Obtaining Coverage for Pre-Existing Conditions After Insurance
Last Modified: November 1, 2001
Dear OncoLink "Ask the Experts,"
I was diagnosed two year ago in April with AML (M3). I have been in
remission since July of that year and have been out of treatment since
November of 1994.
Due to the situation (I am in Graduate student at a State University)
and the limited nature of the group health insurance available to me
($50,000 per lifetime, per illness, per individual) I eventually hit
the cap on my insurance despite having been on Medicaid during the
majority of my treatment. I now still need to see my doctor once
every couple of months and have been receiving regular checkups and
tests. These tests are not cheap, the tests have included standard
histology, chromosome and PCR tests to see if any of the leukemia is
left in the bone marrow. All tests have been negative. Still, I have
been saddled with high lab bills and my doctor has been kind enough to
see me pro bono.
So my question for you is, where do I go from here? I have tried
to get outside coverage, but obviously due to my preexisting condition
insurance companies are not exactly jumping on the bandwagon to see me.
- It is regrettable that the easiest way for this student to obtain
coverage would be for them to find a job which offers health benefits where
there would be no pre-existing condition clause. This may not be
immediately feasible based on their overall goals for finishing school.
However, it should be an important consideration when seeking future
- We also suggest that this student, or if possible their physician,
approach the lab which he or she regularly uses to negotiate a discount on
their charges. The lab director may be willing to pre-arrange a discount
from their charges which could be fairly substantial - at least a 50%
discount if not one that approaches 70%. Use the Medicaid fee schedule as a
guide for negotiating this discounted rate. In addition, we suggest that
they approach a lab affiliated with or owned by the University where they
matriculate to determine if their status as a student would put them in a
stronger position to negotiate a discount.
- We also suggest that this student should directly contact their local
Medicaid office to confirm that their coverage has been exhausted.