Insurance Question!

[chai]

Hi all,

I'm 32 years old and have been diagnosed (in Canada 2008) with mild to moderate mitral valve regurgitation. In 2009, I moved to the US for school and have been going back to Canada for echos once a year. This past check up(DEC '10) my Doc told me that there was some deterioration and he wanted me to come back in 6 months for another check up. Needless to say, I'm kinda scared even though I am still assymtematic.

Anywho, I'd like some help with choosing a good health care provider and plan for a second opinion here in the US. Is it wise to tell them that I was diagnosed in Canada or should I say nothing about it and get the coverage first. Do insurance companies have access to Canadian Health care records?

THanks in advance!

 

[dick0236]

Hi all,


Anywho, I'd like some help with choosing a good health care provider and plan for a second opinion here in the US. Is it wise to tell them that I was diagnosed in Canada or should I say nothing about it and get the coverage first. Do insurance companies have access to Canadian Health care records?
!

It is never a good idea to withold information on an insurance application. Insurers will often issue the policy and if a large claim comes in fairly soon after the coverage becomes effective they will "underwrite" after the fact. If your condition is shown to have existed prior to the effective date, they will cancel coverage as of the initial effective date and refuse all claims. The preexisting condition clause is to be eliminated under Health Care Reform although I do not know if it has been eliminated yet. Maybe some of the younger members know. May be a mute point since our congress may soon do away with the reforms plan.

 

[kfay]

I'm with Dick on this one. I think you are going back to Canada to have your surgery. If you had gotten insurance when you first moved here when you didn't need it and kept your premiums up all this time, they'd probably be paying for your surgery here, but I'd say you'll have a hard time making that happen now. I certainly wouldn't be willing to risk getting a policy, having surgery, then having the insurance company come back and claim that your application was filled out fraudulently and stick you with the bill for your surgery.

 

[chai]

I still think I'm a few years from surgery. How much higher would my premiums be if I disclose my condition?

Also, what plans are best to go with?

 

[Greg a]

do you plan or coming back post your education? Do your parents or other family live here or Atlanta?

 

[kfay]

I still think I'm a few years from surgery. How much higher would my premiums be if I disclose my condition?

Also, what plans are best to go with?

They aren't going to take you if you disclose it. No way, No how! The only way for you to get health insurance here is for you to get a full time job here that offers full benefits. Even then, since you have never had insurance here before, you will probably have a waiting period for a pre-existing condition although that is also supposed to go away under the new law as well.

 

[Jkm7]

You just advised them.
You posted to a public internet forum.

There are no secrets on the internet.
Sorry for your circumstance. Are you not eligible for coverage in Canada where you have already been receiving care?
As to the new health care law and pre-existing conditions, I probably am confused but think it might not be until 2014 when pre-existing limitations will disappear.

 

[Lynlw]

You just advised them.
You posted to a public internet forum.

There are no secrets on the internet.
Sorry for your circumstance. Are you not eligible for coverage in Canada where you have already been receiving care?
As to the new health care law and pre-existing conditions, I probably am confused but think it might not be until 2014 when pre-existing limitations will disappear.

You are correct as far as I know unless nothing changes, the pre-existing clause doesn't change until 2014.

 

[Luana]

Hi all,

I'm 32 years old and have been diagnosed (in Canada 2008) with mild to moderate mitral valve regurgitation. In 2009, I moved to the US for school and have been going back to Canada for echos once a year. This past check up(DEC '10) my Doc told me that there was some deterioration and he wanted me to come back in 6 months for another check up. Needless to say, I'm kinda scared even though I am still assymtematic.

Anywho, I'd like some help with choosing a good health care provider and plan for a second opinion here in the US. Is it wise to tell them that I was diagnosed in Canada or should I say nothing about it and get the coverage first. Do insurance companies have access to Canadian Health care records?

Well, healthcare providers and insurance companies are two different things. If you have group medical insurance through an employer, you should have no restrictions on pre-existing conditions. If you plan to purchase an individual plan, you will be most likely be declined because of the MV regurgitation. If you don't include that on your medical history when your application is submitted and are accepted, when you seek care and/or treatment for it, most likely your policy will be canceled because you've committed fraud by not including it in your history.

Most states now have high-risk pools for those with pre-existing conditions, but what I've found with them so far is that the premiums are quite high and they usually have high deductibles. In the state I live in, the high-risk pool insurance plan would cost me about $400 more per month than what I now have and has a $5,000 deductible, while my current plan has none. They're pretty expensive options and have quite low amounts for what they pay out in lifetime benefits.

 

[Philip B]

Disclosure

Disclosure

"How much higher would my premiums be if I disclose my condition?" You've got to be kidding. This is the wrong question. It should be something along the lines of, "How much will it cost me if I don't disclose, receive benefits and the insurance company discovers my failure to disclose and demands repayment of benefit expenditures?"

If you think you have any chance of fooling an insurance company, guess again.

-Philip

 

[Greg a]

I am curious if you currently have any type of protection now? What would happen if you were to require emergency treatment for this or any reason also I would be concerned about any complications that could lay you up for months. In2007 I was in hospital for a total of almost 6 months

 

[jake]

Chai:

Please make sure you know the health care rules in the state you are living in. Here in Michigan, we have some unique laws that prevent insurance companies from denying coverage to people with pre-existing conditions. Health care laws change from state to state. Take for instance, here in Michigan.....

You can check me on this, but if you come into a policy with "credible covererage" they cannot deny you coverage and have to pay after 6 months. After 6 months, to the state of Michigan, you have no pre-existing condition so once you sign up for coverage, you cant use if for 6 months unless you already had coverage by a credible policy before you applied to the new company. I don’t know if they consider the Canadian system "credible" by law.

The rules for a “not for prophet vs. a for prophet” also differ dramatically. A not for prophet insurance company cannot deny coverage in Michigan regardless of any pre-existing conditions. They can also charge you whatever they want as well.


You can do a Google search on insurance law in the state you live in to find out but a lot of other states have no laws like this and, basically, throw you to the wolves. Right now, in Washington, our new Congress is fighting tooth and nail to make sure people like you have no chance to buy health insurance vs. the Congress we had that wanted to make you purchase it at gunpoint.

My advice to you is to go back to Canada and make sure you have all your paperwork in order back there to travel back here to the US. I was under the impression that you had to pay a nominal fee in Canada for your health care to extend to the US should you become Ill here and require hospitalization. I, for one, would love to know more about the Canadian Health Care system. All I hear is bad stuff about it yet everyone I know who lives North of the city of Windsor seem to love their government coverage. The folks up in London Ontario absolutely swear by it! We were a Hockey family so we used to travel in Canada a lot.

 

[Mileena46]

You can actually talk to an insurance agent, and find out more...but I applied for Blue Cross/Blue Shield of Alabama before surgery and after being diagnosed and was accepted with pre-existing but with a clause that they wouldn't pay anything on my heart condition for 12 months. It was on an open enrollment plan and even though the price was a little steep, it doesn't come close to what you would pay for OHS.


Mileena

 

[Greg a]

AS to your question re disclosure watch this clip closely ...it does note a patient "was skiing in Canada" at the one minute 45 sec point


​

.

 

[ShezaGirlie]

This is one of my favorite Mark Twain quotes:

"If you tell the truth, you don't have to remember anything"​

 

[chai]

Sounds promising. How steep was the premium?

Also, were u able to choose the surgeon?

@Mileena

 

[chai]

Chai:

Please make sure you know the health care rules in the state you are living in. Here in Michigan, we have some unique laws that prevent insurance companies from denying coverage to people with pre-existing conditions. Health care laws change from state to state. Take for instance, here in Michigan.....

You can check me on this, but if you come into a policy with "credible covererage" they cannot deny you coverage and have to pay after 6 months. After 6 months, to the state of Michigan, you have no pre-existing condition so once you sign up for coverage, you cant use if for 6 months unless you already had coverage by a credible policy before you applied to the new company. I don’t know if they consider the Canadian system "credible" by law.

The rules for a “not for prophet vs. a for prophet” also differ dramatically. A not for prophet insurance company cannot deny coverage in Michigan regardless of any pre-existing conditions. They can also charge you whatever they want as well.


You can do a Google search on insurance law in the state you live in to find out but a lot of other states have no laws like this and, basically, throw you to the wolves. Right now, in Washington, our new Congress is fighting tooth and nail to make sure people like you have no chance to buy health insurance vs. the Congress we had that wanted to make you purchase it at gunpoint.

My advice to you is to go back to Canada and make sure you have all your paperwork in order back there to travel back here to the US. I was under the impression that you had to pay a nominal fee in Canada for your health care to extend to the US should you become Ill here and require hospitalization. I, for one, would love to know more about the Canadian Health Care system. All I hear is bad stuff about it yet everyone I know who lives North of the city of Windsor seem to love their government coverage. The folks up in London Ontario absolutely swear by it! We were a Hockey family so we used to travel in Canada a lot.

I have nothing but good things to say about Canadian Health Care so far. I am very thankful it's avail. to me.

Considering my state is Red (Georgia), I'm pretty much screwed!

 

[chai]

As long as I'm in school full time, I am still entitled to OHIP. If I were to get any symptoms while I am here, I would have to fly to Canada for treatment and most likely stay there until I recover fully.

Hence the reason why I'm seeking advice. I don't want to lie but I also want to get coverage....even if it's just for an emergency. ie Car wreck.

I am curious if you currently have any type of protection now? What would happen if you were to require emergency treatment for this or any reason also I would be concerned about any complications that could lay you up for months. In2007 I was in hospital for a total of almost 6 months

 

[chai]

Appreciate the reply. Blue cross looks promising if I could afford it.

Well, healthcare providers and insurance companies are two different things. If you have group medical insurance through an employer, you should have no restrictions on pre-existing conditions. If you plan to purchase an individual plan, you will be most likely be declined because of the MV regurgitation. If you don't include that on your medical history when your application is submitted and are accepted, when you seek care and/or treatment for it, most likely your policy will be canceled because you've committed fraud by not including it in your history.

Most states now have high-risk pools for those with pre-existing conditions, but what I've found with them so far is that the premiums are quite high and they usually have high deductibles. In the state I live in, the high-risk pool insurance plan would cost me about $400 more per month than what I now have and has a $5,000 deductible, while my current plan has none. They're pretty expensive options and have quite low amounts for what they pay out in lifetime benefits.

 

[chai]

HA! very true.

This is one of my favorite Mark Twain quotes:

"If you tell the truth, you don't have to remember anything"​