Diagnosis that hurts your chances of changing insurance plans

OneEyedDiva

Well-known Member
Location
New Jersey
I really don't know about regular health insurance Pauline because I've had an Aetna HMO for decades through my employee, then retiree health plan. When I became eligible for Medicare, Aetna seamlessly slid me into their medicare plan. Now the state is offering Aetna's PPO plan. No medical exam is necessary. However, because I had atrial fibrillation and diabetes when I was looking for a long term care plan, I was denied by both the state health benefits and AARP's LTC plans.
 
I find much irony in the great effort for “privacy”. You have the right to privacy except when it comes to insurance - then it is a criminal offense to withhold any of your medical info that is asked for. Given I have cancer, I am most blessed to be able to continue my insurance after retirement with an early retirement incentive to pay for several years of premium.
 

Pauline1954

Member
I really don't know about regular health insurance Pauline because I've had an Aetna HMO for decades through my employee, then retiree health plan. When I became eligible for Medicare, Aetna seamlessly slid me into their medicare plan. Now the state is offering Aetna's PPO plan. No medical exam is necessary. However, because I had atrial fibrillation and diabetes when I was looking for a long term care plan, I was denied by both the state health benefits and AARP's LTC plans.

It sounds like the transition in your insurance plan was smooth. 👍
 

Liberty

Well-known Member
Location
Texas
Cancer. I have surgery for a cancer on my nose. The slow growing kind basel cell. Im glad Im satisfied with my insurance plan because this may be the only plan. I get the procedure December 21.



What other condition or diseases makes it hard to change plans?
Doubt that having a basel cell removed from your nose would raise your rates or have you denied coverage if you want to change plans. Think its usually taking a lot of meds and having multiple co-morbidity conditions that raise the pesky red flag.
 

Pauline1954

Member
Doubt that having a basel cell removed from your nose would raise your rates or have you denied coverage if you want to change plans. Think its usually taking a lot of meds and having multiple co-morbidity conditions that raise the pesky red flag.
Insurance companies do whatever it takes to keep risk low. I know diabetics are considered high risk. Probably heart disease is considered high risk as well. Id like to hear from others that has bcbs that tried to get a new plan. Curious to learn real life experiences.
 

palides2021

Senior Member
Location
MidAtlantic, USA
We had bcbs through my husband's employer, then we switched during the October enrollment period to United Healthcare. Been with them ever since. Don't know about switching plans at other times, though. :unsure:
 

oldpeculier

Member
Hi Pauline. I tried to switch to a different company last year and was denied because of my history of two primary internal cancers, both treated years ago with no evidence of disease. The reason they denied me coverage was a Melanoma in situ which I thought strange. They considered it a internal cancer even though it was removed from my skin with clear margins via surgery. Not sure about how BCC would register on their scale of approval. Was not BCBS.
 

Aunt Bea

SF VIP
Location
Near Mount Pilot
I’m a diabetic.

I was covered by BCBS during my working years and under COBRA when I stopped working.

I continued with BCBS under Obamacare until I was eligible for Medicare.

I continue to use Excellus BCBS for my zero premium Medicare Advantage plan.

I’ve never had a problem changing plans or having a claim denied with BCBS.

I have had some limits on drug coverage but those are Medicare limitations.

The ability to change plans or coverage may vary from state to state, but I haven’t had any issues in New York State.
 

Pauline1954

Member
Hi Pauline. I tried to switch to a different company last year and was denied because of my history of two primary internal cancers, both treated years ago with no evidence of disease. The reason they denied me coverage was a Melanoma in situ which I thought strange. They considered it a internal cancer even though it was removed from my skin with clear margins via surgery. Not sure about how BCC would register on their scale of approval. Was not BCBS.

Its always the high risk conditons. Ive got surgery for a cancer on my nose on dec 21. Once thats reported and done I wont be able to change. Its almost the same with diabetics. The word diabetic is one that means high risk to insurance companies. I keep that word off my records. Im controlling it on my own through diet and exercise.
I feel better too.
 

oldpeculier

Member
Good on you. It seems we have some things in common as I am also a T2 diabetic that is now well controlled with diet and exercise. My last HbA1c was 5.3 and has been in that range for a few years now. I personally believe the cancers I've experienced were partially caused by elevated blood sugar that went under the radar. The diabetic word is on my records so I will probably never be accepted by another company.

Good luck with your surgery.
 

Pauline1954

Member
Good on you. It seems we have some things in common as I am also a T2 diabetic that is now well controlled with diet and exercise. My last HbA1c was 5.3 and has been in that range for a few years now. I personally believe the cancers I've experienced were partially caused by elevated blood sugar that went under the radar. The diabetic word is on my records so I will probably never be accepted by another company.

Good luck with your surgery.
Sorry, once diagnosed with diabetes they take advantage of us. So yea its a tough thing. I just dont eat garbage like I used to 5 years ago. Im healthier now than I have ever been. Except when a teenager. Thoses animals exist on junk foods. 😄
 

Owlivia

Member
Hi @Pauline1954, I don't have BCBS but I found this on the Medicare site. If you are trying to change Medigap Plans, there are special circumstances. Don't know how this works in real life:

"The insurance company can't make you wait for your coverage to start, but it may be able to make you wait for coverage if you have a

pre-existing condition
.
In some cases, the Medigap insurance company can refuse to cover your

out-of-pocket costs
for these pre-existing health problems for up to 6 months (called the "pre-existing condition waiting period"). After these 6 months, the Medigap policy will cover your pre-existing condition.

Coverage for the pre-existing condition can be excluded if the condition was treated or diagnosed within 6 months before the coverage starts under the Medigap policy. After this 6-month period, the Medigap policy will cover the condition that was excluded.

When you get Medicare-covered services,

Original Medicare
will still cover the condition, even if the Medigap policy won't cover your out-of-pocket costs, but you're responsible for the
coinsurance
or
copayment."
https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap

Before I originally signed up for Medicare I searched the internet for insurance company underwriting policies to see if they could prevent me from having a Medigap supplement. This was before I realized that I was guaranteed coverage due to becoming first eligible for Medicare.

I found the weight charts, the disease exclusions, etc. It was an eye opener in that there were few conditions/diseases that eliminated me from coverage, I could breathe easier. Maybe you could find these, too on the insurance company you are interested in.

If you are a resident of certain states then you may also have options. If you google, this the four states will be named and explained in detail.

People who purchase Advantage plans can change as they like without medical underwriting.

I wish you the best of health and hope your surgery is successful.
 

Della

Senior Member
Location
Ohio
One diagnosis that insurance plans hate is schizophrenia. People tend to get it when they're in their twenties and then go on to live another fifty years or so, needing about a thousand dollars worth of drugs every month that whole time. What a bummer for companies that prefer you just pay premiums for ever and never put in a claim.
 

Pauline1954

Member
Hi @Pauline1954, I don't have BCBS but I found this on the Medicare site. If you are trying to change Medigap Plans, there are special circumstances. Don't know how this works in real life:

"The insurance company can't make you wait for your coverage to start, but it may be able to make you wait for coverage if you have a

pre-existing condition
.
In some cases, the Medigap insurance company can refuse to cover your

out-of-pocket costs
for these pre-existing health problems for up to 6 months (called the "pre-existing condition waiting period"). After these 6 months, the Medigap policy will cover your pre-existing condition.

Coverage for the pre-existing condition can be excluded if the condition was treated or diagnosed within 6 months before the coverage starts under the Medigap policy. After this 6-month period, the Medigap policy will cover the condition that was excluded.

When you get Medicare-covered services,

Original Medicare
will still cover the condition, even if the Medigap policy won't cover your out-of-pocket costs, but you're responsible for the
coinsurance
or
copayment."
https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap

Before I originally signed up for Medicare I searched the internet for insurance company underwriting policies to see if they could prevent me from having a Medigap supplement. This was before I realized that I was guaranteed coverage due to becoming first eligible for Medicare.

I found the weight charts, the disease exclusions, etc. It was an eye opener in that there were few conditions/diseases that eliminated me from coverage, I could breathe easier. Maybe you could find these, too on the insurance company you are interested in.

If you are a resident of certain states then you may also have options. If you google, this the four states will be named and explained in detail.

People who purchase Advantage plans can change as they like without medical underwriting.

I wish you the best of health and hope your surgery is successful.


Thank you. What I was doing was making an effort to let others know that diagnosis can hurt the effort to,change plans. Thank you. I probably wasnt clear with this. 😘
 

Kathleen’s Place

Senior Member
Location
Wisconsin
Gosh Pauline, I’ve had basal cancers and squamous cancers removed (Mohs surgeries) numerous times over the years and never had that play any factor whatsoever when changing insurance plans. I’m schuled for another one next month…theonly downside of being Irish 😊
 


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