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Thread: Question about insurance coverage

  1. #1
    Senior Member wheeliecoach's Avatar
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    Question about insurance coverage

    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.
    "Unless someone like you cares a whole awful lot nothing's going to get better. It's not." - Dr. Seuss

  2. #2
    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
    Embrace uncertainty. Hard problems rarely have easy solutions. Jonah Lehrer

  3. #3
    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.

  4. #4
    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.
    Embrace uncertainty. Hard problems rarely have easy solutions. Jonah Lehrer

  5. #5
    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.

  6. #6
    Quote Originally Posted by leschinsky
    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?
    Daniel

  7. #7
    Senior Member Andy's Avatar
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    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?

  8. #8
    Senior Member wheeliecoach's Avatar
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    Quote Originally Posted by Andy
    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.
    "Unless someone like you cares a whole awful lot nothing's going to get better. It's not." - Dr. Seuss

  9. #9
    Medicare is tied to SSDI. If he is employable, or employed, he isn't on SSDI, and so is not eligible for Medicare.

    (KLD)

  10. #10
    Senior Member wheeliecoach's Avatar
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    Quote Originally Posted by SCI-Nurse
    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.
    "Unless someone like you cares a whole awful lot nothing's going to get better. It's not." - Dr. Seuss

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