Anybody know anything about pre-existing condition

[puzzled]

Ok I have had major issues with my insurance, it does not have any real prescription coverage...a discount card that gives me maybe 15% off, which is peanuts when we are talking about $150.00 meds...and no copays at the dr office...we pay cash for all of those.

I have a $5400.00 deductible, and the only way that Chase's ADHD has affected the insurance company is by the few meds that I cannot get through a patient asistance program and the dr visits going towards a deductible that is never going to be met at least not because of ADHD. So far, I have paid cash for all prescriptions, or got them through a patient assistance program. I did try to get his Periactin with the card at Walmart the other day and it was rejected, but the rep at the insurance co. told me that it was because the birthdate was not entered at the pharm correctly....funny, they only asked for it like 20 times in the hour and a half that I waited for the meds!!! So they are sending me some claim form to get the money back...

So yesterday, I get a letter that the insurance company is wanting all of Chase's records from the doctor...so I call them and ask them why and they tell me that they want to check for pre existing conditions...we got the insurance and the start date was March 1, 2006. Chase's appointment was in March sometime...BUT the appointment was made prior to March....can they claim pre existing just because of the appointment being made, or is it not a condition until the dx is made?

Anybody out there work in the insurance industry, or have a clue about this? I have called the doctor's office to see if it is noted in Chase's record at the time of the appointment being made....waiting for a call back..

[lynn]

wow, insurance is so frustrating when it comes to cognitive disorders....I remeber going round and round with them.

I don't think making the appoint befor march has anything to do with it. just when the actual appointment would be. also talk to the doc and tell him you dont' have good insurance and he may be able to help you get some freebees.

[puzzled]

The doctors office called me back and told me that the insurance would not have any knowledge of when the appointment was made so that is my only worry...I know for a fact that that appointment is the first time I ever mentioned it to the doctor, so there will be no pre existing record.
The doctor knows about our insurance and has always given us samples, but of course with stims you can't GET samples.....

[John]

Puzzled, $5400.oo is quite a high deducktable. Have you chked around lately for something more reasonable ?

[puzzled]

It is a high deductible because that makes the monthly payment more reasonable..We are self employed and have to carry our own..when we got the insurance, we had no real monthly prescriptions and no earthly idea of just how expensive meds can be, being a mostly healthy family. Now it may be more cost effective to switch to a lower deductible , which is an option that I have discussed with the rep at the insurance agency, even if the payment goes up...in the long run, we will be ahead what with the asthma meds that Jake has and Chase's ADHD drugs...but we have to wait until after our year is up to do anything to the policy. That is in March.

[John]

Well that's not toooo far away . . .

[puzzled]

Yep, that is IF they don't find a way to weasel out of paying for anything for Chase's ADHD. I know for a fact that it was never mentioned in his records before that appointment in mid to late March. This is the only doctor that he has ever seen (since 2 weeks old), and though I struggled with thinking that he may have it, I never sought out a medical dx until that day. So I say let them dig! They won't find anything!

[jj]

I personally think there should be a law against medical insurance companies refusing to pay for something if it is a pre-existing condition. Your child was born this way. Most of the ailments that come along in life are because we had a propensity to get it due to DNA/Genetics. It sure stinks.

[charliegirl]

They do that so we don't all wait until we need insurance for big bucks problems and then take out a policy.

I do think that when an insurance company which is covering all the employees for a business, it shouldn't be allowed to do that. When someone is hired in a new place, they have to switch to that companie's insurer. They shouldn't be penalized for that.

I also don't think they should be allowed to pick and choose what they will cover or who you can go to.

[misty]

charliegirl said:

I also don't think they should be allowed to pick and choose what they will cover or who you can go to.

I agree. I hate when someone in my family needs to go to a new type of Dr. I have to find one on the list. Usually I'm lucky & can find a good one who's convenient enough, but sometimes thats darn near impossible!