Want2Move

I did not find an appropriate section to post this message and I am posting it here.

My work does not provide group health insurance, but provides certain amount to pay for the premium and I am responsible for finding my own insurance. Recently, I have applied for an insurance coverage for me and my family. On the medical history form, there were these two questions:

Within the past FIVE YEARS has any proposed member had a thyroid disorder or a disorder of the lymph nodes or lymph system?
My answer was YES because my wife was diagnosed with pituatary tumor about 4 years ago and I thought it has something to do with thyroid.

Has any proposed member EVER had any indication of, diagnosis of, or treatment for cancer or tumors?
I said NO to this question even though she was diagnosed with pituatary tumor and had taken medicine to reduce the prolactine level produced by pituatary gland.

Now the insurance company wants my wife to go through some blood works and we are responsible for paying the cost.

I have been talking to many people since I applied for the insurance and most of them said that I should not have said YES to any of the questions as insurance companies are fraud and they try to do anything to charge you higher premium or not pay your medical bills in the future. I tried to be honest, but as you can tell I was not 100% honest as I should have said YES to the second question too. But the reason I said NO to the second question is that this was related to the first one and I already said YES to the first question.

Can you guys give me some advice what I should have done or what I should do next time I apply for an insurance policy? If my wife does not get insurance through this company, what are our options? I make pretty good money, so she is not qualified for any of those government supported insurance programs. Thanks.

AmerLisa

I believe you have to answer these questions truthfully. And you will find that the insurance company can and will deny a claim if they suspect you have a pre-existing condition you didn't disclose. As far as getting insurance for your wife, I'm not sure (with a pre-existing condition) you can.

NC Penguin

If you think that insurance companies are "fraud" as you put it, why are you even getting health insurance?

You can always get a quote from another insurance company but if I were you, I wouldn't lie.

augigi

You will find it very difficult - if not impossible - to get coverage for a pre-existing tumor. Look at it from the health fund's point of view - what's in it for them, when your wife is already in need of expensive treatment?

There is no advantage to lying on the forms, because once you declare the tumor and present for a claim, it will be denied on the grounds of fraud (by you!).

Poppy girl

I recently took out insurance for myself in the past 3 weeks with Blue Cross Blue Shield and believe me before it goes to the underwriters it is looked at with a fine tooth comb, I had to state that I went to the doctors in the UK at christmas and was given an antibiotic for a bad throat, they have contacted my GP in the UK to verify that I have not had any illness's etc.

I told them everything not that there was much to tell but do not hide anything the problem may not happen now but in the long term if god forbid you need to use your policy and they find out that there was a NO when there should of been a YES then you could be in deep POO and they may not pay out.

Want2Move

Thanks everybody for your time and suggestion.

Anyway, I am going to call them up tomorrow and tell them the answer should be YES in cancer or tumor question. I heard that after certain period like a year or so, the pre-existing condition is also covered, is that right? I guess the insurance company would be able to answer this better, but just wanted to know if somebody knew this rule.

What if I changed my job in the future and went with a company that offers group health insurance? Can they say no to the pre-existing condition? What about the government related insurance once we become a greencard holder (unless they deny our greencard based on medical)?

All I am trying to do is find a hope for my wife, which is hope for me and my two little children. Thanks.

chicagojlo

Group insurance usually does cover pre-existing conditions. Of course every company is different so you need to check. But believe me when I tell you that insurance companies are looking for ANY excuse to not pay out. The slightest mis-representation of any kind can end up costing you very dearly.

Poppy girl

I am not with you on this what goverment insurance!

Want2Move

I do not know all the programs the government has, but I was referring to programs like medicaid and medicare, CHIPS for kids etc. I found this list when searched for goevernment insurance.

"Official information and services from the U.S. government

Children's Health Insurance, by State
Continued Health Insurance after Change in Employment (COBRA)
Doctors Who Accept Medicare
Health Insurance Choices Checkup
Health Insurance Portability and Accountability (HIPAA)
Medicaid
Medicare
Medicare Plan Finder
Medicare Prescription Drug Coverage
Medicare Prescription Drug Plan Finder
Social Security and Medicare Trust Fund Reports"

NC Penguin

There's many eligibility requirements to be fulfilled before accessing these services. As a relative newcomer to the US, you will be ineligible for some, if not many.

Want2Move

That is what I was trying to tell in my previous post. For most of these services, you have to be a US citizen or at least a greencard holder. My wife and I do not have those, but my kids are US Citizens (born here). Hopefully we will have GC by next year (if not turned down by USCIS because of the health issue) and we may be eligible for some of those services. Thanks.

Poppy girl

Pleased you clarified that I thought I had been missing out lol.

To be honest I can't see where the OP would be eligible for any of the categories.

WELCOME TO THE US

Poppy girl

I may get quoted on this but its not going to make any differance to you and your lady wife if the kids were born here it's not going to give you more benefits.

Ray

My wife medical Insurace does not cover her back ..because she had surgery on it ..14 years ago ..or her foot she had surgery on 5 years ago ...

If she cut a finger on a piece of paper ..she is covered ..

Tracym

For most people, even citizens, there is no government medical insurance.

Government insurance generally applies when someone is very low income or disabled (medicaid), or for those who have paid into medicare and are elderly or disabled.

There are also some programs (CHIP) intended again for low-income.

Some states offer insurance programs for those (green-card or citizen generally) who have great difficulty getting insurance otherwise. Depending upon the state, this could eventually be a possibility for your wife.

You should NOT count on you or your family members being eligible for any of those programs imo.

With an individual policy, there is no requirement that they EVER cover a pre-existing condition, as far as I am aware. They could if they chose to, but I don't think they have to. With a group policy, some might cover it - some might wait a year. It depends upon the policy.

I think your answers to the questions should be "NO" to the thyroid question, and "YES" to the tumor question. The pituitary and the thyroid interact, but the are different glands. Just my opinion however.