Health insurance "pre-existing illness" meaning?

Question

I don't completely understand health insurance as I'm still covered under my mother's.

When a person switches health insurances, what constitutes a pre-existing illness that they will not cover?

For instance, I'm on a few medications so will a new insurance company not cover those specific medications or any medication used to treat the overall condition?

If either case is correct, is it possible that a doctor can sign something that says the person must stay on that specific medication so that the insurance company must cover it?

For example: I have GERD and am on Prevacid and Reglan. If I change health insurances will they change the medicine to something else like Nexium or will they not cover any medication having to do with GERD at all?

Answer 1

When you change insurances make sure you get a certificate from your old insurance. I can not reemember the name of the actual certificate but its basically proof of prior coverage.
The pre-exsisting condition applies to people that have not had prior health insurance. But in your case this is not the case. The new insurance will cover you as long as you provide them with that proof of prior coverage.
As far as the med change. I am not sure some companies will try to go with a cheaper drug but most often they will honor the prescription for you need.
I am editing this to add a link. I am guessing that most people dont understand that there are laws in place that govern this.
Please click on the link below to find the specific laws in your state.
http://healthinsurance.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=healthinsurance&zu=http%3A%2F%2Fwww.healthinsuranceinfo.net

Answer 2

Most medical insurance companies have what is called a formulary. This is a list of medications that they will cover under the pharmaceutical portion of your policy. You should ask the company for a copy of their formulary so you can check to see if the medications you take will be covered under that new plan.

The way I understand it, a "pre-existing condition" would be something like arteriosclerosis or hypertension or fibromyalgia or some other condition that is considered 'chronic.' That is, you will always have it for the remainder of your life. If you have something like acid reflux, that can be a temporary condition that will go away once treated.

Basically, health insurance companies don't want to get strapped with patients who have chronic or degenerative conditions that require permanent, on-going pharmaceutical regimens. They consider it a bad risk to have clients with known illnesses that would effectively cost them more money and cause them to have to raise premiums for everyone who has insurance with them.

Considering the spiraling cost of healthcare and the growing inability of employers to provide reasonable healthcare coverage, it would be wise to consider *very carefully* before you change companies. If you have even the siightest doubt in your mind that you may be singled out with a pre-existing condition and you are able to continue with your present plan, you may be wise just to stay where you are. Depending on your situation, it may be that you have no choice but to change companies. I'd advise extra caution to be sure the new company will cover you at a cost you can afford before dropping the first one. Your primary care physician or the one who diagnosed and prescribed the medications for you may be able to help you by providing the new company with a statement that indicates your condition is not permanent and, thus, not a pre-existing condition.

If your condition is in fact temporary, you might even want to consider just not mentioning it to the new company and then paying for the remainder of your medications out of pocket. (No need to send them red flag alarms when none are needed.) Might be a bit more expensive up front but may save you from an overly cautious agent who will insure you but only at such a higher premium that over time the insurance costs will amount to much more than the cost of out-of-pocket meds for the few extra months you need them.

This is similar to what happened to me and I had to pay much higher premiums than the norm. I eventually lost my health insurance altogether because the premiums were simply too high for me to afford.

Not trying to sway you or anyone politically, but the overall healthcare and insurance costs coupled with my own experience made me understand why universal healthcare coverage for everyone is the only thing that will help me and the millions of people like me now and put a stopper in the runaway Pandora's box the healthcare system has found itself in. Unless we have some kind of federal level legislation, this is only going to continue to get worse for 95% of the population.

I do sincerely hope this is of some benefit to you. It is an ugly and unpleasant situation so many of us now face.

Best wishes and good luck to you.

Answer 3

I can't help you on the first parts of your question, but I can tell you the least expensive and most often preferred drug is Prevacid so it would be very unlikely that a new insurance company would want to switch to any other drug.

Answer 4

i change into pregnant after I were given a job, after ninety days, after I were given to signal up in the peace of mind, I had to ask if being pregnant change into considered a pre present challenge. BCBS of FL did not evaluate it a pre present challenge, yet i do not understand if it truly is throughout the board or if it differs by the plan or the state you stay in. if you're contained in the early ranges i might want to settle for the area. likely you've not lengthy previous to the physician yet to verify it, so technically this is not a pre present challenge because it has not been clinically determined. you may want to favor to carry off on your first visit till the peace of mind is in position. strong success!

Answer 5

GERD most likely would be considered a pre existing condition as would diabetes, MS, cancer ect... An illness that is long term. Yes you can have your doc write a note and tell the ins to shove it and to cover it anyway and they most likely will. My mother did it with my brothers diabetes. They covered it.

Answer 6

Oh, don't they have their ways to give the screws to ya...A preexisting condition is one that you have before you sign on to their insurance. But I guess this is necessary, after all, the insurance companies are going broke!