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Thread: looking for coverage

  1. #1
    Join Date
    Jun 2009
    Location
    Los angeles
    Posts
    122

    looking for coverage

    Does anyone here got an individual policy in california?
    Did you say that you have scoliosis when you applied?
    Does anyone did not get denied?
    How did you do it and with what company?
    And if you don't mind how much are paying for it a month?
    I am shopping for insurance online and I got a phone interview with a broker next week, so I want to have an idea of what to say.
    Thanks.
    Pilar

  2. #2
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,336
    Hi Pilar...

    The only advice I can give you is not to lie. If you lie, they may find out, and not cover an expense at the time that you need it the most. The cost is based on your age, and the amount of coverage that you take, so anyone else's premiums are irrelevant. Good luck!

    Regards,
    Linda

  3. #3
    Join Date
    Jun 2009
    Location
    Los angeles
    Posts
    122
    I told the Broker that I have scoliosis, and she said that it could be an issue depending on how big is my curvature and if I have surgeries done or not.
    Well, my doctor said that I need surgery, of course, with my 90 degree curve. I am 31 years old, and besides my spine, I am healthy.
    So, all need is a company that will not drop me or deny me.
    She said that we will talk...
    I don't know. I just want to know if anyone here had this experience.
    Pilar

  4. #4
    Join Date
    Aug 2009
    Location
    NW OHIO
    Posts
    132
    Quote Originally Posted by pilar View Post
    I told the Broker that I have scoliosis, and she said that it could be an issue depending on how big is my curvature and if I have surgeries done or not.
    Well, my doctor said that I need surgery, of course, with my 90 degree curve. I am 31 years old, and besides my spine, I am healthy.
    So, all need is a company that will not drop me or deny me.
    She said that we will talk...
    I don't know. I just want to know if anyone here had this experience.
    Pilar
    O yeah. Im dealing with the same thing right. Im self employed and have been on a discount plan for a couple years now. Its really hard to deal with them and it seems they hardly do anything for me. Pretty much a waste of money.

    Recently I found out that ALL insurance companies have to accept so many patients per year by law on an open enrollment basis. I have applied for a few recently and it looks pretty good so far. They will cover everything, including surgery. My premiums will be anywhere between $300 and 500 per month. I know its alot, but Ive heard of other open enrollment premiums costing as much as $1300 a month. I think you are from California, so if I were you, Id get ahold of the California Dept. of Insurance. They will give you a list of companys accepting patients and when. If nothing else, its worth a try. I think its going to work out for me.

    Hope this helps and good luck.
    80* thoracic/ 60* lumbar
    33 yrs. old, 6'7"
    mikes spine

  5. #5
    Join Date
    Jun 2009
    Location
    Los angeles
    Posts
    122
    Yeah Mike I tried that the High risk Program, but it has a cap of 75,000 a year. That would not cover my surgery, and the monthly is around 500 dollars.

  6. #6
    Join Date
    Jun 2009
    Location
    Los angeles
    Posts
    122
    Mike, are you sure your surgery will be covered. I know you are in Ohio, but can you tell me the companies that you have a applied for? I checked the California department of insurance, and yes the we have the high risk program here, I just don't think that 75,000 per year maximum is going to do any good for me. What is the year maximum in Ohio?

  7. #7
    Join Date
    Feb 2007
    Posts
    251
    Did you check for an individual policy with Kaiser? I know a lot of people dislike Kaiser, but I have always had wonderful Drs and care through them.
    Patty 45 years old
    Surgery May 23, 2007(43 Birthday)
    Posterior T3- L4
    Pre surgery curves
    T-53degrees
    L-38degrees
    and a severe side shift to the right.
    Post surgery curves
    Less than 10 degrees
    Surgery April, 2006
    C4 - C6

  8. #8
    Join Date
    Aug 2009
    Location
    NW OHIO
    Posts
    132
    Im not exactly sure of the specifics right off hand, but under the open enrollment, by law, they have to accept a certain number of people. And yes, the premiums are high, but I know for sure the max is more than 75,000. I sent an application out to American Republic, and Mennonite Mutual Aid. I am also waiting for a response from Medical Mutual. When I get more info from one of these agents, Ill let you know asap.
    80* thoracic/ 60* lumbar
    33 yrs. old, 6'7"
    mikes spine

  9. #9
    Join Date
    Jun 2010
    Posts
    47
    I am self employee and looking for insurance as well. I heard you can go w/ "group insurance" and they are open insurance.. so that's probably the best one if you can not get it anywhere else.
    62/75 (T4-T9 68 degree & T11 - L4 80 degree) 10/19/2010
    45/50 year 2000
    36 yrs old
    Considering, researching surgery for the first time
    S. California
    http://s1210.photobucket.com/albums/...ashionista889/

  10. #10
    Join Date
    Oct 2009
    Location
    PA
    Posts
    749
    To whom it may concern,

    Until when the new "no-pre-existing conditions exclusions/ratings up" kick in (have they already?), there are only a few states where one can get coverage without pre-existing conditions causing you to be either excluded or significantly priced up.

    Not in connection with scoliosis but possible breast cancer, I investigated this a few years ago, and found a few. I had to be ready to move if testing revealed a malignancy, because my insurance had a $3000/yr. cap on meds - not even a drop in the bucket for chemotherapy.

    Massachussetts allows/requires all residents coverage without increasing costs for pre-existing conditions (not even cancer) and also no waiting period. I think all other states (e.g. New York) have at least a six month waiting period even if they don't exclude or price up pre-existing conditions.

    OTOH unlike for cancer, waiting this long doesn't matter so much for scoliosis.

    I guess what I'm getting at is that unless the new regs have been put in force (and since as Linda says, you MUST NOT LIE), you might have to change residence if you want your condition treated soon - especially surgically. Either that or wait.

    However, at your age, you will soon (if not already) be able to purchase any insurance without deception because of this important change in pt rights. I'd think your broker could advise you best about this. I assume s/he is not just brokering for one particular company (?)

    Best of luck!
    Last edited by Back-out; 06-14-2010 at 08:37 PM.
    Not all diagnosed (still having tests and consults) but so far:
    Ehler-Danlos (hyper-mobility) syndrome, 64 dammit,
    main curve L Cobb 60, compensating T curve ~ 30
    Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

  11. #11
    Join Date
    Aug 2009
    Posts
    1,164
    Which states require insurers to cover you *with* a waiting period?

  12. #12
    Join Date
    Oct 2009
    Location
    PA
    Posts
    749
    Quote Originally Posted by hdugger View Post
    Which states require insurers to cover you *with* a waiting period?
    Don't remember off the bat, but if you find a willing worker, the American Cancer Society is GOLDEN as a source of information for questions like that. Also, if you hit on a good search word combo - good ol' Google. too. Cancer is no fun but owing to population numbers, they have a great organization (even help with housing almost anywhere you might travel for treatment, etc.)

    Best of luck!
    Last edited by Back-out; 06-23-2010 at 08:10 PM.
    Not all diagnosed (still having tests and consults) but so far:
    Ehler-Danlos (hyper-mobility) syndrome, 64 dammit,
    main curve L Cobb 60, compensating T curve ~ 30
    Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

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