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Question

Hi,

I recently signed up for Kaiser through my employer. I'm in California. I've been uninsured for three years before this. I have a couple of issues that could be considered "pre-existing conditions."

If I go to the doctor to get something treated, and they think its a pre-existing condition, what will happen?

Will they treat it, give me surgery, and then send me a bill?

Will they tell me I'm screwed and refuse to even treat me? Can they, under the law, refuse to treat me, if I'm not on their plan?

Can I sign up for a higher rate? How much higher would it be from the $265 a month I'm pay in individual costs right now (my employer has a group policy, but does not kick in anything)

How likely is it that they will even check to see if it is a pre-existing condition, especially if I tell my doctor it started bothering me weeks into my new coverage?

Please help, I really don't know what to do. I need some advice.

Answer 1

Have you gone to a doctor for your "pre-existing conditions"? Is it documented that you've had treatment for any of the conditions? I can't answer your question completely or even accurately as I don't know your insurance company's policy, but your doctor and your insurance company are (or should be) separate entities. He won't determine if your condition is pre-existing before he treats you. However, with many companies, you will need prior approval from your insurance company before having the surgery, to determine if they will pay for it or not. If they won't, you will have to make arrangements with your doc for payment. You should have gotten a pamphlet from the insurance company regarding those issues.

Your monthly payment is high!! You must have great coverage, or be older with some health problems. If you have health concerns, go to your doctor and be checked out. Then take it from there. Putting off treatment could lead to more serious problems, which will end up costing you and your insurance company a lot more money. Doctors are very familiar with insurance company tactics, and have ways of reporting or coding health conditions that may optimize the amount your company will pay. Go to the doc and see what he/she says.

Good luck.

Answer 2

A lot of insurance companies will refuse to pay for pre-existing conditions. If it's determined that the condition you're being treated for is pre-existing, the insurance company will deny the claim. Your doctor will probably treat you for the condition, but if your insurance doesn't pay, the responsibility will be yours. It's really not a question of whether or not you can receive treatment, it's a matter of whether or not you'll be covered by the insurance. Most doctors, even if they would want to do you a favor and not report anything pre-existing, they are usually too ethical to lie about such things, as it would get them in trouble. It's best to be honest. I guess the only thing I would suggest is to try different insurance companies. Some are less particular about pre-existing conditions and may accept you, but will probably charge you a higher premium and give you less coverage. Talk to the insurance representatives and make sure you understand what a pre-existing condition is. If you're a known diabetic, for example, you'd be classified as pre-existing. If you've been treated in the past for a minor ailment, such as a cold or a heartburn, that would not be considered pre-existing if you were treated for it under the new plan. It really depends on the type of condition and whether it was minor or serious. Good luck!

Answer 3

I dont want to say I know the answer to this, but I do know that at least in Oregon there are some basic guidelines. Usually a pre-existing condition is one you have sought treatment for in the last X months. Also, there is usually a period after you get the insurance where they can call something pre-existing but after that anything goes. I would call your insurance and ask them about it. Dont give specific details just ask them to define a pre-existing condition for you. OH, they always check. They are all about the money and they hire peopel whos only job is to study your past history. Also, usually your doctor is your friend and can help you with negotiating with the insurance company as long as you give him a heads up before treatment or visits. I know how scary it can be. Good Luck, Jen

Answer 4

Generally, pre-existing conditions are ones that you've been treated for in the last 6 months. Also, group plans through employers often accept pre-existing conditions as part of their contract with the employer.

Answer 5

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Answer 6

one million) I can by no means discover knowledge in this one. Most of the circumstances that I pay attention of include one ofs. I can let you know that I have not heard of a unmarried case wherein it's been for anything that was once vastly wanted, which is smart, when you consider that Canada does no longer positioned the ones desiring cure for a lifestyles threatning situation on wait lists. It is simplest the ones desiring experimental or beauty therapies. Even Shona Holmes (no longer certain for those who noticed the ones commercials) and her "mind tumor" (which was once honestly a cist that, if left untreated for an extended interval of time, can have impaired her imaginative and prescient - as mentioned via the Mayo Clinic wherein she went for cure) was once a case of a Canadian crossing the border that was once blown out of share via lobbyists who're paid via coverage corporations. two) Unfortunately, the final stat in this was once from 1992 (possibly that has anything to do with the coverage enterprise overlaying the numbers up). In 1992, it was once six hundred,000 in Ontario on my own. It is envisioned, nonetheless, that during 2008, Americans spent over $one million billion in prescriptions on my own in Canada. Apparently, it may be somewhat difficult to monitor, when you consider that there are Americans who hop the border to pay much less for special therapies (simplest residents can pass to the health center free of charge, however Americans pays lower than one million/10 what they do in America for special approaches) and others who gets false provincial well being playing cards to get loose cure (the ones are those who're difficult to monitor).