What qualifies as a pre-existing condition for insurance, and is there any way around it?

Question

My boyfriend is self-employed and also works about 20 hours/week for a retail store. (No benefits.) He is uninsured and now just learned he needs to have surgery. It is not life-threatening, but could be if left untreated for a long time. His doctor reccommended he have the surgery as soon as possible. Is there any way to apply for insurance now and not have them count the surgery as part of a pre-existing condition? What do people do in this situation?

Answer 1

A pre-existing condition is something that is already wrong with you. Whatever is wrong that requires the surgery, is a pre-existing condition.

What do people do? Negotiate a cash price for the surgery & hospital charges, and take a second job to pay for it.

Answer 2

It will be considered a pre-existing condition if it's been documented in his medical records.

Since you don't specify what the issue is, it's difficult to comment much beyond that. He may still apply for insurance and be accepted; however, even if he does get accepted, he will be rated up for having a pre-existing condition and the company will still refuse to pay anything toward medical care related to the pre-existing condition for 6-18 months (depending on local state laws.)

Think about it... otherwise, everyone would go uninsured until they had some serious health crisis and suddenly they'd grab insurance for just long enough to get surgery, or whatever resolution was necessary. If we let people do that, it would be more expensive to have insurance than it would be to pay for the surgery out of pocket in the first place!

If he were able to still get approved for health insurance, it might still be worthwhile for him to do so. The health insurance company won't pay for the surgery; however, the hospital may be willing to give him the network provider discount and that alone may be worth 40-90% of what he'd be billed otherwise.

Answer 3

it is definitely a pre-existing condition. That said, you have two choices: First, apply for medical assistance from Medicaid. You may qualify as medically needy. Second: tell your doctor your situation and see if he'll accept payments and a discount (10-20% is a normal discount). He might. If ask him if he knows one that would accept payments. This leaves the hospital (assuming its an outpatient or inpatient procedure). Go visit the social worker(s) and tell them your predicament. They may know of grants or other aid. They probably won't take payments, but may take pre-payments. If a hospital is involved, the price tag will be five figures. You can ask them to tell you what they will charge and they won't be able to. You can try to negotiate it - good luck.
You might take a second on your home. You might be able to get an early refund from the IRS as well, especially if your medical deduction ends up being huge becasue you paid so much.
The last alternative is go to a foregn country. I am completely serious. The procedure you need will be way more affordable - you could probably fit it on a credit card. I recommend Singapore or Thailand. There are certain hospitals you go to, and ones you should never go to (in the same country) so you would need to do your homework. The NY Times ran an article on this very recently.

Answer 4

Pre-existing conditions are often determined by individual insurance companies. Some try to use the pre-existing clause for a cold, others use any chronic condition - such as asthma or diabetes.

The ONLY way I know of around the pre-existing condition is to give proof of previous insurance - which doesn't qualify in this case. Otherwise, the insurance company can ask for the doctors' notes from a certain time period - and to not provide all of them is considered fraud.

Answer 5

Now that his condition is medically documented, it is considered as pre-existing (which it actually IS). Sometimes, if he were to take on a full time job with an employer who has excellent healthcare coverage offered, they will waive pre-existing immediately, or after a specified period of time of being employed, but this is also becoming more rare.

If he is considering purchasing a private plan, I know of none which will waive pre-existing. Options include self-payment for the services, including the possibility of taking a trip to India or similar, where medical charges are far less expensive than they are in the States. Of course, if anything were to go wrong, your chances of obtaining any settlement for malpractice drop to about zero.

Answer 6

If it is documented in his medical records it is considered preexisting. There is no way around it. But, most hospitals will charge you less you are paying for it yourself. Also, there are lots of ways that you can negotiate the amount you owe in the end.

Unfortunately, this is the bad part of being uninsured. You never know when or when you may need insurance.