Home >> Help understanding medical insurance, please help?
Help understanding medical insurance, please help?
I just purchased this medical insurance a few minutes ago,
"Breakthru 80 Plan, $500 Deductible" with Regence Blueshield. I am a little concerned on what is going to happen. I see a ANRP (well I just started to see) for anxiety. She diagnosed me with Social Anxiety with Agoraphobia and Bipolar 2. I am taking BuSpar but haven't started the Effexor. (I really don't want to take two meds at once, call me weird!) When I set my appointment up with the ARNP, I didn't have insurance, I was paying out of pocket. So I did mention check off anxiety and that I take medicine for it. How much privacy do I really have? I certainly don't want the insurance company denying coverage for seeing an ARNP. (I'm not much of a liar and perfer to be honest) I'm pretty clueless on what to expect, any help is appreciated. Thanks.
When you applied for coverage, did you disclose the fact that you've been diagnosed with anxiety and Bipolar disorder? If not, once claims are submitted for your treatment, the insurer will rescind your coverage. (This means the insurer cancels the policy from the effective date; it's as if the policy was never issued. All claims are denied.)
As another answerer has pointed out, your insurer does have the ability to obtain your medical records; however, you can instruct the ARNP to withhold them. But understand this: if you tell her to withhold the records, your claims will all be denied and the insurer may rescind based on information on the claim forms, such as "date of onset" being prior to the effective date of coverage. The ball would then be in your court to prove these are not pre-existing conditions, which you'll be unable to do. I'm sorry to be the bearer of bad news.
Call your state insurance commissioner's office to ask if there's a state "high risk pool" (this is not Medicaid) and how you can get into it. Some require that you be turned down by a commercial insurer FIRST -- so in this instance, call Regence and tell them you left medical history off of the application. As soon as you're declined, you should be able to join. On the other hand, if your insurance commissioner's office tells you a declination isn't necessary, you should cancel the pending application with Regence.
You're welcome. Once you get the policy, look thru it VERY carefully; mental health cvg. is mandated by the feds & most states as a "mandated benefit." Be VERY careful! Send me a message if you have trouble. Peace. Report It
I used to admistor health insurance benefits and there is a law called HIPAA which is a health information privacy act from 1996 which basically protects anyone from obtaining your personal health records without your consent. It protects everything from your past to the present and even any future conditions you may develop. Only certain people that you authorize (parents, significant other) may access your information if you sign a consent form stating that they may do so if in the event of an emergency. For more detailed info try http://www.hhs.gov/ocr/hipaa/
Hipaa doesn't cover this situaituion as an insurance company that you want to insure you has legal access to your medical records.
Odds are your "anxiety" won't be covererd for up to 2 years on this new insurance as it is a pre-existing condition. Unless you already have insurance and it has not lapsed.
In all honesty with social anxiety and Bipolar 2 you will find more relief from the Effexor then the Buspar. The Insurance company has no reason to deny you coverage.
I am very sorry I made un of your FART question recently. You are a very troubled and needy person. I apologize. Blue Cross / Blue Shield has a record for treating people right... even with prior conditions. I assume this is an affliation with the parent company . I wish I knew more about your previous attempts for coverage. I think you are on the right path if you will stay with them. Be totally honest with them. By law, they have boundaries and cannot deny you. Be very careful... make certain your primary caretaker is aware of all past and present meds.!!! I cannot tell you how important this is !!