Why does having health insurance before being diagnosed with a serious condition make a difference?

Limited with my health insurance?

  • After 6 months of me working for this company I finally received health insurance for my family and I. My husband just started a job after being laid off for more then 1 year and is unable to get health insurance since the job is so new. Since I have a history of high blood pressure and blood clots I thought I should take advantage of my new health insurance. At my first doctor's visit they found a lump on my uterus which the doctor is saying is a tumor and I'm taking all these different tests now. The thing is...because the size of the tumor the insurance company is telling me that even though I was JUST diagnosed with it...the size shows it's a preexisting condition and they wont pay for any treatment for it. I thought about Medicaid....but in my state for an adult to receive it I need to make 5 thousand or less a year...I'm hard up but I make way more then that. My doctor spoke to the hospital administrators and they said it has to be a life threatening condition before they can look past the no health insurance... I'm not at that point...but of course the doctors and I don't want to wait till that point of life or death to take of it. What should I do?

  • Answer:

    So I assume you cannot buy any insurance. Even if you got a policy premiums would be high and there is probably a waiting period for serious treatments. All I can think of is that you go to a community clinic or the county hospital. They will charge you according to your income. They will refer you to a specialist or get one there to see you for your condition. Medicaid is for low income people as you say but you must also meet other criteria to get it: disabled, pregnant, blind, small children, under 21 or over 65.

cj at Yahoo! Answers Visit the source

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Talk to your doctor, see if you can work out a payment plan. If you've got ANY cash, you can negotiate a hefty prepaid discount. Don't let it go. Just because someone ELSE isn't paying for it, doesn't mean you shouldn't get treated. Agree to pay for it, work out the payment plan, have the tumor removed.

mbrcatz

go get it checked bc it sounds like its neccesary..no matter the situation do wht u feel is best for u.U can always pay later.

2amanda

Find out from your doctor and research the condition yourself. Then take you appeal yourself to the hospital administrators. First the hospital president. Then the hospital or health system CEO and CFO, then go system wide if it takes that much. Usually if you contact the president, he will answer. You can also write letters to all the administrators and financial chief executives at once. Explain essentially you have no health insurance. Explain your finacial inability to pay. They do not like receiving such letters. They always want to find the answer of least resistance. An executive likes to pass the letters back down, and usually want it to go away, and they really do want to help in some way. ~~Write a formal paper letter, save copies, be accurate and concise. Even if it is not life-threating at this point, it is very stressful having a tumor inside of you growing and you are also afraid. Ask for their help and consideration. Tell them of your insurance and that you cannot afford the surgery. Every hospital hs funds allocated for just cases like yours. Be polite and respectful and neat. If you do not hear from them in 2 weeks call their offices. Again respectful, calm and polite. You can get the names of all of the executives for the hospital and health care system on their web-site and by calling the hospital.

Normally under group health insurance, they will pay for pre-existing conditions since it is a "group" policy, but in your case, prior to getting this health insurance with your job, you had no prior health insurance, so they can in many cases deny it. 1st off, pull out your policy and verify this. In many group policies, they could have a 12 month to 18 months for any pre-existing condition to be covered, if no prior insurance. But even in a couple of companies I worked for, they had this clause, even though I was never un-insured at any time, but had this clause in the policy for everyone. So say they have a 18 month exclusion, "you might" have this covered after 18 months if you are able to wait. But is this policy states, that any pre-existing condition is not covered, then you will be SOL. Also, if possible and it appears that your doctor has gone over and above to help you, have the doctor go thu your medical records to verify that nowhere does it state that you had this problem or was suspected of having this problem. Granted the size of the tumor could be suspect that it was pre-exisiting, but with the economy and so many people out of work and many even if they can get cobra from a prior job, cannot afford health insurance, thus they go w/out health insurance and "hope for the best" and not get sick till they find a job with health insurance. Also while unemployed, many people don't go to the doctor regularly since they don't have the money and only go if in an emergency. You can also file a complaint with the state insurance commissioner on this, but that may not guarantee you will win. Your only argument is that you did not have health insurance and both you and your husband have finally gotten jobs, that if not for this, you might have seen the doctor earlier when the tumor was smaller and maybe treatable w/out less treatments and/or other options that would have been less. good luck

lucy

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