How strict is Humana health insurance with pre-existing conditions?

Question

I've had acne since my teens but it's really been bothering me lately psychologically and hurting alot when trying to sleep on my back from cysts. Also sometimes minor acne on my face has been causing permanent scars. I want to go to the dermatologist and see if I can get accutane, but I just got my health insurance beginning of the year and had no creditable coverage before that. According to their written policy, I might not be eligible since I actually went to the doctor and got antibiotics for acne less than 24 months before enrollment in the health plan. I would like to say that the condition manifested itself in the past month psychologically which caused me to seek out accutane, which is true. Should I even mention my past diagnosis can they check it somehow? I really don't want to pay $3000 out of pocket for accutane, but I feel I really need to do this now for my own well being. What should I say to the doctor, how much will they investigate preexisting condition

Answer 1

I have worked in medical claims before and there is a good chance with this diagnosis they will deny it for a pre-existing claim. They will request all medical records and will know you have been treated for your acne in the past. There is no sense in lying as they will find out. If your acne is that bad you should not let this stop you, you should seek medical help and pay for the visit and the medicine out of pocket if you can afford it. It would be worth it. You can also call your health insurance and ask them straight up if they will cover it instead of worrying whether they will or not.
Good Luck.

Answer 2

You can call the insurance company and discuss the situation and verify your waiting period. If you have a 24 month wait period for pre-existing and it was almost 24 months ago, worse case you will only have a short wait. Do not lie to insurance...they have MIB to check on - which is a reporting company on medical information. Trust me, when I was working on a new health policy, they knew more information about my medical visits than the doctors told me. They are like big brother.

Just call them, I am sure the stress isn't helping your situation. Take care of yourself! Be happy you have some sort of insurance -- even if you have do deal with the pre-existing conditions and your deductible!