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Motherofmany

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Interesting topic...see one started by Old Goat on now the bills come.

Gotta watch those insurance companies. Between us and the Post Office, we pay close to $1000 a month for health care coverage. Correction, Rick says closer to $1200 PER MONTH! How often do we actually use it? They are making plenty of money and don't want to pay. SHAME!
 
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Gringo

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I didn't disclose it. Their policy says they will NEVER pay un-disclosed. I think my private insurance is probably different than your group plans.
 

Jamie

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Gringo, I have known several folks who went to battle with their insurance companies and won. Can you enlist the help of your surgeon? They have staff that handle this kind of thing all the time and should be able to help you.
 

loggon

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Gringo

That is a bunch of %&$&%# the insurance Company is feeding you.
There is a specific time and it does not matter you are on an individual plan or group plan. It all depends on the application.

Did it save ever? I doubt because then you would have to go back to childhood.

Call you agent and see what they say and also call (where you purchased the plan) the Insurance Dept.

You really need to fight this. So how long is the waiting period before they will pay for a pre exisiting cond. They have to have one.

You need to have your agent go over the application and the policy with you.

Fight it.

Kim you are sooooooooo right. We have humans that need medical care and they are spending millions on stuff like a bridge for turtles!?! Love animals and wildlife but enough is enough. Lets get our priorities straight.
 
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Gringo

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This is the wording in the policy manual:



"PRE-EXISTING CONDITIONS: Pre existing conditions fall into two (2) categories:



(a) Disclosed at the time of the application:

i. Free of symptoms, signs, and treatment during the five (5) year period prio to the effective date of the policy, pre-existing conditions are covered upon expiration of the sixty-day (60-day) waiting period, unless specifically excluded by an amendment to the policy.



ii. With symptoms, signs, or treatment any time during the five (5) year period prior to the effective date of the policy, pre-existing conditions will be covered after two (2) years from the effective date of the policy, unless specifically excluded by an amendment to the policy.



(b) Not disclosed at the time of application: Pre-existing conditions not disclosed at the time of the application will NEVER be covered during the lifetime of the policy. Furthermore, the Insurer retains the right to rescind, cancel or modify the policy based on the Insured's failure to disclose any such conditions."
 
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And when did you get this policy???? Fight fight fight Gringo do not let them push you around!!!!!
 

Clunker

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Gringo,you have spent a life time under water.
I would suggest taking your agent to the ocean,,going deep into the water, then asking them if they would like to cover you or not?
 

loggon

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Did you have any treatment in last 5 yrs prior? The condition you had treated over 20 yrs ago is not the same as you have now.

As for as you were concerned at the time of application (if not treatment during past 5 years) you did not have a prior condition as it was taken care of 20 years ago.

Where did you get the policy and how long have you had it .Those are standard exclusions. I just was not sure if it was 5 or 2 years for pre existing cond.

I think you should fight them on it. Write the State Board where you got the policy. You can go on line and get the address and most have a complaint form to complete and mail back to them.
They will check it out.
 

Judles

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Sure something "pre-existing"at the time of one ailment shouldn't count against you! Soooo much WRONG with these horrible insurance companies!!!Waaaay too much greed and their profits are sinful!!! ;(
 

Jamie

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Gringo, I would first write a letter to the insurance company (or see if your doctor would prepare one - sometimes they will) to get an official response in writing that they will not cover your case and why. The why must be more than stating the standard exclusive clause. Isn't it true that you have not been treated for this second knee within those exclusion periods? Then once you have their official written denial (maybe you already have it anyway and you could skip this step), I completely agree with Pat that you need to file a complaint with the state insurance board.

I hope you decide to fight it. I believe these folks think that if they are tough, you will just go away....don't let them get away with that. This is what you pay the premiums for.
 

Josephine

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Dang it.

I just got some info from my insurance company. They are saying that the other knee is not covered, calling it a non-disclosed pre-existing condition. Well, yeah, two and a half years ago when I was filling in that application, it wasn't bothering me. And i also didn't list finger joints, neck, ankles, elbows, hips, and toes that were not bothering me at the time, either.

In any case, I am already looking into alternatives. I just found out that I can get a knee replaced in India for less than $ 6K USD!

I always wanted to see Goa...
Well, if you do decide to go there, be careful which surgeon you use. There are some and there are some ...

But hope you get your insurance company to come to heel!
 
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Gringo

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Well, I continue to fight with the insurance company. Their stance is that I had a scope for a bit of meniscus 22 years ago, and a bike accident five years ago, which tore a ligament, and didn't disclose them so they are not covering anything on that knee.

My position is that the scope 22 years ago fixed the meniscus, and the bike accident five years ago tore a ligament, NEITHER of which has anything to do with the osteoarthritis which was diagnosed while I was insured by them. totally unrelated to the injury. the reason I need a new knee is the bone damage from the OA. Not the old meniscus tear. Not the ligament which I have been living with.

They say they are not buying it. I am thinking of legal representation and have told them so.

Meanwhile, how does one find a good OS in India? I had someone to advise me, here, but I don't know a soul in India.
 

cindy88fan

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Google: Orthopedics in India. You will find a page that is so fascinating! The Dr.'s name is - Dr. Mohandas. Read about him and see what you think. There's also another list of well respected Dr.'s on that page. Good Luck! I went through a similar situation years ago. It's hard to fight the insurance. I fought...lost and ended up with a $28,000.00 hospital bill because they said it was pre-existing. Fight it as long as you can. If it doesn't work google the Dr. I mentioned. Best wishes!
 

loggon

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Will the OS you had on other knee be willing to write a letter that this surgery is not related to either past medical problems.

Legal is the best way. And I hope you sock it to them, big time.
 

Texas

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Me too with the Ins keep trying but be careful getting a Dr gringo. There are 2 people on here that are from India I think I saw that. I will try hard to find it....
 
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Gringo, Please be very carefull in finding a doctor in India,many things to think of like when you are in the hospital can your wife stay in your room then going back to the hotel at night?all thoses people talking a langues that you dont know or do you?and the food its not like here just remenber dont eat the beef!ooo I dont think you would find any beef there
I would fight the insurance
 
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Gringo,
Have you talked to the Dr. in texas and told him what is going on? You might just be surprised what he would write for you. And again you have everything in front of you that says non of this had to disclosed anyway according to the Insurance time line.
I have fought and won many times with the insurance co. You have nothing to loss but time. Do you have any friend that are Lawyers tha twould help you write up a letter?
 

Josephine

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Well, I continue to fight with the insurance company. Their stance is that I had a scope for a bit of meniscus 22 years ago, and a bike accident five years ago, which tore a ligament, and didn't disclose them so they are not covering anything on that knee.

My position is that the scope 22 years ago fixed the meniscus, and the bike accident five years ago tore a ligament, NEITHER of which has anything to do with the osteoarthritis which was diagnosed while I was insured by them. totally unrelated to the injury. the reason I need a new knee is the bone damage from the OA. Not the old meniscus tear. Not the ligament which I have been living with.

They say they are not buying it. I am thinking of legal representation and have told them so.

Meanwhile, how does one find a good OS in India? I had someone to advise me, here, but I don't know a soul in India.
Actually, that's not entirely true, Gringo. Any damage, trauma, surgery or other intrusion into a joint will lay the foundations for arthritis. It's well known that arthritis is the long term result of some kind of trauma that's why it's called "wear and tear".
 
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