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Health Insurance Mess - advice needed!!

Health Insurance Mess - advice needed!!

Old Apr 12th 2011, 3:51 pm
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Default Health Insurance Mess - advice needed!!

Okay guys, here's the deal.

To cut a long story short, when we first moved here to the States last February, I took out private health insurance for me and the 3 kids. After a couple of months, it was working out way too expensive on one wage, so I did a lot of research and found a company, who specifically did insurance for people like us on H1-B's and H4's. Things were fine, I have a back problem dating back to February 2009 which is in my lumbar spine. Before Christmas I was getting real bad back pain in my thoracic region, so went to a doctor listed under my insurance as being in Network. She referred me to a clinic in the next town to see an orthopedic surgeon, but before I went there, I phoned and asked if they took my insurance. They weren't sure so took all my details and phoned me back and told me that yes, they did, there would be an initial charge for the consultation and every subsequent consultation after that, which I said was fine. Everything went okay, bla bla, and now I have to have a consultation with a pain management doctor who I was referred to by the Surgeon.

My problem is, I have had 3 different bills in stating that I was being denied any payments towards these procedures. The clinic phoned while I was there to assess whether they could just send me for an MRI etc and the insurance company said that was fine. They have sent me a letter this morning stating that I will receive nothing as this is a pre-existing condition which isn't covered under my policy. The thoracic problem in my spine is a new condition and when I originally went to the doctor the insurance company phoned me and asked me when I started getting problems. I said I couldn't remember, end of last year, she said she needed a date and stated "What if we say October 1st" at which I said that was okay. They are saying that because my policy didn't start until Oct 28th, that it's not covered either.

So I now have bills which are amounting to over $2,200, I haven't even been for the pain management yet and don't think I'll be able to afford to at this moment in time.

So I guess what I'm asking is, should I fight the insurance company, or just back down and pay the amounts they're asking for. As I can't work, we are going to struggle to pay all this and I don't see me being able to afford any more procedures for a while, until we save up. Any advice on how to deal with this would be very much appreciated. I knew this was going to be an issue but I suppose I was naive not to realise how much it would amount to, especially since I've read so many threads on here about this. Thanks for any help, if you haven't lost the will to live after reading this - sorry
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Old Apr 12th 2011, 4:21 pm
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Default Re: Health Insurance Mess - advice needed!!

There is no such thing as 'special insurance for H1B or H4'. I am sure that you have been sold a travel insurance policy. You purchased that kind of insurance by cancelling your domestic health insurance (because that was expensive), but you were most likely not even eligible for it.

In your situation, there is no point in fighting with the insurance company because your problem would not be covered as it would be considered a pre-existing condition.

I suggest that you buy the insurance that you are eligible to purchase so that you will be properly covered when you need to use it. I understand such insurance might be expensive, but it is better than not getting any coverage.
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Old Apr 12th 2011, 4:36 pm
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Default Re: Health Insurance Mess - advice needed!!

Originally Posted by Brat1 View Post
I said I couldn't remember, end of last year, she said she needed a date and stated "What if we say October 1st" at which I said that was okay. They are saying that because my policy didn't start until Oct 28th, that it's not covered either.
(
Looks like they really screwed you on this -- very manipulative. Perhaps you could get your doctor to state that this date is wrong, and that this new problem started later than the policy? Beyond that, sorry, don't know what to suggest.
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Old Apr 12th 2011, 4:39 pm
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Default Re: Health Insurance Mess - advice needed!!

You say that you moved here in Feb 2010 and took out this specific insurance last year . However you have had a back problem since 2009.

That makes it a pre-condition. Did you identify this back problem on the application form when you applied for this insurance? If you did and they accepted you without any special policy restrictions then you would have a case for contacting them and fighting this decision. If you did not then you don't have a case. (Note that you also said the current problem started October 1st and your policy started October 28th !)

You also say that you went to the second clinic and they said that they took your insurance. Lots of places will "take" you insurance. It does not mean that your insurance will pay the bills. You should always check with your insurance company yourself.

I too have never heard of a medical insurance company specificially for H1 and H4's.

I'm sorry you are having to deal with these problems.
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Old Apr 12th 2011, 4:48 pm
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Default Re: Health Insurance Mess - advice needed!!

Originally Posted by Brat1 View Post
Any advice on how to deal with this would be very much appreciated.
http://www.ct.gov/cid/cwp/view.asp?q=254352
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Old Apr 12th 2011, 5:02 pm
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Default Re: Health Insurance Mess - advice needed!!

Originally Posted by britishdraft View Post
There is no such thing as 'special insurance for H1B or H4'. I am sure that you have been sold a travel insurance policy. You purchased that kind of insurance by cancelling your domestic health insurance (because that was expensive), but you were most likely not even eligible for it.

In your situation, there is no point in fighting with the insurance company because your problem would not be covered as it would be considered a pre-existing condition.

I suggest that you buy the insurance that you are eligible to purchase so that you will be properly covered when you need to use it. I understand such insurance might be expensive, but it is better than not getting any coverage.
Sorry, maybe I've put it wrong. I got this insurance through this website. http://www.nriol.net/immigrant-health-insurance/

The original domestic health insurance I purchased through a broker, with a really high deductible, no co-pay or anything, so for a doctors visit it was costing around $90, for an in network doctor. As far as I'm aware, I'm eligible for the insurance I have, I just wanted to see if it was worth fighting them for the non pre-existing condition which I originally went to the doctor for, and for the girl on the other end of the phone deciding on 1st October as the date, when she must have known that you can't claim for any condition that manifests itself before the policy start date. Thank you for your help, and looks like I need to start from scratch again to look for a better policy and this has been a bitter lesson for me and it's putting pressure on everything at the minute, between paying for College fees and now having to pay for this. Looks like I'll just need to put the pain management off for a while until I save up enough to pay for it. Thanks again.

Last edited by Brat1; Apr 12th 2011 at 5:02 pm. Reason: missed out the link!!
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Old Apr 12th 2011, 5:03 pm
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Default Re: Health Insurance Mess - advice needed!!

Is there any specific reason why you and the children are not on your husband's Company Group policy?

Group policies tend to not have such strict pre-condition restrictions and they are also (usually) much cheaper and more comprehensive than any "private" policy.
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Old Apr 12th 2011, 5:06 pm
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Default Re: Health Insurance Mess - advice needed!!

Originally Posted by fatbrit View Post
Thanks FatBrit, but I think I'm screwed whichever way you look at it. This is all I needed right now as our daughters college fees are due too. I knew the health insurance was a minefield but I really think I need to look in to it in much more depth and I feel like a total idiot
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Old Apr 12th 2011, 5:12 pm
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Default Re: Health Insurance Mess - advice needed!!

Originally Posted by Brat1 View Post
Thanks FatBrit, but I think I'm screwed whichever way you look at it. This is all I needed right now as our daughters college fees are due too. I knew the health insurance was a minefield but I really think I need to look in to it in much more depth and I feel like a total idiot
File a complaint regardless. An hour of your time and nothing to lose.

Back ache is a bugger. Of course, if you lived in AZ you would now legally be able to smoke pot as some small compensation.
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Old Apr 12th 2011, 5:15 pm
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Default Re: Health Insurance Mess - advice needed!!

Originally Posted by fatbrit View Post
File a complaint regardless. An hour of your time and nothing to lose.

Back ache is a bugger. Of course, if you lived in AZ you would now legally be able to smoke pot as some small compensation.
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Old Apr 12th 2011, 5:17 pm
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Default Re: Health Insurance Mess - advice needed!!

You are certainly not eligible for the insurance that you purchased. If you already had a domestic insurance, you can't cancel that and buy the one that you did.

In fact, through Google serach, I found a very useful article at http://www.insubuy.com/h1-visa-medical-insurance/, that exactly describes the situation that you got into.
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Old Apr 12th 2011, 6:10 pm
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Default Re: Health Insurance Mess - advice needed!!

Originally Posted by SanDiegogirl View Post
Is there any specific reason why you and the children are not on your husband's Company Group policy?

Group policies tend to not have such strict pre-condition restrictions and they are also (usually) much cheaper and more comprehensive than any "private" policy.
+1, most health insurance in the states comes through your or your spouses employer. That would be the first place to start.
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Old Apr 12th 2011, 6:45 pm
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Default Re: Health Insurance Mess - advice needed!!

Originally Posted by SanDiegogirl View Post
Is there any specific reason why you and the children are not on your husband's Company Group policy?

Group policies tend to not have such strict pre-condition restrictions and they are also (usually) much cheaper and more comprehensive than any "private" policy.
He looked in to it but for me and the 3 kids, it was even dearer than the policy I had before, if we had GC's and I was working it wouldn't be an issue, but on only one salary for the time being, with the cost of everything at the moment there's only so much we can put out per month - we really want to make this work and are trying to put a wee bit away each month as savings, but that's going to be impossible now with this bill so I'm going to go back to the drawing board and start looking for different insurance again, as this policy was for 6 months and is up at the end of this month - my back problem is going to be ongoing so I'm going to have to just hope and pray that it doesn't deteriorate even more.
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Old Apr 12th 2011, 8:19 pm
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Default Re: Health Insurance Mess - advice needed!!

I took a look at the NRIOL website and they are aimed at the short-term/interim insurance market.

Unfortunately, these policies are notorious for taking you on for the first 6 or 12 months, but if you make any claims they usually don't renew your policy I also observed that most of the plans had no coverage for pre-conditions, anything from 6 months to 5 years back from the onset of the policy.

With the changes in the health reforms I think you will find that your children (if under 18) MUST be given health insurance - or some States have special child plans which you should look into.

Have you looked on ehealthinsurance.com ?
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Old Apr 12th 2011, 8:24 pm
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Default Re: Health Insurance Mess - advice needed!!

Originally Posted by Brat1 View Post
He looked in to it but for me and the 3 kids, it was even dearer than the policy I had before, if we had GC's and I was working it wouldn't be an issue
This sounds strange. A family policy through your husband's work should be far less expensive that you buying it on the open market as your husband's employer will subsidize the premiums.
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