View Full Version : Question about insurance coverage
wheeliecoach
11-20-2007, 10:28 PM
I have a question concerning insurance coverage. My boyfriend (T-7 complete) has been unemployed for over a year (he was laid off due to downsizing), and has been looking for a job ever since (jobs are hard to come by out here). In any case...he has been paying COBRA since his benefits expired...so there has been no break in insurance coverage. He applied recently for individualized insurance coverage, and was denied because (as the letter states) he has a spinal cord injury with residual disability. I thought that because he continued being insured without a break in coverage that a pre-existing condition does not apply here.
Anybody have any insight on this? Any and all thoughts would be appreciated. All he wants is some coverage until he finds a new job.
Thanks in advance.
leschinsky
11-20-2007, 11:28 PM
nope doesn't matter with individual plans, they can deny us, this is what the Democratic candidates want to put an end to so vote with that in mind. I hope his cobra isn't as expensive as mine, one of my friends even offered to marry me:D
-scott-
11-20-2007, 11:42 PM
um... I was able to get on an individual plan b/c of the HIPAA code after riding out COBRA. The sales rep for my insurance company said I couldn't be denied, and I met w/ her face-to-face (so my SCI was obvious). Insurance costs me an arm and a leg but it's coverage.
The political mention is BS. President Clinton was the one who set up this provision in the first place; it worked for me.
leschinsky
11-20-2007, 11:52 PM
No it's not BS as they have said they want to make it impossible for insurances to deny you for having a pre-existing condition.
I can't get any coverage until I go thru 3 years of COBRA, which is now $1700 a month, and next Sept they can raise it again. I'll be broke by that time.
Sugarcube
11-20-2007, 11:53 PM
I have tried many different types insurances in Connecticut too. All of the companies offered a plan, but refused to cover anything related to my SCI (pre-existing illness). Before that, I had insurance through my parents (I was a minor at the time of injury). After a couple years, they stopped coverage entirely on anything related to SCI. They said that I had exhausted all coverage. I don't think there is anything you can do. I hope I am wrong though.
dan_nc
11-21-2007, 04:09 AM
No it's not BS as they have said they want to make it impossible for insurances to deny you for having a pre-existing condition.
I can't get any coverage until I go thru 3 years of COBRA, which is now $1700 a month, and next Sept they can raise it again. I'll be broke by that time.
Which candidates have taken a stance on this insurance question?
Someone clue me in...you guys cant get Medicare? I know about the Medicaid wanting you dead broke, but Medicare should cover the bulk of doctor stuff right?
wheeliecoach
11-21-2007, 09:21 AM
Someone clue me in...you guys cant get Medicare? I know about the Medicaid wanting you dead broke, but Medicare should cover the bulk of doctor stuff right?
This takes a lot of time to determine eligibility for...and he is working with the state to get a new job...so this should be temporary...but his COBRA runs out soon...which is what prompted us to get interim insurance.
SCI-Nurse
11-21-2007, 12:22 PM
Medicare is tied to SSDI. If he is employable, or employed, he isn't on SSDI, and so is not eligible for Medicare.
(KLD)
wheeliecoach
11-21-2007, 01:52 PM
Medicare is tied to SSDI. If he is employable, or employed, he isn't on SSDI, and so is not eligible for Medicare.
(KLD)
And he is employable and not receiving SSDI...so another reason why he is not eligible.
Doesn't this sound fishy? I mean he is considered employable so he cannot get Medicare...but yet he has a pre-existing condition of SCI...so he can be denied insurance? What are we supposed to do then? Pay out of pocket? Show me someone who is disabled and can afford that.
leschinsky
11-21-2007, 02:30 PM
Wheeliecoach my state has a program for people who are denied coverage as long as they are not eligible for COBRA. Unfortunately the disabled are entitled to 3 years of COBRA. Sigh. Has he checked out options thru the state government?
Dan, Hillary, Obama and Edwards have that provision in their healthcare plans (http://www.siecus.org/policy/PUpdates/pdate0352.html); as does Richardson (http://www.richardsonforpresident.com/issues/healthcare?id=0001). Biden's appears more nuanced (http://www.joebiden.com/issues?id=0003). Kucinich is for a single payer system.
Sorry about drifting this OT a bit, but maybe some of you guys can answer something I've been wondering about...
After my accident I was collecting SSDI and they mailed me the Medicare stuff after the usual waiting period from time of injury. In the meantime I went back to work, so I ignored the Medicare stuff as I had insurance from my employer. Now if I was to find in the coming years that I no longer am able to work and would 'retire' so to speak but not be old enough to actually 'retire' with my company's medical benefits, could I just hop back on the SSDI train with the automatic qualifying SCI injury, then draw Medicare as well? Or would they look back and see that I was working with SCI before, and say find a job somewhere else, you arent getting SSDI and Medicare?
darkeyed_daisy
11-22-2007, 12:43 PM
If you draw your SSDI even for a limited time. You are entitled to Medicare after the 2 yr waiting period. Then when you go back to work you can keep your coverage for several years and then when you reach that point, you can actually buy Medicare if you still are able to work.
Medicare should not be tied to SSDI...it should be for the disabled. But then again it would be abused like handicapped parking.
We need to make sure our votes count at election time.
leschinsky
12-01-2007, 11:25 PM
I meant to post this last week, for those who may have missed it:
The catch in GOP contenders' health plans (http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2007/11/21/MNU7TFVFF.DTL&type=printable)
As cancer survivors, 3 key candidates probably couldn't get insurance under current proposals (http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2007/11/21/MNU7TFVFF.DTL&type=printable)
Sugarcube
12-01-2007, 11:43 PM
I meant to post this last week, for those who may have missed it:
The catch in GOP contenders' health plans (http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2007/11/21/MNU7TFVFF.DTL&type=printable)
As cancer survivors, 3 key candidates probably couldn't get insurance under current proposals (http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2007/11/21/MNU7TFVFF.DTL&type=printable)
Great article! It explains things very well.