Insurance

[jjuls22]

yay for being under the 90 days! what a life saver! wooo good luck with the stoopid people ;D

[omaklackey]

so I'm still waiting... not patiently. I called first thing this morning to talk with my appeals coordinator who said that enrollement has to review the papers/documents I sent. She didn't sound like she understood what I was even tryiing to say either so that was a little frustrating. I reminded her that I'm in a great deal of pain and on narcotics and the 800mg of motrin every four hours. She promised she would talk to enrollment today and see if they can hurry up. they have to have the appeal done no later then 14 days after it was initially made. we will see...

[ouchy]

In the meantime, can you reschedule your hystorectomy for a later date? That way you'll be ready to go when it's time and fixed with the insurance?

[omaklackey]

no, my office will not reschedule until the appeal is done

[omaklackey]

they won't help me with appeal and they won't reschedule. I may have to figure out how to pay for all this....

[ouchy]

Oh. That sucks.

[omaklackey]

anyone want to help me read this and figure it out? I'm not sure what it means. Someone who has more experience reading insurance documents. I'm kind of on my own for fighting all this...

copied from basic health handbook;

d. Credit toward the waiting period
Credit toward the waiting period will be given:
(1) If Basic Health delays your enrollment (up to a maximum of three months) due to
budgetary constraints, and you have been determined eligible.
(2) For any continuous period of time during which a member was covered under similar health coverage if:
• That coverage was in effect at any time during the three-month period immediately preceding the
date of reservation or application for coverage under Basic Health, or within the three-month period
immediately preceding enrollment in Basic Health; and
• The coverage terminated not later than the first of the month following the effective date of coverage
in Basic Health.
If similar coverage was in effect both prior to the date of application or reservation and the date of enrollment,
credit will be given for the longer period of continuous coverage.
“Similar coverage” includes Basic Health, a

[omaklackey]

I was covered by basic health from 1999 until nov. 31st 2008. I was in appeal with basic health over an income issue until jan.31 2009 when I was accepted again. They made me wait though for coverage to begin unti april 1st 2009.

[Karen]

Sorry, I'm not fluent in insurance...

[omaklackey]

you would think all of us with Endo would have to be?

[JC]

I think it's telling you the "credits" or exceptions to the rules. The first one says that if they delay your approval for coverage then they give you credit for that time and it doesn't count against you in that 90 day period. I think the second one is saying that if you had similar coverage within the three month period from when you applied for the new coverage then you get credit for that too. The second bullet point on the the 2) section says that as long as your previous insurance terminated no later than the first month you were covered under your new health.

If they made you wait for coverage then that's their fault! That's what section 1) is saying.

Karla did you have your previous insurance when you applied for the new one? Or did it terminate first before you applied for the new insurance?

[omaklackey]

I was with basic health for six years. Do you suppose they count that as credit. never missed a payment, never had a late payment. I have company over this week since they were planning to come for the surgery. I sure am getting tired. My mom and aunt thelma are easy guests. help clean and stuff. Just frustrated or something

[omaklackey]

So I spent the last two hours researching my health insurance issues. I'm actually excited right now which is bad cause I should be sleeping. I found the HIPAA rules and regulations and read through them. BY FEDERAL LAW! they can not use my pre-exisiting condition because I had crecditble coverage with a loss of less then sixty days. So if anyone else ever gets stuck in this situation: this is really important! Look up the Hippaa rules and regulations! There is a way out. I copied and pasted this:
''The exclusion period must be shortened by one day for each day
of creditable coverage that you have. If the amount of creditable
coverage you have is equal to or longer than the exclusion period,
no exclusion period can be imposed on you. When figuring out
how much creditable coverage you have, however, you receive no
credit for previous coverage that has been followed by a
significant break in coverage – a period of 63 or more full days
in a row during which you had no creditable coverage.''

So anyways. I thought I would post this for anyone else who may sometime have this problem. I will call my appeals co-ordinator tommorow. i'm so glad I found the HIPAA regs. I'm feeling much better now with some federal papers to look at and argue with. HERE IS HOPING!!

[Karen]

Any chance you can post the website where you found this? Might be helpful for someone else down the road. Fingers crossed (still)!

[bigal]

Good luck Karla! Let us know what they say.