cost $475/mo. This is ridiculous. I thought about paying out of my pocket for a year til I can get on BC/BS. Don't really wanna do that, but hey...

    This is kind of scary, since over here you can't be turned down and everyone is insured. I don't know why so many people are against this kind of health plan in the states...anyway. I'm gonna have to contact the American Cancer Society and see what they have to say.

    I appreaciate your help.

    Jen

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  • lago
    lago Member Posts: 17,186
    edited January 2011

    jelong didn't have to wait 6 months of being uninsured but I am paying more than $475/mo with a $1000 deductable. I'll have to check on that but I think it's closer to $700/mo for a BC&BS PPO that covers 80% of in-network. Trust me as expensive as that is it's cheaper than no insurance. Granted I should be on my husbands insurance in a few months.

    Mine might be higher because I'm older than you and it's different state.

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  • EstherMSKCC
    EstherMSKCC Member Posts: 45
    edited January 2011
    Dear Jen,

    I'm sorry to hear of your diagnosis. I'm an employee of Memorial Sloan-Kettering and wanted to suggest some resources that may be helpful in obtaining financial assistance during and after you sort out your insurance issues.

    The National Cancer Institute (NCI) has good information on government-sponsored and other national organizations that offer financial aide for cancer-related expenses, including cancer-related expenses, including treatment, copays, etc...
    http://www.cancer.gov/cancertopics/coping/financial-legal

    Cancercare also provides links to resources that offer financial assistance for cancer patients:

    http://www.cancercare.org/get_help/assistance/cc_financial.php

    Livestrong offers a searchable listing of resources (financial, legal and others):

    http://www.livestrong.org/Get-Help/Find-More-Resources#/f/FinancialGovernmentAssistancePrograms

    Cancer.net (patient information from the American Society for Clincial Oncology) offers an overview on managing the cost of cancer care and some helpful resources:

    http://www.cancer.net/patient/All+About+Cancer/Managing+the+Cost+of+Cancer+Care/Financial+Resources

    Patient Resource.net: http://patientresource.net/Financial_Resources.aspx

    I hope this information is useful and wish you the best of luck finding the assistance you need. --Esther

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  • 3monstmama
    3monstmama Member Posts: 1,447
    edited January 2011

    Jenlong,

    A couple of questions:

    are you a german citizen?  I know some countries with national healthcare allow you to move to another country--if the move is not permanent---and take your health coverage with you.  Not sure how it works but worth checking out.

    How is your husband insured now?  Is he a us citizen with a US policy?  Can he switch to a family plan?  And it you don't mind my asking, is he employed privately or publically?  If he will be employed by the US government, you should be able to be added onto his policy with BC/BS as they don't bother with the preexisting condition issue.

    good luck!

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  • jenlong
    jenlong Member Posts: 13
    edited January 2011

    @lago

    Wow, more than $475? That is a lot. I could never come up with that kind of money. My husband will be the only one working for a while...so not a lot of money coming in. Does BC/BS always cover people after a year of waiting or do they sometimes turn you down for good?

    @Esther

    Thank you so much! Those look like very helpful links. I have to check them all out and hopefully  find a solution. I appreaciate it.

    @3monstmama

    Yes, Iam a german citizen. I already talked to my health care provider and they said there's no way I could keep my insurance. It's because the move is permanent. Maybe I shouldn't have told them ;-)

    Iam on my husbands health insurance right now. He does have a german policy. That's the problem. He is employed privately right now. Are you sure about BC/BS covering preexisting if he works for the government? That would be great.

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  • mrsnjband
    mrsnjband Member Posts: 1,409
    edited January 2011

    Hi Jenlong.

    You might want to check into qualifing for state aid since you won't have any insurance.  In some states having a female related cancer is considered a disability. 

    I think all insurances have a one year waiting period for pre-existing conditions.  Are you one your husbands insurance now?  If you are then you should be able to continue that here as long as you don't go more that 63 days without.  If you hubby is a new hire, then they can't exclude you unless it doesn't go into effect after the 63 days.

    As to cost, I pay about $480.00 for my insurance & it cost me almost $800.00 to have hubby on my plan. Know wonder we are broke.

    Insurance sucks with or without it.  NJ

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  • lago
    lago Member Posts: 17,186
    edited January 2011

    jenlong yes it is a lot. I have been out of work for over a year now and my husband just started working again. This is the only option. Not having insurance would cost us more. Yes we are dipping into savings. We don't plan on being on this insurance for long. We should be able to move over to husband's employer insurance one that kicks in. The issue is I have to have continuous coverage or my "pre-condition" will be denied. I don't know how old you are but it is based on age and the type of coverage you choose and of course your state plan. You might pick a higher deductable or lower coverage rate to lower monthly premiums but in the end it might not be saving you. This does include a prescription plan which in our case I highly recommend.

    I believe cancer is a precondition that they can refuse to cover for ever if you haven't  had continuous coverage. Granted all this will be gone in 2014 once Obama's health care plan is running. Highly unlikely at this point it will be overturned but of course 3 years is a long time for us to wait.

    You situation is very complex. I know they have social workers at The American Cancer Society that deal with this kind of stuff. You really need to contact them.

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  • jenlong
    jenlong Member Posts: 13
    edited January 2011

    Hi mrsnjband

    I've heard about the 63 day gap. It sounds good and makes sense but then I was wondering how this would work if you have like a 3 month probation at your new job? You probably ain't gonna get insurance til your probation is up, correct? Wow, $480 is a lot of money...I'd be completely broke, too. But health should always be your priority so I'd pay it, too if I had to.

    Hi lago

    I understand since my situation is similar to yours. If nothing else comes up I guess I'd have to look into the high risk pool. Looks like my only option right now. How come you didn't have to wait 6 months? I thought that was the law? Wow, this is all so complicated and confusing! You are right, 3 years is a long time...and who knows what's gonna happen...

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  • lago
    lago Member Posts: 17,186
    edited January 2011

    I have never had to wait more than a month to get on an employer's insurance. Most companies have a 3 month probation period… that doesn't mean they don't give you your benefits.

    I didn't understand about not having to wait the 6 months either. After I did the initial research my husband took over. What we both found is the people in our state running the program were very helpful. I much rather deal with them then any insurance company any day. Once you know what state you will be in then you can call and find out more. It can be different depending on the state.

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