Important Information for those with Lupus and other chronic conditions who were denied health insurance in the past

 

President Obama signed the Health Care Reform package in to law in March 2010, which will extend insurance coverage to as many as 32 million Americans who currently do not have health insurance, as well as provide much-needed protections for people with lupus and other chronic conditions.

Americans who have been denied health insurance coverage because of a pre-existing condition can now apply for the Pre-existing Condition Insurance Plan (PCIP). This temporary program provides insurance to people who have been unable to obtain coverage because of a preexisting condition. The PCIP coverage could start as early as August and will serve as a bridge for people until 2014 when the reform law bans health insurers from denying coverage for pre-existing conditions.

In order to enroll in the PCIP a person must have been without medical insurance for six continuous months and have been denied coverage due to their pre-existing condition; documentation of denial is required.

For more information on the PCIP and to learn about what health care coverage is available in your state, visit the new Department of Health and Human Services (HHS) website.

Source:Department of Health and Human Services

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  • Janilee: In response to your concerns with getting disability.
    I found an Attorney who helped me battle SS – 3 times denied, finally accepted. The attorney was compensated, barely, out of the S.S.D. once that was approved. As far as L.T.D. or S.T.D. for that matter, I found the policies I had were hardly worth the paper they were written on. They paid for not quite a year then stopped, citing improved health status and an ability to return to work. SSD did not discontinue my monthly amount despite this finding from the L.T.D. that I received after having received it for not quite a year. The insurance co. badgered me so badly during the period of time they were sending checks to me, that I chose not to fight them after they had quit sending checks to me seemingly out of the blue. I have found SSD to be much more reasonable to work with. You just have to persevere through the approval stage.

    Good luck!

    Cheryl

  • Val

    In 2014, that’s when the exchanges go into effect. Exchanges are for people who either don’t like the coverage the employer offers them, or who don’t have employer insurance at all. Since insurance coverage will be mandatory in 2014, your best option is to use the Exchange program. (But you can also keep your current plan if you wish — current plans will have to ditch any “pre-existing” clauses too).

    Employers who don’t provide employee health insurance will have to pay a penalty, which goes to assist lower income people in purchasing insurance through these exchanges. Basically, they are paying a fee to help their own employees get health insurance so they may as well start helping them get coverage. And many more will, since it comes with a tax write off too.

    The “Exchange” will basically be:

    1. The state where you live will select 3 or more private companies to belong to the “state insurance exchange”. One of those companies must be a non-profit, member-run company.

    2. Each of these companies will have 5 products to offer — from lowest cost to highest cost. (bronze, silver, gold, premium). These will have different deductibles, co-pays etc. Bronze pays 60%, silver pays 70% etc. There will also be a cheaper plan for those under 26 – the age that typically doesn’t use insurance very often, and can get by with less coverage. Probably a 50/50 plan. Nobody can be turned down for pre-existing conditions and the longest wait for acceptance can be only 90 days.

    3. You decide which level of plan is best for your needs — and then thousands of other people who also want that plan will join you as a “group” to bargain for the best price. The final rate these 3+ companies offer will be what EVERYONE can get. Since they don’t want to lose thousands of customers in one stroke, they’ll try to beat their competitors rates. This is similar to how the senators and congressmen bargain for good rates too.

    4. COST: Even though we all will be offered the same premium price, the price of the (lowest) plan can not exceed 8% of your income if you are below $89,000 yearly income level. There is an online calculator to estimate how much your premium will be for the “Silver” plan:

    http://healthreform.kff.org/SubsidyCalculator.aspx

    Hope that helps!
    Val

  • Val

    Here is a summary of the reform plan that is very easy to read.

    http://www.kff.org/healthreform/upload/8023-R.pdf

    Most of these provisions won’t take affect until 2014. I am currently paying for what is called an “Up Rated” individual family plan, which means I’m paying a high premium in order for Blue Cross to cover my migraine headaches. (Graves was discovered *after* I got this policy, so I’m uninsurable now, but they cannot cancel this policy I already have unless I miss a payment).

    Since I do have a policy in force – even though it is costing me $1,214 per month – I don’t dare lose it (my 16 year old son was also Dx’d with Graves) We both would been denied the abitlity to purchase a plan if we had that diagnosis when applying.

    My husband’s employer only hires via contract labor and thus, does not supply worker benefits. So we have to buy an individual family policy. In group plans, they can make you wait 12 months if you have a pre-existing condition —- but in individual plans, they just refuse to accept your application and send it back “Denied”.

    That has been the most FRIGHTENING thing for me — to know that my son might always be denied coverage.

    So I am REALLY looking forward to 2014, when I’ll finally be able to “shop” for a plan through the state exchanges, and maybe even be able to bargain for a good deal. AND they can’t turn me down just because of Graves or migraine headaches.

    Visit this site – it’s great:
    http://www.kff.org/healthreform/upload/8023-R.pdf

  • Val

    From http://www.kff.org/healthreform/8066.cfm

    Explaining Health Reform: Questions About the Temporary High-Risk Pool

    The health reform law creates a temporary national high-risk pool to provide health coverage to people with pre-existing medical conditions who have been uninsured for six months. It is a temporary measure designed to bridge the gap until the implementation of other coverage provisions in the law that will take effect in January 2014. This summary provides answers to basic questions about the high-risk pool program.

  • Also, I checked my state’s “high risk pool” for those who can’t get insurance, and the price is over $500 per month. That’s far too expensive for someone like me who can only work part-time due to pre-existing condition.

  • Like Jennifer, I have insurance, but even though I have not been without insurance for a single day since being diagnosed, they won’t pay for anything — not even my annual physical — saying that everything is related to pre-existing condition.

    THIS is what insurance reform really needs to address.

    Janilee, talk to a lawyer — they won’t charge you until they win the case.

  • Victoria

    Or what about those with an individual private health insurance plan who keep getting premium increases every few months? Or those with an individual private health insurance plan with a lifetime maximum? My plan allows me to go anywhere for medical care which is a must since I have a rare, life-threatening medical disease — Mitochondrial disease. There are only about 4 mitochondrial specialists who treat adults and all are 2000+ miles away. How are those with insurance protected?

    Also, as others have said, how can we get our insurance companies to pay for the medical care and/or treatments we need to live? And how do we get the needed specialists to provide care for rare diseases like mine, especially for those with developmental disabilities such as a sibling of mine? Unfortunately, he is frequently left without medical care due to a doctor’s refusal to treat since he’s “too complex” or “time consuming”, and he has the same disease that I have.

    Any new laws that will ensure medical care AND health insurance for all?

    Any legal leads or suggestions would be greatly appreciated. 🙂

  • Janilee

    Also wondering what to do if Insurance has denied me long term disability, and I’m being forced to go back to work? I can’t work due to my fibro, but can’t afford an attorney. If anyone can help me, or point me in the right dirrection please let me know.

  • Jessica

    Seconding Jennifer – I can get coverage, but they won’t cover the fibro for a year. Are we eligible for this?

  • Jennifer

    So what about the people who have insurance but the insurance is refusing to pay for anything that has to do with the pre existing condition?