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Author Topic: Insurance help  (Read 741 times)

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Offline pomo2000

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Insurance help
« on: October 09, 2004, 09:07:33 PM »
Sorry, I know this is a UK forum, but I was hoping there might be some US residents or expats around for advice on getting insurance.

I am undergoing surgery for OCD in Europe where I live. I have good insurance coverage from a government scheme here.  

The problem is I am planning to return to the US, and am afraid that follow-up surgery may be necessary (always a risk of set backs , right).  I would need to get some insurance coverage in the US, and I am looking for a good plan, which covers things like arthroscopy, MRI, and surgeries if needed, as well as rehab.  

Can anyone tell me which companies or plans are the most cooperative and flexible--allowing me to see good doctors and get good care?  I don't want to be in a situation with problems in my knee and some insurance guy telling me that the necessary treatment is considered "experimental".  

Also, most insurance companies have a 12 month "pre-existing condition" clause so I probably can't get any treatment during that time. Are there any plans that don't?  


Offline dm

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Re: Insurance help
« Reply #1 on: October 09, 2004, 10:17:37 PM »
The HIPPA laws here, they're pretty new so you might want to read up on them, say that if you have had "creditable coverage" in other words, coverage from an employer or other insurance that can be documented - such as getting a letter from your current insurance provider stating the time which you have had coverage - then the preexisting conditions clause cannot be called, providing you do not have more than a 60 day lapse in coverage.

The short of it is that with a letter from your current insurance carrier showing dates of coverage, if you obtain new coverage through an employer or other plan that becomes effective before the 60 day period passes, then the new carrier cannot exclude your preexisting condition.

For example, I was laid off and had coverage under my old employer thru the july 31. I had all of august and all of september to get new coverage before they could put the preexisting condition clause into effect against me. The latest I could have new coverage take effect and not have to worry about preexisiting conditions would be Oct 1. I had new coverage effective sept 1, so the new insurance cannot refuse to cover any of my issues.

Hope this helps explain the rule a bit. there might be other issues or exceptions involved since you're coming back from overseas, but at least it's some info to start with.
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline CelticNagel

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Re: Insurance help
« Reply #2 on: October 10, 2004, 12:53:58 AM »
As far as which companies - probably the one accepted at most facilities and my most physicians is BCBS (Blue Cross Blue Shield) and they have many different products.  The PPO would allow for nationwide access.  An HMO would restrict you to certain states.
2002 partial menisectomy R (2x),2003 partial menisectomy R,2004 partial menisectomy L (2x),tibial fractures, tibial plateau fractures,HTO (L) 10/27/04;HTO (R) TBD