Belle2003
01-19-2004, 07:44 PM
We had Blue Cross insurance and in January 2003 I had a cornea transplant. Then my husband had to switch jobs where he would have Kaiser in CA. We wanted to keep Blue Cross because then we could continue with my cornea specialist so we are on Blue Cross Cobra. His company pays 95% of the Blue Cross bill and we pay the rest.
In April of 2003 we tried to get individual insurance through Blue Cross but they said they do not accept anyone who had a transplant less than a year ago.
In mid 2004 the Cobra will end and I am afraid Blue Cross will not let us on as individuals due to me having a cornea transplant and then having MOHS surgery for basal cell skin cancer. I love my current doctors and I want to find an insurance where I can still go to them. With Kaiser I would have all new doctors. I am sure Kaiser is good, it is just a tremedous hassel. Do you think Blue Cross will take us even though 2003 was a bad year for doctor visits? I have rarely had doctor visits until then.
Am I worrying for nothing? Any advice is appreciated.
In April of 2003 we tried to get individual insurance through Blue Cross but they said they do not accept anyone who had a transplant less than a year ago.
In mid 2004 the Cobra will end and I am afraid Blue Cross will not let us on as individuals due to me having a cornea transplant and then having MOHS surgery for basal cell skin cancer. I love my current doctors and I want to find an insurance where I can still go to them. With Kaiser I would have all new doctors. I am sure Kaiser is good, it is just a tremedous hassel. Do you think Blue Cross will take us even though 2003 was a bad year for doctor visits? I have rarely had doctor visits until then.
Am I worrying for nothing? Any advice is appreciated.
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Mara
02-24-2004, 09:19 PM
I think you may need to check into the exclusionary period for pre-existing conditions with or without a lapse in coverage. Isn't there a difference between a lapse of coverage altogether vs. a change over but with continual coverage? Ask for a notice of effective dates of continual coverage, the declaration with no lapse from your carriers. This then is provided to the new ins. company as proof of coverage so you don't get pooled in the wrong class. Different states have different rules, not sure if this applies in your neck of the woods but some health ins. carriers may impose one 12 month exclusionary period especially if there is a lapse in coverage. If you had continual coverage (cobra I think would be considered continual coverage of same insurance), does that disqualify you from continued care through another? I don't think so, but could be wrong. You should be able to access this info from the Cobra cite.
If there is or was an exclusionary time period imposed, would that exclusionary period have already come to pass? That would be a question for the employers designated health administrator. Good Luck to you and feel better :)
If there is or was an exclusionary time period imposed, would that exclusionary period have already come to pass? That would be a question for the employers designated health administrator. Good Luck to you and feel better :)
pinenut
02-28-2004, 04:52 PM
I worked for a health insurance company for several year in the individual plans department. Typically if you have anything major recently (meaning last 5-10 years) they will deny you coverage.
If they do offer you coverage it will be very, very expensive. I would say that your best bet will be to talk to your doctors to see if they can join the Kaiser network. I hope this information helps.
If they do offer you coverage it will be very, very expensive. I would say that your best bet will be to talk to your doctors to see if they can join the Kaiser network. I hope this information helps.
californiasunflower
02-29-2004, 11:23 AM
Pinenut, even with a "Certificate of Coverage" to go from one carrier to the next won't help her with getting eligilbility and avoiding pre-existing conditions with Blue Cross Individual Plan, etc?
I know that Provider Relations helps only providers, but I know of certain cases where Provider Relations got involved with the Plan trying to get benefits for subscribers. They are also involved in Marketing. Could BC Provider Relations rep help this family get the individual coverage with BC that they need?
Belle, that might be an avenue to explore. Pinenut may be able to answer about the Cert. of Coverage that is issued after your coverage is terminated. That helps families go from one carrier to the next without interrupted coverage--so to speak!
Hope this helps! :)
I know that Provider Relations helps only providers, but I know of certain cases where Provider Relations got involved with the Plan trying to get benefits for subscribers. They are also involved in Marketing. Could BC Provider Relations rep help this family get the individual coverage with BC that they need?
Belle, that might be an avenue to explore. Pinenut may be able to answer about the Cert. of Coverage that is issued after your coverage is terminated. That helps families go from one carrier to the next without interrupted coverage--so to speak!
Hope this helps! :)
Belle2003
03-01-2004, 12:27 PM
Thank you so much for all of your advice! You don't know how much I appreciate it!
pinenut
04-13-2004, 07:27 PM
Sorry for waiting so long to reply. I haven't been on the boards much lately.
The certificate of coverage applies to any type of policy (read: employer or individual) so as long as you have had coverage for the prior year continuously, you won't have a lapse in coverage and they can't deny coverage for a pre-existing condition.
The difference is that a group/employer's policy can't deny you coverage based on health conditions, period (at least in my state, not sure about others).
However, you can be denied an individual policy based on health conditions.
The reason for this is that with a group plan there are a lot of people that will be paying premiums but will not use the insurance much, if at all. These unused premiums help pay for other plan members dr bills.
On the other hand, if you are on an individual plan and you have a serious health condition, it's pretty much a guarantee that you will be using your benefits extensively.
The insurance company is not going to cover you if they are going to lose money on your plan (lose money = insurance pays more dr bills than the amount you pay in premiums).
I'm happy to answer more questions if you have them.
The certificate of coverage applies to any type of policy (read: employer or individual) so as long as you have had coverage for the prior year continuously, you won't have a lapse in coverage and they can't deny coverage for a pre-existing condition.
The difference is that a group/employer's policy can't deny you coverage based on health conditions, period (at least in my state, not sure about others).
However, you can be denied an individual policy based on health conditions.
The reason for this is that with a group plan there are a lot of people that will be paying premiums but will not use the insurance much, if at all. These unused premiums help pay for other plan members dr bills.
On the other hand, if you are on an individual plan and you have a serious health condition, it's pretty much a guarantee that you will be using your benefits extensively.
The insurance company is not going to cover you if they are going to lose money on your plan (lose money = insurance pays more dr bills than the amount you pay in premiums).
I'm happy to answer more questions if you have them.
dmwccddt
06-27-2004, 03:03 PM
I've been told that Blue Cross has one of the strictest underwriting of all insurance carriers. My guess is you will be denied and if you have a denial on record - good luck getting insurance from anyone.
Belle2003
06-28-2004, 03:28 AM
I've been told that Blue Cross has one of the strictest underwriting of all insurance carriers. My guess is you will be denied and if you have a denial on record - good luck getting insurance from anyone.
Is there some huge databank that all of the insurance carriers keep their records in so that can see who was denied insurance?
Do you know of any insurance company that is not as strict as Blue Cross?
Is there some huge databank that all of the insurance carriers keep their records in so that can see who was denied insurance?
Do you know of any insurance company that is not as strict as Blue Cross?