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avidlearner 11-30-2007 03:27 AM

Require health insurance assistance
Not sure what to do. Been without insurance for a while now, but i know I need to get it eventually. One potential problem is I have chronic pre-existing condition. One thats not immediately dangerous, but will definitely require medical attention at some point. I play poker for a living, and make enough money where getting a real job just for insurance doesn't make much sense. I also don't want a real job, I love what i do.

Anybody in the health insurance field, or been in this situation before? I feel totally lose and am pretty scared. Please help.

Mitch Evans 11-30-2007 07:51 AM

Re: Require health insurance assistance
Not sure what your dilemma is. Just apply for insurance. You didn't state your age or what you pre-existing condition is, but I don't see what the problem is. You don't need a "job" to get insurance, you just need to pay the premiums. Depending on your health and whether the state you live in allows unrestricted medical underwriting will determine how high your premiums will be, if your existing condition will be covered, and how soon you can get covered. Shouldn’t take more than a few weeks…

mikalina 11-30-2007 12:18 PM

Re: Require health insurance assistance
The sooner you apply, the better. It depends on the state that you live in, but in general, for cases of pre-existing conditions, if you have had coverage under the company for x years without an issue with the condition, they cannot deny your claim due to pre-existing condition.

Someone chime in and correct me if I am wrong, but I believe in my state it is 3 years. This applies if you do not disclose the condition at the time of application. If you do disclose, they have the right to completely remove claims that relate to your condition from your coverage.

I would do a bit more research on this than what I just said (although I should know this [censored], it's my field). I just can't remember if this is one of the things that is excluded from the statute of limitations.

Nicholasp27 11-30-2007 12:21 PM

Re: Require health insurance assistance
EVERYONE should have health insurance in the US

even if you SELF-INSURE, you should get cheap insurance with a high'll be cheap since insurance company will never pay out each year unless you have a major illness/surgery

so what's your benefit? you will pay what the insurance company allows

say u go to the hospital and have a few tests run on you...the hospital will try to charge say $2500 for this...if u don't have insurance, then you owe $2500

if u have insurance, even with a 10k deductible, then they send the bill to the insurance company...who comes back and says: this is only billable for $500...u then pay that $500 for your deductible and that's it

so u saved 2k because u pay those insurance prices

this has less of an effect on a standard doctor office visit, but will still save you $100 or so on those as well each time

MissT74 11-30-2007 12:24 PM

Re: Require health insurance assistance
Health Insurance companies can deny anyone for any reason UNLESS it's through an employer. So being self employed, and with pre-existing conditions you may have a hard time finding a company to cover you.

HOWEVER, if you're willing to accept a "rider" on your plan, then you can probably get coverage. It would basically state that any thing done related to your pre-existing condition would be denied, and you would be responsible for those charges.

Another idea that I would strongly suggest is Comprehensive Insurance only. It's much, much cheaper and would cover you in any emergency (broken arm, stepping on a nail, etc etc) and also cover you for anything major (cancer, AIDS, etc etc). For anything "normal" or routine (cough, cold, flu, etc) you simply pay cash at your doctors office.

For the most part people go to the doctor about 2-3 times a year at $120 a visit (average) vs. $200+ per month for health insurance. Unless you are on expensive medication, this is the way for most healthy to semi-healthy people.

(I own a medical billing service, feel free to ask any more questions that I may be able to help you with)


MissT74 11-30-2007 12:26 PM

Re: Require health insurance assistance
Nicholas is correct, but also realize that there are a lot of doctors offices out there that offer "cash paying" discounts. Some don't, so you would have to call around.

I know my clients offices LOVE cash paying patients, no paperwork, revenue for the office instantly vs. waiting 2 months to get paid, etc etc.


Ghazban 11-30-2007 12:30 PM

Re: Require health insurance assistance
The state you live in is key here. I just moved to Nevada and am also a professional poker player. Due to my pre-existing condition, nobody will underwrite an individual policy for me. In some states, there is a carrier of last resort that cannot turn you away for a preexisting condition (be careful, though, they may charge you through the nose for major medical).

This is not an easy question, particularly if you have a chronic preexisting condition so I'd recommend looking into your state's laws regarding individual policies. If you don't know where to start, just call around (BCBS, etc.) and get some quotes. If a given company will not underwrite a policy for you, they can probably tell you who in your state is the carrier of last resort (if such a thing exists).

mikalina 11-30-2007 12:49 PM

Re: Require health insurance assistance
All good responses. I guess I am the only one who likes to find loopholes.

Another suggestion (especially if you are a poker player earning a high taxable income) is to look into (here come 2 different names for the same thing) a high deductible health plan or a consumer directed/driven health plan.

Downside: high deductible (~1200/year for individual coverage)

Upside: all preventive care visits are covered for free (checkups, lab work, etc), you have access to an HSA

HSA is a Health Savings Account... think 401(k) but you are allowed to make withdrawals without penalty for health-related purchases (anything down to Advil qualifies). This is just a really slick tax shelter with a $2,900 annual max for tax-free contributions.

And the plan should generally be one of the cheapest available.

Edit to add: deductible is not ~1200, its >=1200... the higher you go the cheaper it gets. Sorry for the confusion.

neuroman 11-30-2007 12:52 PM

Re: Require health insurance assistance
EVERYONE should have health insurance in the US

even if you SELF-INSURE, you should get cheap insurance with a high'll be cheap since insurance company will never pay out each year unless you have a major illness/surgery

[/ QUOTE ]
This does not seem to be the case. I tried inquiring into high deductible, catastrophic type coverage and it would be over $1000 a year for a completely healthy mid-20s non-smoking male.

If I am wrong feel free to point me in the right direction but I don't consider that "cheap."

z28dreams 11-30-2007 12:55 PM

Re: Require health insurance assistance
Mika's right - I'm in the process of changing jobs, and just applied for an HSA account w/ catastrophic coverage.

I'm 27, and it cost around $40 a month with a $5000 deductible. That's $480 a year... where are you guys seeing > $1000 a year ?!?!

HSA's are a GREAT idea if you are young and normally healthy. Even if you have a regular 9-5 job, you still still look into these and see if your boss will let you use it as an option. Think of it as being able to keep your premium at the end of the year if you don't actually use it.

Someone told me to use the Golden Rule plan, but I ended up going with Humana because for $10 less a month, it also allowed $300 of annual checkups and had a higher lifetime maximum.

For OP though, the preexisting condition will probably trump all other decisions - so check into your state laws.

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