denied health insurance

heads up friends - if you have mild UC, and just take Lialda(no generic) - you may well be denied insurance. That's the only reason I Can think of why I Was denied. I'm otherwise healthy, but the underwriters thought otherwise. COBRA is my only option now, at $700/mo. Ouch! I'll need to try and get off of lialda onto something generic before I can re-apply again. COBRA is only good for 18mo

Post Edited (beachlife) : 7/31/2012 8:25:33 PM (GMT-6)

What meds are you on?

my broker and I surmised the reason must be b/c Lialda is so expensive at cost, with no generic. From what I see Lialda is ~$400/mo(over $3 a pill!!) , if I Was on generic mesalamine pill cost would be closer to $1/ea

Have u looked into the states pre existing plan? I'm in Texas and only pay 268 which is the highest plan bc of the deductable which is only 1000, so far its been real nice , but only last till 2014 when the Obama care is suppose to go into effect.

I feel the same way but unfortunately, it's not easy to become a citizen elsewhere and I can't really afford a move nor can I afford a career change. It's not a good situation but it seems to be a common one.

I ordered from Canada for quite some time when I was uninsured. I went ot the doctor too and she didn't charge me an arm and a leg. I definitely spent less overall than I would have spent on insurance. The problem is if you need a procedure. I ran into that problem and I was able to get one for free through a clinical trial but I was lucky.

UC sucks, and pre-existing conditions barriers also suck.

If someone does not have access to group coverage, getting a policy when on meds or having a chronic condition diagnosis is truly at the whim of the private insurance companies.

I am not sure the reason was Lialda, and don't think you will be successful with a cheaper drug. They could always have figured the cost of Lialda into the premium. I think it was UC itself. The condition is chronic, subject to flares, might call for expensive infusion meds and/or expensive surgery. I suspect they took all those possibilities into account. I as still not clear why they just don't quote a high premium, since they have models that pretty accurately predict (on average) costs. Maybe that only works when there are enough folks to average, and there are not enough UC patients willing to pay higher premiums to make risk-pooling financially viable for them.

But not every health plan includes prescription coverage. I have a BC/BS health plan from my employer and they also provide a separate Caremark prescription plan. The copays and deductibles and caps are unrelated.

Then there are major-medical only plans that do not even cover doctor visits and checkups and diagnostic test, but just kick in for hospitalization and surgery and big-ticket expenses.

I would try to find some coverage even if it did not pay for you Lialda and GI doc visits. The money you save on premiums might help offset you drug costs, but it will not be enough to cover a week in the hospital, or the cost of a heart attack, or stroke, or falling and breaking you hip, or an auto accident involving serious trauma.

Yes, keep looking for coverage that includes everything, but try a major-medical only type policy before going with nothing at all. It could prevent bankruptcy.

Under the healthcare act in 2014, you can't be refused coverage or charged more for a preexisting condition. You must maintain coverage after that date ,ie you can't go off and on insurance, or you will be fined. If you are low income, the fine might not exist and policy subsidies may be available.

The changes are very good news for UC folks as we can shop for individual policies and won't be stuck on a plan with ever increasing rates. You can move to a new policy and/or to a new state and still be insured.

Texas has the highest rate of uninsured people across the US. The cost of medical insurance in Texas is one of the highest in the country, so we all can pay for the health care of the uninsured. And hospital charges are very high here, too, so that hospitals can cover their expenses when they are treating a high number of indigent patients. I'm sorry, RH_Texas_Gal, that you are having to pay so much for this basic need.

I work for a small nonprofit that has no insurance. I was covered under hubby's before his layoff and got lucky with COBRA because of those Obama subsidies at the time. However, once it ran out, that was it ... I have had a number of people who told me to find a new job to get group health. I'm sorry but when I am in a job that was tailor made for me, that gives me the ultimate job satisfaction and a job that I have invested 13 years into and have flexibility to to work at home or take time off as needed without calendar watching or paperwork ... I am NOT going to quit. My hubby agrees and we find other ways to ensure we can afford insurance at the rate we are paying. Who can say they actually look forward to work each day with a smile on their face?

I came to find out the hard way that my "premium" insurance doesn't cover meds. This means I pay for my Lialda ($400/m) Imuran ($50m) and Remicade ($2000 every 8 w) MYSELF :(

The flip side is that I live in a very affordable country where it costs me less than $200 to have my doctor sit by my side all morning and administer the Remi.

Even though I found a similar insurance which DOES cover meds, I cannot switch because of having a pre-exisiting condition. But you bet I'm switching my husband and kids as soon as this year runs out!

beachlife said...
great conversation going here!

@DBwithUC - that's a good thought - to not have the Lialda covered. I can surely get it from Mexico(close by) or internet - but if what youre saying is true, and it may very well be - won't I still be denied b/c of UC, regardless of meds?

I think if you are not getting health coverage, buy truly major medical, you might not get excluded by every company or have to pay too high a premium. UC is mostly chronic and only some patients have major hospitalizations.

On the other hand, over 20years (at least backwards, hopefully not in the future) I think I recall it is something like 20% of UC eventually has a major hospitalization and/or colon removal. So, maybe they will still exclude.

I was just going on the principal that affordable insurance is based on risk of an unlikely event. Having health coverage that covers routine care, chronic conditions, and known conditions - that's not insurance, that's a payment plan.

If all else failed, I would at least get coverage for accidental injury. UC has nothing to do with that. It should be cheap because what it covers is very specific, and you don't have to worry that a broken hip or something flying into you eye will cost yo 10's of thousand in hospital and rehab.

Best of luck!