OT - anyone work in health insurance?

[lisaross]

I have a question about changing coverages during testing -

 

[Marionnette]

I have a question about changing coverages during testing -

I'm not in health insurance, but we did change coverage while my husband was going through testing for his open heart surgery last fall. If you have questions, I might be able to answer them based on my own experience.

 

[scrappinmom]

Hi - I work as a case manager for a managed care company. I can try to answer for you. What's your question?

 

[lisaross]

Hi Thanks...

OK i have insurance now through the exchange....I had a mammo/sono and need to go back for a biopsy - hoping it will come out good but incase it does not or i need further testing etc., i will be changing health insurances as my husband will be getting coverage through a job - so if that insurance then kicks in and i need to do further testing will it be a problem? thank you.

 

[Marionnette]

Hi Thanks...

OK i have insurance now through the exchange....I had a mammo/sono and need to go back for a biopsy - hoping it will come out good but incase it does not or i need further testing etc., i will be changing health insurances as my husband will be getting coverage through a job - so if that insurance then kicks in and i need to do further testing will it be a problem? thank you.

Based on my experience, the answer would be 'no'. Your doctor's office manager or testing coordinator should be able to deal with both insurance companies during the change. Your new insurance company cannot deny you treatment for a per-existing condition and that includes any additional testing needed to continue your treatment.

In our case, we were dropped from our first insurance company because our business did not meet the definition of a "group" under the rules of Obamacare. That was less than 1 month after my husband's aneurysm was discovered and it left us with 2 months to find new coverage. During those 2 months, the first insurance company continued to pay for all the testing needed for his eventual surgery. Coverage for the first insurance company ended on Dec.1. His surgery was on Dec.8. All bills for his hospital stay were covered by the second insurance company.

But here's the rub: when you switch insurance companies mid-year, you also reset what you paid into your deductible back to $0. So if you have a high deductible right now and have been paying OOP for a lot of your health care needs, none of that will be considered when you switch your insurance over to your husband's new plan - even if it is with the very same insurance company that you have now. If you expect to be spending a lot on medical bills under the new insurance plan, it might make sense to pay for a gold plan with $0 deductible for the remainder of this year.

 

[lisaross]

Based on my experience, the answer would be 'no'. Your doctor's office manager or testing coordinator should be able to deal with both insurance companies during the change. Your new insurance company cannot deny you treatment for a per-existing condition and that includes any additional testing needed to continue your treatment.

In our case, we were dropped from our first insurance company because our business did not meet the definition of a "group" under the rules of Obamacare. That was less than 1 month after my husband's aneurysm was discovered and it left us with 2 months to find new coverage. During those 2 months, the first insurance company continued to pay for all the testing needed for his eventual surgery. Coverage for the first insurance company ended on Dec.1. His surgery was on Dec.8. All bills for his hospital stay were covered by the second insurance company.

But here's the rub: when you switch insurance companies mid-year, you also reset what you paid into your deductible back to $0. So if you have a high deductible right now and have been paying OOP for a lot of your health care needs, none of that will be considered when you switch your insurance over to your husband's new plan - even if it is with the very same insurance company that you have now. If you expect to be spending a lot on medical bills under the new insurance plan, it might make sense to pay for a gold plan with $0 deductible for the remainder of this year.

Thank you....Hope your husband is doing well..

 

[scrappinmom]

No - especially for mammo & those results ... Insurance companies are very careful not to penalize for mammograms - your deductible may set back to 0 - although you can try petitioning the new insurance company to allow your paid deductible to date to be counted - this is especially true if you stay within the same "parent" company. Say you have BCBS basic thru the marketplace & your hubby's company has BCBS anthem - you might win that arguement. Good luck! I went thru the whole mammo-second mammo-aspiration-biopsy 5 years ago - ended up fine but every year now is s major sleepless week while I wait for results

 

[themouseandme]

I work in health insurance and I would agree with the above comments. You won't have any problems getting the coverage approved, as pre-existing is a thing of the past.

Your deductible will start over if you are going from a private policy on the exchange to a group policy through your husband's employer. You will want to check to see if his benefit period runs calendar year or plan year. Hopefully he has a great plan with low out of pocket costs, though those are few and far between these days!

Good luck with everything and let me know if you have anymore questions!