Ann G's Question

[bigblueagain]

Ann just saw your post about your grandson I believe it is that is in need of coverage. That is a really hard situation. However, if he has been covered for the last 12 months with no break in service, and can be covered by some type of group coverage, he cannot be denied for a pre-existing condition. Even if it was thru a state program. Individual coverage is much more difficult to obtain, and usually because the risk to the insurer is so much greater. That may be why you are having difficulty finding it for him. I am not really sure why your son would not want to continue coverage, unless the family coverage vs self is cost prohibitive. However if there is a custody and divorce issue, the courts could maintain that he has to continue to provide the coverage. Also have you all tried Medi-Cal by chance? Or do you have guardianship. If so you should be able to put him on your coverage without pre-ex applying. Let me know. BLUE

 

[Ann G]

Hi Blue! Sorry I forgot I'd posted an insurance question...and thank you for answering it! Christian had insurance through the State (Healthy Families). SOMEHOW...Dad let christian's renewal (a yearly application) slip thru the cracks. Tried getting him private insurance thru Blue Shield or Blue Cross. Denied because Christian had ADHD/ODD and taking Risperdal and Clonidine. At the same time he was OK'd for Kaiser (perhaps someone forgot to answer a question???) Anyway....when Christian has had Kaiser HMO for a year could I apply for Blue Cross/Shield with-o the "pre-existing" ADHD/ODD??

I am VERY unhappy with this HMO care. My husband and I have Medicare and we are not Christian's guardian (YET, might I add). I've had it up to my eyeballs with Christian's Dad right now and am seriously considering guardianship (his Dad wouldn't mind, that's for sure). Do you know anything about this process? How would I go about getting Christian on MediCal?

ann

 

[bigblueagain]

First question about if you could get him on BC/BS after he has been covered for a year under Kaiser, yes I believe you should be able to. This is the main intent to the HIPAA law that you are now havign to sign sooo many papers on every time you go to the doctor or the pharmacy(this portion is more on confidentiality of records tho). The initial intent was to allow people to be able to continue to have coverage even if they changed jobs 6 times a year. (HIPAA = health insurance portability act) As Long as there was no break in coverage and they had had coverage for a least a year, they could not be refused or have "pre-existing" conditions that new carriers would deny coverage over. So once he has had the continuous coverage they shouldn't be able to deny.
As to MediCal, it is probably pretty well based on family income, and if you and your husband have good income, or whoever does have custody at this time, then I doubt you will be able to go that route. I would definitely check into it though. I guess the best thing would be to find the website for MediCal and see if the eligibility criteria is listed there. Good luck!!! BLUE

 

[Ann G]

Thanks, Blue. I wasn't aware of the year with no break in coverage. I'm VERY excited about it!!! I can't WAIT to get back on the policy that will cover our family's pediatrician. We've been with him for 29 years this June 6th!!! Actually....it should be a year this coming August. Hooray!!!

So...in your experience, having ADHD should not be a cause for denial of coverage? I know how picky insurance is...my daughter was declined because she'd had migraines as a kid!!!

ann

 

[bigblueagain]

Ann, according to the federal law, as long as you have had employer group coverage for one year, then no they should not deny for ANY preexisting condition. Now if you are trying to get an individual policy, which is not employer sponsored then they may be able to deny. Reasonable as individual carriers maintain a much higher risk of catastrophic types of occurences ( and possible treatment for ADHD when you could foresee a Residential Treatment Center (RTC) admission would be considered catastropic considering they usually run about $10,000/mo), therefore an individual policy underwriter has different laws they operate under. BLUE