Any advice? - Health Insurance Issues Message Board

Belle2003 · 01-19-2004, 04:44 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.

02-24-2004, 06:19 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

pinenut · 02-28-2004, 01:52 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.

californiasunflower · 02-29-2004, 08:23 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!

Belle2003 · 03-01-2004, 09:27 AM

Thank you so much for all of your advice! You don't know how much I appreciate it!