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Insurance Issues Discuss Is this a way: HIPAA Guaranteed Issue Health Insurance? in the Main forums forums; I need 2-level cervical ADR very soon. I am unemployed with Cobra coverage that is about to expire. As ...

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Old 06-22-2010, 08:48 PM
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Join Date: May 2009
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Default Is this a way: HIPAA Guaranteed Issue Health Insurance?

I need 2-level cervical ADR very soon. I am unemployed with Cobra coverage that is about to expire. As you know most insurers are still refusing to pay for the surgery. Others now seem to cover it. Aetna is one of the ones that do cover adr as a matter of policy(http://www.aetna.com/cpb/medical/dat...9/0591.html).A

Unfortunately my Cobra insurer is United Healthcare which does not cover it. I cannot simply purchase an individual policy from an insurer such as Aetna. When I tried I was told that my preexisting condition precluded me from qualifying.

Then I learned of a State of Florida(where I live) HIPAA (Overview Health Insurance Reform for Consumers) program for which Aetna is the provider. Apparently I can purchase the “same” policy that is unavailable to me directly as a “Guaranteed Issue Health Insurance plan”. The only difference is the much higher cost. However I have read that companies selling HIPAA policies will simply place what is called an "Exclusionary Rider" on your policy and/or change the preexisting condition clause in the boilerplate of the policy to exclude your prior medical problems. Here is a great article about this: Florida Health Insurance - preexisting conditions

1. Are they really the same policy? Is there any way I can know ahead of time what is actually covered by my HIPAA Florida Aetna policy before I buy? How can I know for sure if the policy I buy will have any Exclusionary Riders?

The Aetna HIPAA agent could not definitively answer this question. Believe it or not, she told me I would have to purchase the policy in order to then read the details of the coverage! If it turns out that something I need is not covered I have 10 days to cancel the policy and receive a refund. Ten days is not enough time to put in a request for preapproval and wait to see if it’s accepted or denied.

2. Is this a good idea? Am I missing something?
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Old 06-23-2010, 04:03 AM
mmglobal's Avatar
Join Date: Sep 2006
Posts: 2,511

It seems insane that you cannot read the details of coverage prior to purchase??? I would attack that issue and see if you can get them so you can flush these issues out more.

I don't know the answer to your questions. Have you tried contacting lawyers who specialize in insurance or other professionals? A quick google search turned up Insurance Patient Advocates: Patient Advocate Foundation :: 1-800-532-5274.

Good luck... let us know how it goes.

1997 MVA
2000 L4-5 Microdiscectomy/laminotomy
2001 L5-S1 Micro-d/lami
2002 L4-S1 Charite' ADR - SUCCESS!
2009 C3-C4, C5-C6-C7, T1-T2 ProDisc-C Nova
Summer 2009, more bad thoracic discs!
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Old 06-29-2011, 06:04 PM
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Join Date: Oct 2006
Location: Los Angeles
Posts: 1,596

I think there is more than one issue here. I was told that pre-existing conditions are covered as long as you have continuous health coverage that has not lapsed for even 1 minute. However, that is for group coverage and may not apply to individual policies. If applicable, you have to be careful in obtaining coverage to read the policy and then cancelling within 10 days.

You might want to try an insurance broker. They know more about this and can probably obtain wording within specific policies if you cannot.

Don't you just hate this?????

3 level Prodisc adr S1-L3, Oct 12, 2005
Dr. B in Bogen, Germany
Severe nerve damage in left leg, still working on it
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Old 06-30-2011, 04:25 AM
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Join Date: Sep 2006
Posts: 2,405
Default in the past

I've always asked to see Underwriting policies as this will state clearly what is covered and what isn't. I wouldn't purchase anything I couldn't see before purchasing.
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