Here are all the articles I've written about Pre-existing condition. Enjoy!

May 11th, 2017

Are AHCA concerns making you sick? Pre-existing conditions and MacArthur and more….

Holy cow, folks!  What a crazy time for health insurance!

Politics aside, The Insurance Mom wants you to be really, totally clear about what’s happening in the wacky world of health insurance.

The first thing most clients ask me these days is about pre-existing conditions.  What if I have an illness before I buy health insurance?  What if my sick child loses coverage?  “What-ifs” all over the place!

All we can do right now is breathe.  We don’t know what’s going to happen with this bill (it’s not a law yet!).  But I did want to shed some light on the latest MacArthur Amendment.

The LA Times did an EXCELLENT article on just this issue here:

Here are a couple of excellent quotes… but the whole article is awesome.

“And it protects people with pre-existing conditions much as starving people may be welcome at a restaurant, but only if they order the most expensive dishes on the menu.”

“This much is clear: Republican lawmakers have provided a textbook example of how not to enact major legislation.  They’re aiming to radically overhaul the $3-trillion U.S. healthcare system yet have shunned the input of major stakeholders such as medical organizations, hospitals and patient-advocacy groups, which are uniformly against the measure.”

What do YOU think, my lovely peeps?  Do you believe everyone should help pay for the sick?  Did you like the old way of doing things before the ACA?  Do you benefit from Obamacare?  Do you hate Obamacare (aka ACA)?  Tell The Insurance Mom your every little thing!…

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June 20th, 2013

Aetna Bites The Dust

Did you  know?  If you are in California and have an individual health insurance policy with Aetna, you are being abandoned on January 1, 2014.   Because of certain provisions in ObamaCare (aka The Affordable Care Act aka ACA), Aetna has decided to get out of the California individual market (can anyone say “profit margin”?) and focus only on employer-sponsored plans.

You are one of approximately 50,000 who will be left to figure it out on your own.    Aren’t you relieved that The Insurance Mom is here to help you!?  What ever will you do?

Fortunately, by the end of this year there’ll be lots of options but you’ll need help to figure them all out.   This health care reform stuff is confusing!    The Insurance Mom is a phone call or an e-mail away.  Let me know your FAQs!




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May 1st, 2012

Kids, kids, kids…

If you’re in California and have health insurance in California, then this one’s for you.

As of 7/1/12, you’re all going to have maternity benefits added to your existing coverage.  Wahoo!

Yes, it’s true… SB 222 and AB 210, passed last year by our illustrious governor, are going to give each and every one of you this brand new benefit in your health insurance.

The new benefit will include, office visits, prenatal care, delivery and postnatal care.    The benefits for maternity costs will be treated just like any other benefits under your plan… deductible and co-pays will still apply.

And to reassure your pretty little heads, because this benefit is being added to all plans – and, therefore, the cost risk is spread over many, many more policies – your monthly premiums should not be affected.

Babies for all!…

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October 22nd, 2011

Wanna Save Some Money (part 3)?

Getting a prescription from your doctor doesn’t mean you don’t have choices about how to spend your money.

Ask your doctor if a generic drug is available and make sure it’s in the same class of drugs as the expensive brand name drug he wants to you to buy.

Generics have the same active ingredients, strengths and dose as the more expensive brand name versions.

A single manufacturer no longer holds the (17 year!) patent, so there’s more competition to keep the price down.

Tell your doctor that if he wants you to have a brand name drug, then spend his money not yours!  Or give you free samples.

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October 21st, 2011

Wanna Save Some Money (part 2)?

Need to get lab work done, such as blood or urine tests, PAP test or biopsy?

Think about using a lab that isn’t located in or part of a hospital.

They’re often way less expensive than a hospital lab, and some health insurance plans have a lower co-pay for outside labs.

And many outside labs have more flexible hours, like when you need to go early in the morning before your half-caf-half-decaf-low-fat-vanilla-with-a-hint-of-cinammon-latte.

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May 9th, 2011

I’d like to trust them, but…

The Insurance Mom wants to know… does this make ANY sense to you?

Last year it became possible for an unhealthy, uninsurable person to get guaranteed health insurance.  The government enacted the Pre-Existing Condition Insurance Plan (PCIP).   It’s available.  It’s affordable.  And the benefits aren’t too bad either.  Sounds too good to be true, doesn’t it?    Read on.

My uninsurable client qualifed and voila! — on March 1st he had pretty good health insurance.    But because of his escalating mental health problems, he forgot to pay the premium and his coverage was cancelled.

Under other circumstances, he would be allowed to pay the back premium and get his coverage reinstated.  But because this is a government run program the guidelines are different.

PCIP won’t allow payment of back premium.  PCIP won’t allow reinstatement.  PCIP will only allow my client to file an appeal… one that could take up to two weeks and has the possibility of being denied.    If the appeal is denied, my poor, suffering client cannot re-apply for 6 months.

He is unwell.  He cannot begin treatment.  He cannot continue treatment.   And he may not be able to get another PCIP policy for 6 months.

Because in order to qualify for the government run PCIP, one must be uninsured for 6 months or more.

And this is from the folks who want to give us government run health care insurance.

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September 23rd, 2010

Today’s The Day in Health Care Reform

“They” say that today, September 23, 2010, is a milestone in health care reform, or as I’ve affectionately been calling it, Stealth Care Reform.   Some of the new federal mandates go into effect today, but will affect only some of you:

1.   Removal of pre-existing condition exclusions for minors up to age 19.  But, the law does NOT state that insurance companies must issue a policy to a child.  It only says that IF a policy is approved, all pre-existing conditions must be covered.  The insurance companies said early on that they will abide by the intent of the law, which was to provide insurance to any child, regardless of the child’s health condition or history.   The unintended consequence: now most of the major players in the country have said they won’t issue “child-only” policies, meaning that at least one adult must be on an application with a child in order for the child to get health insurance.

2.  Coverage for dependents up to age 26. If an adult child wants to stay on Mom & Dad’s policy they can.  Isn’t it time to grow up?

3.  Preventive care with no co-pays and no maximum benefit. All new policies that you buy after today must include this provision.

4.  Removal of lifetime dollar limits. This one is going to be a pricey mandate for you.  Watch how the insurance companies raise their rates to offset this unlimited financial exposure.    The Insurance Mom has said it before and I’ll say it again… mandates are expensive!   Must I repeat myself?!

5.  Removal of annual coverage limits. Fortunately, in California, our policies have not had annual limits on benefits (except for the state’s High Risk Pool, which has an annual limit of $75,000 in benefits, and is not subject to …

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August 24th, 2010

Change Is The Only Constant

ObamaCare — aka Patient Protection and Affordable Care Act — aka PPACA — aka PeePeeCaCa — is about to launch the first round of big changes in health insurance plans in every state, every insurance company, every plan, every one.

No later than 9/23/10, there can be no lifetime limits on health plan coverage.  This will apply to new policies you buy which go into effect 9/23/10 or later.  For existing policies — the ones you bought before 9/23/10 — you probably won’t see any changes until 1/1/11.

No later than 9/23/10, all plans must include preventive care benefits at no cost to you, no co-pays, no deductibles.  Again, for existing policies, you probably won’t see this new benefit until 1/1/11.

No later than 9/23/10, dependents can stay on their parent’s plans until age 26.

No later than 9/23/10, insurance companies better have a damn good, provable, reason to cancel (rescind) your individual policy.

No later than 9/23/10, the government had to create a high risk pool for people who cannot get individual insurance due to pre-existing conditions.   The government did launch its website a couple of months ago.  Twenty-nine states are not participating on the federal level, including CA.  But these states must have their own high risk pool launched no later than 9/23/10.  So far we have absolutely no idea what the insurance plans will cover or what they will cost.   It’s all still a mystery.

No later than 9/23/10, insurance companies must cover pre-existing conditions for children through age 18.  Interestingly, the PPACA does not say that an insurance company must insure a child with pre-ex conditions.  The law only states that, if approved, a child’s pre-ex conditions must be covered.  But, the insurance companies are complying with the intent of the law which was to …

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July 26th, 2010

Unintended Consequences

So you thought the new Health Care Reform law was on your side, didn’t you?  Ha.  Not so much.   There is nothing in the new law that will stop these unintended (but predictable) consequences.

A provision of the new “stealth” care reform law says that insurance companies must issue health insurance to children, regardless of their health status or history.  In other words, guaranteed health insurance for children up to age 19, no matter what.

Fooled you!!  Guess what?   The new rules are leading health plans in some states to stop issuing new child-only coverage.   Which means that families are going to have to include their high-risk child on a pricey family plan.   In the past they could have saved money by buying separate policies for themselves and their children.

Florida and Oklahoma, come to the front of the class to get your wrists slapped!   Go sit in the corner.

Some families may wind up paying higher premiums because of the requirement in the new law that plans cover sick children.   The rule barring insurance plans from turning away sick children or denying coverage for specific illnesses for children who are already covered was one of the most popular parts of the new law.

The Insurance Mom recommends that if you have a high-risk child, get that health insurance in place fast before the insurance companies in your state play follow-the-leader with Florida and Oklahoma.

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July 19th, 2010

Uninsured? Uninsurable?

In March of 2010, Congress passed and President Obama signed the Affordable Care Act—the new health law.  The law creates a new program – the Pre-Existing Condition Insurance Plan — to make health coverage available to you if you have been denied health insurance by private insurance companies because of a pre-existing condition.

A couple of weeks ago, the government launched its health insurance website.     Click on the “Understand The New Law” tab to find information about plans and costs which might be available in your state.

If you’ve had no health insurance for at least 6 months, have been declined for health insurance and have a letter from an insurance company to prove it, you may be eligible for the government-run high risk health “insurance.”

However, 29 states, including California, have opted out of the federal government program.   Instead, by September 23rd, California, and other states, will launch their updated Major Risk Plans with new federally mandated benefits and rates.

These high risk plans — both federal and state — will provide coverage through 2014 when all insurance companies in the country will be mandated to offer health insurance to everyone, regardless of your health status.

BUT… between now and 2014, watch out!  If you already have private health insurance, I predict that rates are going to skyrocket.   The insurance companies are going to have to fill the coffers and gird their loins in preparation for 2014, when the bulk of the “stealth” care reform goes into effect.    If insurance companies are forced to sell to everyone, then everyone must buy.  It’s the only way the system can work.

And if you think that buying health insurance through the government’s Exchange network is going to be fun, then think again.  There will be no one to look out …

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