"No, there is no way that we will cover preexisting mental health issues."

[Gravitycollapse]

This was my brief discussion with an employee of Golden Rule health insurance. Yes, the name is viciously ironic.

"I was denied coverage for treatment of depression even though I agreed to pay a higher premium specifically for mental healthcare coverage. I don't understand how you guys could deny me coverage for a benefit that I'm paying MORE for."

"We have underwriters that must calculate risk and they have determined that we cannot provide such coverage."

"I understand the assumed greater risk. That's why I am paying more for the extra benefits. That's how I compensate for the risk your underwriters are so worried about. Why offer me the extra benefit if you're going to reject anyone who actually needs it?"

"The extra benefit is for people who may need it in the future."

"Yes, but I need it right now. That's the whole point of insurance."

"Again, the decision is up to the underwriters. You can appeal it by sending in additional medical records."

"So if I appeal it, they can overturn the rejection?"

"No, there is no way that we will cover preexisting mental health issues."

"So what is the point of an appeal?"

"...for you there would be no point."

I've officially fallen into a bizarro existence where health insurance is only offered to those who don't need any healthcare.

[randome]

1. When will Obamacare kick in for pre-existing conditions?

Or will it apply to you?

[Deep13]

8. 2014 nt

[kestrel91316]

16. Less than 9 months from now this BS will end.

[Honeycombe8]

2. I understand what he means. It's offered to those who need it, if it's not pre-existing.

The pre-existing rule usually means you can't have had treatment for it within a certain period of time before buying the insurance.

Is this a group or individual policy?

The ACA supposedly prevents ins. cos. from denying coverage for pre-existing conditions...but maybe it hasn't kicked in yet. Or maybe that doesn't apply to mental health. Or maybe it doesn't apply to group policies. My employer's insurance won't cover conditions you've rec'd treatment for within the year prior to signing on to the insurance...but then it will cover it after a year has passed or something like that.

The pre-existing condition provision should've been listed somewhere in the basic description of your plan.

[Gravitycollapse]

3. I'm not stupid. I know about the preexisting condition clauses.

[Honeycombe8]

15. Then why were you surprised? nt

[pnwmom]

21. How long did you wait after getting the insurance

before you applied for the mental health reimbursement?

I'm asking on behalf of someone who recently got insurance with mental health coverage, but has been afraid to see a therapist for this very reason. Many people who go to therapists are dealing with longstanding issues. At what point is a condition considered preexisting?

I'm so sorry this happened to you. I hope 2014 fixes this problem.

[Gravitycollapse]

22. I applied for the mental healthcare premium immediately.

You pay extra for the coverage.

[pnwmom]

23. So, in order to get mental health coverage,

did you have to say you'd never received mental health care? And then they denied you the opportunity to pay the extra premium and get mental health coverage?

Or did they let you pay the premium and then tell you afterwards they wouldn't cover you because your condition was preexisting?

[Gravitycollapse]

24. Well, they didn't ask it so forwardly.

They make you fill out your history. They will grant you coverage if you put nothing down.

The problem is if you go in for treatment, they will start looking into your history to see if you lied about any preexisting conditions. If they find out you did lie, they will stop coverage and demand their money back for any treatment.

[Warpy]

6. That doesn't kick in until next year

The Republicans were sure they'd overturn it before then and they're still trying.

I suppose they'll just have to sell all that stock they have in health insurance companies that making a killing (literally) by refusing to insure the sick.

It's been a vicious, evil system for far too long.

[Honeycombe8]

17. Ahhhh, I see. Next year. nt

[Flying Squirrel]

4. Don't let this stop you

from getting treatment. I don't know what your situation is, but in my area I was able to get a doctor's assessment from a low cost clinic that caters to the uninsured. They were then able to set me up with a low-cost prescription filler and I can get a 3-month supply of my meds for $45. Help is out there, check around.

[A HERETIC I AM]

5. Basically, the entire point of Michael Moore's movie "Sicko". n/t

"I've officially fallen into a bizarro existence where health insurance is only offered to those who don't need any healthcare."


Yup.

[BainsBane]

7. They will under Obamacare

They have no choice.

[Gravitycollapse]

9. I hope Obama feels great knowing I have to pay 900 dollars a month for meds...

But you know, it's great and all that after I'm thousands of dollars in the hole, after the pharma companies have vampired their fill out of my wallet, I will eventually overcome the brutality of our shit system and be able to pay excessively high premiums for inadequate care.

Awesome. Great job team.

[BainsBane]

11. There might be other options

contact the local NAMI office in your area for advice on where to go for information.

[Gravitycollapse]

12. What other options? I've already looked.

I have to wait 6 fucking months before I can apply for high-risk insurance. 6 goddamn months.

I don't qualify for medicaid because I make "too much" money. No insurance company will insure me unless I underwrite out treatment for any health conditions.

There are no other options.

[BainsBane]

13. If you want to PM I can offer some suggestions

[Honeycombe8]

19. Did you see the above post? You'll be covered for mental health starting next year...thank Obama.

It's the ACA. What you are experiencing is the holdover from the old way.

[Gravitycollapse]

20. Why would I thank Obama for letting them hold me upsidedown and shake for change in my pockets?

It's great an all that in January 2014, I'll get insurance. Unfortunately, I've been uninsured for months and likely will not be insured for several more. Even then I'll pay high premiums for inadequate coverage.

No, Obama deserves no thanking.

[Honeycombe8]

26. Someone hands you something on a platter, and you're complaining the platter wasn't given sooner?

Interesting. I suspect you just like to complain.

As for me, I'm grateful that the ACA has that benefit coming for those who need it. I don't need it. But I am grateful for those who do, like you. I will be grateful for you.

Thank you, Obama and Democrats who passed the ACA, for helping Gravity and others like her.

[Gravitycollapse]

27. "I suspect you just like to complain." - Nailed it. I just love complaining about being robbed.

Don't thank people for me. It's not your place to do so. If you like it so much, be thankful for yourself. I'll keep trying to break us out of our terrible system that isn't going to magically disappear on the 1st of January.

[DearHeart]

28. The ACA is not a gift on a platter. The insurance companies will figure out a way to screw people

with existing conditions, like they did when they came up with "pre-existing conditions" clauses. Even if the insurance companies can't "discriminate" against these people, they will jack the premiums up so high that they will be priced out of coverage. How are people who can't afford insurance now, afford insurance if that happens? I don't recall a provision in the ACA forbidding insurance companies to jack up their premiums, if there is one, I will stand corrected.

A lot of people will benefit from the ACA, but not everyone. I'm glad that you don't need the ACA! Good for you! But, being without insurance is incredibly scary and stressful, especially if you have a pre-existing condition. So, please don't insult and belittle us. We don't want anything handed to us on a platter. We're not moochers, we're scared and yes, angry.

[pnwmom]

25. Have you figured out yet how much you will be paying for insurance after

Last edited Fri Apr 5, 2013, 10:48 PM - Edit history (1)

accounting for tax credits?

I don't understand why some people blame Obama for not being able to push something better past the Republican Senate filibuster. We never had a 60 vote majority in the Senate, not for a single day.

[rhett o rick]

10. Can we spell single payer for all? nm

[freshwest]

14. Next stop on this train will be 'You're CURED! It's a MIRACLE!'

Your best chance is getting another insurance company, if at all possible. You have met what is called by some as an insurance 'headchopper' and your doctor may forced to play 'gatekeeper.'

Been there, been done that way for whatever cause they choose to use to save money. It's also known as suffering from a bad case of 'Failing the Wallet Biopsy.'

[indepat]

18. We are set genetically from the first moment, so the insurance industry can virtually pull the

"gotcha' at will. The only workable solution is to completely do away with the for-profit industry which ain't gonna' happen in this fuc*ed-up right-wing soused society which serves primarily to further enrich the already-wealthy oligarchs.