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Health insurance question (U.S.)
ToProtectTheInnocent
Registered User regular
Registered User regular
26 months ago, I went to the hospital a couple of times until I was properly diagnosed with gallstones and an infected gallbladder. I wasn't "treated" for the stones, but I was given a painkiller and antibiotics to kill the infection. I was told that surgery to remove the gallbladder would cost around $30000 (and I'm guessing that's without all the fun "extras" that always get included in a hospital bill). So I said screw that and just took my meds for the infection. My gallbladder has been quiet since.
I finally crawled my way partly out of the hole of debt created from that episode because my job doesn't offer health insurance. I was barely making it paycheck to paycheck before that episode, so I couldn't purchase private health insurance.
I want to purchase private insurance now, but I worry about my gallstones being a pre-existing condition. However, I haven't sought treatment for the gallstones in 26 months. But from what I understand, a pre-existing condition is one in which you've sought treatment for in the previous 24 months (or however many months they choose. The plan I want to purchase states 24 months).
Does that mean my gallstones wouldn't be considered pre-existing and treatment for them would be covered immediately? If so, I want to go ahead with the insurance. If not, then fuck it, I'm going to the doctor because my gallbladder is hurting oh so bad again and I want to go to the doctor and get meds for this, even if it is out of pocket.
Also, please no comments about "why didn't you have health insurance; you should have had it no matter what." I mean, you can say it, but it would be moot. I understand now how incredibly stupid it was (and is, I still don't have insurance). But I was younger and stupider and was only making $200 a week at the time.
I finally crawled my way partly out of the hole of debt created from that episode because my job doesn't offer health insurance. I was barely making it paycheck to paycheck before that episode, so I couldn't purchase private health insurance.
I want to purchase private insurance now, but I worry about my gallstones being a pre-existing condition. However, I haven't sought treatment for the gallstones in 26 months. But from what I understand, a pre-existing condition is one in which you've sought treatment for in the previous 24 months (or however many months they choose. The plan I want to purchase states 24 months).
Does that mean my gallstones wouldn't be considered pre-existing and treatment for them would be covered immediately? If so, I want to go ahead with the insurance. If not, then fuck it, I'm going to the doctor because my gallbladder is hurting oh so bad again and I want to go to the doctor and get meds for this, even if it is out of pocket.
Also, please no comments about "why didn't you have health insurance; you should have had it no matter what." I mean, you can say it, but it would be moot. I understand now how incredibly stupid it was (and is, I still don't have insurance). But I was younger and stupider and was only making $200 a week at the time.
ToProtectTheInnocent on
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Rather then buy a plan, have you looked into state assistance?
Also, as others have said, state assisted healthcare is a thing and you probably qualify for some sort of assistance. There's no shame in any of this, what matters is you realized what a shitty life that is. And 30,000 seems like a lot, did you tell the doctor you are self pay? He might have done it for a lot less.
I'm see now that not having insurance is really really unwise (I shouldn't have said "stupid"). Insurance can be as little as $70 a month, and it is EXTREMELY risky not to get a second job to afford at least a tiny little bit of a safety net.
I'm not being judgmental here against those who can't afford health insurance. I completely understand how hard it is to afford all of the stuff in life that you're "supposed" to have. It's hard out there.
I think I probably could get some assistance, I'm just not sure what the magical combination of trickery and words it takes to get this. Because so far, I've been met with an resounding wall of "no, unless you're pregnant."
Yeah. $30,000 was actually their version of "charity."
I'm hoping that insurance will cover the cost of the antibiotics to kill the infection. I really can't afford the time off for the surgery. Not to mention surgery is gong to be way more expensive than I can handle even WITH insurance.
Your health insurance may or may not count any prescription refills you've gotten in that 26 month window as part of a preexisting condition, provided you've gotten more pain pills for it since you were initially diagnosed.
Thanks for your reply.
I've been very careful not to touch the condition since it quieted down. I've not needed the pain killers until a couple of weeks ago when the pain started again, and I've been chowing OTC pain medicine and crying myself to sleep since it's started hurting. So as far as the paper trail goes, I haven't had a single member of the medical community in contact with my gallbladder in 26 months.
This is probably false. You should look again, because programs are available in Texas... however there is a tough means-testing hurdle to get over if you aren't a pregnant woman or a minor.
When she said "like you", she meant "adult single employed person with no kids". Anyway, it's not up to her, so file for Medicare anyway and see what happens. However, it's still not going to help you right now... if you're accepted today your coverage probably won't start until May 1.
It sounds like you've read your potential plan correctly. I suggest you buy it and get the operation. Also, if you're in the Austin area I suggest you go to Brackenridge Hospital to get it done - it's run by a Catholic order of nuns (the Daughters of Charity) and while they'll hound you for the bill if you have to pay, they'll also willing to work things out with you.
This is incorrect. Current protection against pre-existing condition denial is only extended to children. Abolition of the denial for pre-existing conditions will not be waived for adults until 2014, in conjunction with the enforcement of mandatory health insurance purchase for all uninsured citizens.
Well that's certainly shitty as shitty fuck shit shit.
Yeah, plus by 2014, it will have changed majorly, if not completely, or it will have been repealed.
Thanks for the reply. I could hold out until May 1st and manage the pain (unless my appendix or liver starts to fail, which are the two major complications with gallstones that you have to watch for). The problem is it WAS up to her. I was denied help from the state by her.
But like I appreciate any advice anyone's offering.
My current provider, for example, covers preexisting conditions, but not until coverage has been in place for 90 days. I'm not sure how many providers/plans cover this, but it's worth a look.
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I've been trying to find one like that, but haven't had luck. Private insurance differs greatly from insurance offered through your job.
Can I ask what plan you have?
$30,000 is INSANE for that procedure. You REALLY need to find a different surgeon/hospital. I had mine out in 2006 and I paid about $7,000 for everything involved. Including the surgeon's fees, the anesthesiologist's fees and the hospital fees. I didn't even shop it around, I'm sure if you looked around or were willing to travel some to get it done, you could have that pesky gall bladder removed somewhat affordably.
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REALLY?! That brings me hope.
I wouldn't bet on it. There are provisions for states to implement their own solutions but a wholesale repeal of the ACA is extremely unlikely (but that's a topic for D&D, not H&A).
As for your current situation, you may have to disclose your condition as part of the insurance application. When I was in the private insurance market in Illinois the questions I had to answer were phrased like "do you suffer from or have you been treated for X in the past year." Saying no and then immediately going to get your gall bladder removed or treated for gallstones is likely to be grounds for them to deny payment, and then you'll be worse off than you are now. Even if the questions aren't phrased that way, make sure you read the fine print. The private insurance market is great at finding ways to not pay for stuff.
Not making any value judgements (I've been poor, sick, and desperate before too) but you shouldn't consider wrangling insurance coverage as a sure-fire solution to your problem. If I were you I would look again at state aid, and/or start figuring out how to self-pay. I never found a private policy that covered pre-existing conditions after a year of looking, though of course the market has changed a lot since 2005.
Let me put it into perspective. The itemized cost of a kidney transplant works out to about $40,000. This is non-routine surgery.
While gal-bladder certainly isn't out-patient, that is... way too much.
Thank you for your advice. I did worry about what you precautioned me against.
It's the most common surgery in the US if I remember the statistics correctly.
Maybe I'll start shopping around. That $30,000 figure scared the CRAP out of me, so I retreated.
Laproscopic cholecystectomy is most definitely an outpatient surgery. I went in at 7 am and was home by 1pm. Obviously I was completely out of my gourd on pain killers, but it's not something you have to be checked into the hospital for. Unless of course you have complications.
It looks like they can exclude coverage for your pre-existing condition for 1 or 2 years, depending on if they ask about it specifically if you don't go with an HMO. If you go with an HMO, I guess you can get treated for it immediately? That seems weird. Though I guess they could just flat-out refuse to cover you, but there's no harm in applying.
Seems to be verified by Aetna Texas. I'd try that asap.
Correct. They'll probably do this as a keyhole operation anyhow... they don't even keep people overnight for gallstone removal anymore.
@Ceres: thanks for the advice. Sorry to hear about your crappy time.
Start here: Pre-Existing Condition Insurance Plan