insurance question

[Gary Jackson]

cousin is 21 yrs old. She didnt have insurance for several years ( since She was 18). She started a a home buisness and thus got self insurance. In her policy it saw pre -exisiting condions not covered for 1 yr. During the first year on this insurance she had a heart mumur ( doctor said it was nothing to worry about) But after she conferred with doctor decieded to go for echo. on the echo. 1.4 mm was on the left ventricle septum. She went to cardiologist then took a holter which showed nothing. Cardioligist also mentioned a stress test she hasnt taken this yet. so no diagoisis has been made.
Her first yr insurance is up in Novemeber for pre -exisiting condtions.
Shoud she wait till novemebr to do more testing? She says she has no symptions.
If she waits till Novemeber for more testing woud they insurance deny any claims?
And if she does wait after the first yr will the insurance cover any claims after diagnosis. Since HCM runs in the family I am afraid she may have it as well. i couldnt answer the question

thanx

[Lisa Salberg]

Pre-Ex means something you had been treated for in the 6 months prior to the policy (some may say for 1 year prior). If there is not diagnosis then it is not a pre-exsisting condition.

Hope this helps!
Lisa

[Gary Jackson]

Lisa

thank you I will tell her... So she should wait for the 1 yr pre- exisiting clause to expire . then get treated in the second year of the policy and thus it woulnt be pre exsisting andt he the insurance will cover her.

The concern she had was that if she was diagnosed the first yr of the policy of hcm ( if it is) would not be covered for her lifetime? or it just the first yr it wouldnt be covered? I told her that if she could wait for the first yr to pass ( pre -exisit clause) it would be best? advice?

Gary

[Gary Jackson]

would going to a cardiologist, taking the holter monitor test and the advice of having a stress test( though not taken yet) be considered being treated even if not diagnosed with the condiiton in the first yr of a policy wth a pre-exisiting policy? i just dont want her to get tested diagnosed before the first yr of the policy was up to circumvent the pre-exisit clause.
does this make sense?

thank u

[Lisa Salberg]

Let me re state this I think you misunderstood me.
If a person had treatment prior to the policy taking effect - for example the policy began on June 1, 2005 and she was TREATED for lets say cancer on May 15, 2004 - this is a pre-exsisting condition. HOWEVER lets say she had not idea on June 1, 2004 she had cancer and on June 2, 2005 heads to the doc and then finds that she had cancer - it is NOT a pre-exsisting condition. The part that is confusing to many is that OBVIOUSLEY she would have had 'cancer' prior to the date of coverage - but she did not get treatment nor was she diagnosed.

In some cases people can actually be diagnosed but not have recieved any treatment for a conditon, take me for example when I was 12 when I was diagnosed with HCM - however I had no treatment and in fact did not see a doctor again for my heart until I was 19 and on my own health insurance plan, therefore HCM was not a pre-exsisting conditions as it was not treated for 6 months prior to the start of the policy.

I hope this makes things clearer - in short if you have not been diagnosed not treated prior to the date the policy began it is not a pre-exsisting condition.

best wishes,
Lisa

[Gary Jackson]

Lisa

Thank you. It clears it up for me. No i will be able to explain it to my cousin. This is ineed good news for her. I am sorry for being dense on it. Just wanted to be able to give her accurate information.

best wishes
Gary