Insurance woes!! Does anyone know?

Is your new insurance a group plan? I believe that the pre-ex is waived if you had so many months (varies by state) of continuous health ins coverage prior to joining your current group plan.

It is possible the the Rx coverage is under a different benefit provider than the medical. Usually the benefits and coverage conditions are in sync between the two, but it is not outside the realm of possibility that the pre-ex applies to one and not the other.

It is also possible that one of the benefit insurers are applying your benefits correctly, and the other is not. Since these are administered separately, the Rx may be doing it right and the medical benefits division is not, or vice versa.

You'd have to look at your policy provisions for the definition in your specific plan, but I believe filling prescriptions and taking medication over the past year is typically considered "receiving treatment" even if you didn't make a personal face-to-face visit with your doctor.

Well my problem is my certificate of credible coverage is over the 63 day window. I guess at the moment I am going to be thankful that my Humira is being paid for right now because that is what has made me so much better.

I only went once today so far! Hopefully the Humira keeps me well and I don't create anymore bills until I get this figured out.

I wish I could move to Cananda too! Insurance drives me crazy. We didn't continue my COBRA because we couldn't afford it, I hadn't worked in a year and my fiancee got let go in May. We finally got to a better place both got job and now this. If I didn't have medical bills from before I would have probably been able to afford my COBRA longer, now because I couldn't afford my COBRA for a continuous 13 months I will probably have a lot more bills again.

I am just tired of feeling like I can never get ahead! Anyway this time I have decided not to let it stress me out. Money is money. At least I am healthy again and have great family and friends supporting me!

This is something I know a little about. Unfortunately it doesn’t matter if you had been treated or not while not covered. Pre Existing is the diagnosis or a condition prior to your new coverage. Since you had been diagnosed and then lapsed the coverage for that long, it is now pre existing. I don’t think it a crazy assumption that your rx insurance company is a different than your medical insurance company, and your rx probably doesn’t have a pre x policy.

Other things you should keep in mind... I have problems with my pancreas and liver and though not proven it’s caused by Crohn’s,if this would happen to you, your medical could also deny that as pre x, because they would look at it as secondary to a pre x condition. Also if you were to change to Remicade that would most likely be denied as pre x, because it would be paid under medical and not rx.

Last but not least....Make sure you go to HR and find out exactly how long the pre x is to last. Once it runs out make sure they are paying and jump right on it if they continue to deny them.

I’m glad that your meds are covered. I wish you the best luck. They aren't easy to fight.