Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Insurance--How does AS work with this?

If I am dxed with AS, and then change companies.... is this covered? Or is it deemed a pre-existing condition? I am planning on having pretty good insurance... as a public school teacher. How does this work? Should I try to avoid the actual dx before I switch this summer?

Aly

I don't know exactly how it works, but I had a tentative diagnosis and then moved across the country and had to change insurance. It was the biggest nightmare. I was uninsured for a long time (6 mo) in the change, got really sick and now finally have insurance and am trying to work backwards from there although a lot of damage has been done.

Good call on being cautious... I'd make sure multiple times from the new insurance that pre-existing will be covered. I say this because I was told that my student insurance would cover me and that ended up not being the case.

Aly,

I'm not sure what kind of insurance deals the teachers union has worked out with the insurance companies on pre-existing conditions, but if you are covered by a plan already you might find the answer to your question in your insurance pamplet from your current position.

I know some insurance companies will not cover pre-existing conditions until you have gone a full year without being treated for it. I have heard some companies won't cover them for two years. If you are a member of the teachers union I would talk to one of the union reps to find out what you can expect. If you do not have a cut and clear diagnosis of AS you should not have any problems once you switch.

Brent

Assuming that you currently have medical insurance you should be ok. The HIPPA act of 1996 restricts pre-existing condition exclusions in group health insurance. There is a maximum 12 month exclusion period which must be reduced by 1 month for every month of "creditable" insurance coverage that you have/had - see this link http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html
So if you are moving from a group plan of 1 year or more to your new group plan, under federal law, you will not be subject to an exclusion. However, that does not mean that your new coverage will cover expensive treatments like biologics. It does mean that you must be treated like everyone else covered under the same policy. Make sure that you understand what your policy will cover. Most large employers (like school districts) provide a choice of several policies. The cheapest base option is probably not for you. Paying a higher premium in this case generally will get you a more comprehensive policy. I sit down every year and calculate the real cost of every option. The best option for me has been to pay slightly more in premiums, but receive much better coverage that ends up costing me less over the course of the year. This won't be true in every situation, but has been true for my family through three employers.

Thanks for the link!

I am currently tricare prime... which means that so long as I am at a military base, or have a referral from them I pay $0. Occasionally I will pay like $6 on a prescription if I'm out of town.

My hubby is considering doing reserves so that we can continue in having insurance. We will have a premium and some copays... but it may be much cheaper than trying to go on my teacher insurance alone.

It's going to be a big change either way.

i don't remember all of the details now, but i do remember that when i moved from one job to another across state lines, i was OK if i transitioned through COBRA but might not have been if i hadn't used COBRA. i had to use COBRA because i was considered an employee at the one school until the end of the one academic year, and not picked up by the other school until the beginning of the other academic year. and even though i paid my summer salary with grant money; i was considered "a temporary" employee until september rolled around. but COBRA took care of everything for me. yes, it was a bit costly. but for me, i just couldn't put a price on peace of mind. i needed to continue with trigger point injections that were really helping. and needed the option of PT if needed. during those summer months. plus traveling is so hard for me, and the trip was 500 miles of driving so i knew i'd need good medical care as soon as i got up here.

i think i remember reading that its not just diagnoses that count as "preexisting conditions" but also being treated for the same symptoms as well. so even though i didn't have a disease diagnosis, i wouldn't have been able to have any of my already existing symptoms treated either. maybe this depends from insurance to insurance.

but that HIPPA Act of 1996 made it possible for me to avoid "preexisting conditions" problems by staying insured through COBRA.

sue

I wouldn't take the chance. I would definately wait. I have been droped by an insurance co because of what they claimed was a pre-existing condition.

Stormy, that's an interesting sight. Thanks for sharing it with us. Do you know of one for personal insurance?

If you currently have insurance and there will be no gap in coverage when you switch jobs, you *should* be covered. If there will be a gap, try to pick up COBRA insurance for that period, it will ensure that you are continually covered.

Jeff

If you can *afford* the super-expensive COBRA payments, that works just fine...otherwise, you're out of luck.