Health Insurance; Exclusion Issue Question

14 years ago

DH & I are shopping around for more affordable health insurance and want to go back to an HSA. We got a quote which will save us almost $5K on health insurance premiums. But there is a catch.

The underwriters came back and said they want to exclude my right knee. I had surgery for a torn cartilidge about 6 years ago, and currently had some arthritis in the knee (I am 46). I got a shot of Orthovisc about a year and a half ago, and was thinking of getting another one in the next 3-6 months. It helped a lot.

The exclusion means that they will not cover any injury or disease (other than cancer) to my right knee, even if it is unrelated to the arthritis INDEFINITELY.

In my current condition I do not expect any more surgeries for a long time, though I suspect "Some Day" the knee will have to be replaced. I suspect it will be in 15 years or so.

Would you take this risk to save $5K/year on insurance (in additin to the tax benefiits we would get for having an HSA)?

Do you know if we accept this exclusion will that be a black mark on my record forever if we try to change health plans again?

Sort by:Oldest

Comments (3)

weedyacres
14 years ago
First of all, I'd shop around to other insurers to see if you can find one without the exclusion.

In answer to your question, though, exclusions aren't something on your medical record that future insurers would know about. It's an administrative thing that your insurer would have in their records.
jakkom
14 years ago
>>In answer to your question, though, exclusions aren't something on your medical record that future insurers would know about. It's an administrative thing that your insurer would have in their records. >>

I'm not so sure about that. First of all, EVERY insurance application is added to the MIB (Medical Information Board), a clearing house run by insurers, for insurers.

Second, I've never seen a full insurance application that did not ask, "Have you ever been rated on any insurance policy?" (or similar question).

Now, it's perfectly true that what one company might rate you for, another company will not. But that your answers become part of your insurance application, is certainly true.

AND, every insurer has the right to contact any other insurer who has a policy on you, to look over the medical information you submitted. It's one of the waivers you have to sign before they'll even consider the application.

When I worked for a major reinsurer for 13 years, we didn't often request additional medical information from other insurers - but there were occasions when we needed to do so, and we exercised our legal right to do it.
Related Discussions
New widow needs health insurance
Q
Comments (25)
I read your link tom418 (which is to a blog, BTW), and I stand by what I said. There are many HDHPs available in Mass, but they do have to meet minimum standards. That by no means makes them "deluxe" policies, to use your term. For example, in order not to trigger the tax (or fine, if you prefer), a MASS HDHP: must not limit benefit payments because an individual develops Alzheimer's, mental illness, alcoholism or other chemical dependency after the policy is issued; it can't have a pre-existing condition limitation that lasts for more than six months after the policy's effective date; it must be guaranteed renewable or non-cancelable, etc, etc. Standards like these are a long, long way from demanding that people can only buy "delux" plans, which is what your post claims. What will happen and who will pay their health care costs if one or both of the Williams eventually develops Alzheimer's and their policy doesn't cover it and they, themselves, run out of money? Why should the rest of the taxpayers of Mass pay for them just because they opted for the cheapest type of insurance they thought they could get away with? Apparently, the plan the Williams couple has doesn't meet the minimum standards, but there's just no way to tell why from your link because no further info is provided. So given that you don't have the foggiest idea what their plan covers and doesn't cover, your question "In what way would a high -deductable plan (like the MA couple I mentioned had) be useless?" can be answered, "Don't know exactly, but maybe in a lot of ways."
...See More
Bummed about health insurance!
Q
Comments (36)
As roarah says, all states are not equal. I live in a state whose gov. has done everything he could to stymie the ACA & refused to expand Medicaid - leaving many of our citizens w/o access to coverage. Also, our insurance commissioner is reportedly prohibited from regulating the insurance 'providers' - essentially allowing them to gouge consumers. If it were not for the ACA, I would not have insurance (had none for over 30 years before now) & I've already made good use of it. My individual plan is costing approx. $4400/yr, but I'm paying only about $800 of that w/ the subsidy. Not to let anybody off the hook, but I think the biggest culprit is medical costs - which continue to balloon out of control, it seems. Insurance providers, & ultimately we, are definitely paying through the nose for services & prescriptions. I was recently in a hospital room for about 6 hours - not even an overnight stay & no meals & the charge for that my ins. co. paid was $23,000! Has anyone else heard about the new push to require providers to disclose prices? The prediction is that this may result in lower costs - eventually. Right now, the $$ charged for a procedure can vary as much as 70% or more... http://www.npr.org/blogs/health/2014/02/12/276001379/elusive-goal-a-transparent-price-list-for-health-care Oh & love him or hate him, I recently heard a good 1 from Ralph Nader: isn't it ironic to be calling the folks who gouge everyone on medical costs 'providers'?
...See More
Question re health insurance wellness programs
Q
Comments (1)
I moved my response to the x-post in Kitchen table.
...See More
Average cost for family health insurance premiums?
Q
Comments (37)
I've been paying roughly $1000-$1200/month for myself since my husband's retirement over ten years ago. That does not include kids. We covered them on student health plans, which turned out to be cheaper in sum. I can give you a couple of tips: Don't bother with the Federal Health Exchange site unless you will qualify for a supplement of some kind. It's not a terrible site, but you'll have to do everything yourself. You are better off contacting a local insurance broker (I found mine on NextDoor). It may end being a very simple decision because in many markets there is only one company that sells to non-group members. So I can buy a gold, silver or bronze plan, but only from Community Health Choice (Houston suburb). My plan offers a 10% discount for completing an annual survey. I'd had the same plan the year before but never knew about that discount until the agent told me -so ask about that. Try not to panic when you read the crazy deductibles. I think mine is $5000 (whereas ten years ago, it was probably $500), but so much preventative care is now covered pre-deductible, thanks to Obama care, that I think I'm spending less out-of-pocket than I did before. But I'm a pretty healthy person who doesn't use a lot of medical services except preventative, so your mileage may vary... When I first began to buy my own insurance plans (after DH's retirement), I made the mistake of picking the plan first, rather than the doctor. The last few years (when I had a choice of at least 2 companies to choose from), I compiled a list of at least a dozen primary physicians I could abide, and then called their offices to see if they were accepting new patients, when I would be able to get an appointment, and whether they had any plans to cancel coverage with insurance company X the next year, etc. I had learned the hard way (in January), that I may have had a great plan, but I couldn't find a dr. on that plan who would see me as a new patient before August. I kid you not.....So that year, I was paying $1200/month and actually didn't have a dr. I could see until August.....
...See More
barbcollins
Original Author
14 years ago
Follow up -

I did find out that I can appeal, but they would require a letter from my Ortho and all my medical records from him. Basically they want a letter stating that my knee problems are "no big deal" and that he does not foresee a knee replacement in the near future.

My Dr said he can't write a letter like that because if something were to happen they could sue him for fraud.

I did the math and figured that if I stay on with my employer as a single, and put my husband on the new plan (no exclusions for him), then we would save about $3K a year in premiums, and we would still have the HSA benefits for him. This assumes that my employer will let me change to a single from a family plan, but I don't see why not. Doesn't mean they pay any more or less than they do now.

Health Insurance; Exclusion Issue Question

Comments (3)

weedyacres

jakkom

Related Discussions

barbcollins
Original Author

COMPANY

BUSINESS SERVICES

GET HELP

CONNECT WITH US

Health Insurance; Exclusion Issue Question

Comments (3)

weedyacres

jakkom

Related Discussions

barbcollinsOriginal Author

COMPANY

BUSINESS SERVICES

GET HELP

CONNECT WITH US

barbcollins
Original Author