I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: Tinah1968 on February 02, 2009, 10:29:32 AM
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:stressed; I have no clue where to begin. I recently changed jobs and of course that means that I had to change insurances, Which should not be a hassle but it is. I transfered my insurance over and the new insurance group is now fighting me on Dialysis. My Old insurance already had me ready but my new insurance says since it is pre-existing even though my insurance over-lapped and I have proof of insurance... I have to wait a year. I don't think I can wait a year, I am not on Dialysis yet but, I had my fistula placed in Oct. 2007 and I am ready when the Dr's say its a go. Now when I transfered insurances they said it would just roll over and I put that I hd ESRD on my Insurance application, Now they changed it and saying that Policy says I had to wait 1 year. So I will have to apply for Medicare just as as back up. And I do not know where to begin... Any Ideas?
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you need to apply for medicare when you start dialysis, even if you have insurance. you are entitled to both. the only thing i can suggest is fight the insurance company loudly and publically. try contacting on of the news channels. it's my understanding that as long as you have had insurance they can't consider pre-existing conditions as a reason for non coverage. but then even if what they are doing is against the law if you just accept what they say and go quietly away, no one will ever know and they will get away with it. remember the squeaky wheel.
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We are in California so it may be different where you are. I called the California Department of Insurance (our State Insurance Commissioner) which I found using this map: http://www.naic.org/state_web_map.htm
I gave your story (as much as I knew from your post.)
The commissioners office said that a company can require a 6 month to a year waiting period (depends on the size of the company you're at, ie, number of employees) - however - if you had no lapse in your group plan there's something called a "credible coverage period" which would be applied to that wait period, since you had continuous coverage. Try mentioning this to the insurance provider.
Depending on the type of insurance (PPO, HMO or indemnity plan) there may be a different agency that regulates health insurers.
You should contact your state agency and file a "request for assistance" or a complaint, depending on what they require.
In California there is the Department of Insurance and the Department of Managed Health Care. You should have similar agencies to assist you.
In the meantime you definitely should file for Medicare. Call your local office to ask about what they require. Be sure to mention ESRD.
If for reason you cannot get anywhere with your state commission or Medicare, there's probably a similar plan like this one that you may qualify for:
Major Risk Medical Insurance Program (MRMIP) - This program provides comprehensive health insurance for Californians who are unable to obtain coverage in the individual health insurance market. People enroll in the program because they have been rejected for coverage by an insurance company or health plan due to a pre-existing condition.
Don't give up - this is worth fighting for! Good luck!
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:clap; After being on the Phone yesterday for 3 hours with my Insurance Company and my Brother (He is a paralegal for a medical attorney) Anyway, I sent the Certificate of benefits over and I should be covered by my current Insurance. They have a clause that states that if you have insurance and there is not a lapse that they will take on the Pre-existing.But, there is still a waiting period but just not as long. (60 Days) Which is a blessing as I was stressing out at the thought of not being covered. I was at my last job for 12 years before they closed and it was just a hassel looking for another job knowing I would have to go on Dialysis soon..
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Thanks Everyone
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:yahoo; Tinah. Glad you got things sorted out. I hate dealing with insurance crap. :cuddle;
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That's wonderful news! Congratulations on winning your fight! There will be more in the future! :boxing;