Insurance Question

Tammy

What you heard is a misnomer in a way. The misunderstanding comes from this: Most insurance companies have a waiting period if you were uninsured and had a preexisting condition. For example: If you get insurance after a lapse in being covered and in that time were seen for eczema (as my fiance was) then there’s a certain period of time the insurance will make you wait before it will cover the condition. I don’t know how they figure the waiting period out (usually six months, for him nine) but i think the idea behind it is that if you were without insurance, you weren’t having medical problems taken care of and they don’t want to bear the brunt of your waiting since it usually makes problems worse. So, if he had been covered continuously for a year before getting insurance through his new job, the company figures he would have kept up with his health and not let it get too bad. Thus, they’d cover all the things immediately.

So if you weren’t covered continuously for teh past year, anything you’ve been seen for in the interrim will be a bit of an obstacle. But since GBS related stuff is so nebulous, unless it’s something like physical therapy you and your doctor just have to tapdance a little. Like I told Tim, if it comes to it, we’ll just go see a general practitioner because he’s having knee pains (he has a touch of arthritis since both of his knees have been broken twice each) and then while he’s there mention oh yeah there’s something else I wanted to ask you about. Then technically the visit is covered because it’s not a pre-existing condition he received treatment for in the past year. Most docs don’t like insurance companies and will help you get around as much of the bureaucracy as they can.

Good luck,
Abby

Abby is correct. In Texas, if you’ve had uniterrupted coverage, they must cover you. They may put you on a 90-day probation period but often will not since you’ve had continuous coverage. Insurance is so wonderful but you have to be your own best advocate and be educated. Just like what you’ve done with this post—if it seems odd—ask questions. I always ask for something in writing and ALWAYS get the name of the person you’re speaking to. If you do not received something that you’ve requested within a 2 week period, I will write a letter stating with whom I spoke to and the date and exactly what I requested. I also learned that it’s usually to your advantage to leave to the company insurance person (your fellow employee) out of the loop. I always spoke directly to the insurance company.

Good luck,

Tammie, the only way to know what coverages you would have is to ask, or read the specific policy for that employer. Some insurance has limitations on pre-existing illnesses, and some do not.

My wife went to work for a county/city agency and she had a physical before she was hired, but they cover everything and anything for me and her, pre-existing or not. We don’t have to contribut to the cost of the coverage (PPO) and we get benefits for life when my wife retires with 15 years employment. I have cost them a small fortune already!

If you are still working for the same company and they are the ones who switched insurance plans then it is my understanding your illness should not be considered a pre-existing condition. It is not your fault that your comapny decided to switch insurance companies.

Tammie
I agree with Ken. The best thing to do is read the policy. Unfortunately you might need some help. If you know anyone in the insurance or legal profession, they may be able to help you. The way these policies are written you might mistakenly think you are not cover when you indeed are. Good luck.

Jim C