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Old 09-15-2013, 04:58 PM
 
2 posts, read 2,129 times
Reputation: 10

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Hi everyone,

I'm self employed and haven't had Health Insurance for about 5 years. Last time I had insurance was with a large employer in which I had a great PPO plan. In 2008 I had an MRI done on my ankle and they had found some torn tendons / ligaments. I never ended up getting surgery and quit my job, thus not having insurance since then.

I'm finally making enough money to afford the monthly bill for private insurance. I applied for Health Insurance through Cigna, which is one of the providers NOT joining HealthCare reform in the California marketplace. Being that I'm still young and healthy I have no suspicions of being denied for the plan.

Regarding my ankle, I can still participate in day to day activities and is generally about 80%. For the most part it's not an issue. However there are times (when I go for a run) it will cause much discomfort and become swollen. Not sure if I will need surgery or not.. if so, i'd like to be able to choose a specialist.


If I did end up needing surgery, I have a few questions:

- Is it possible to find out (get it in writing) if the insurance will cover the claim BEFORE getting the surgery done so that I can make the decision before getting slapped with a huge bill?

- What are the chances that they will deny my claim based on being newly insured?

- How many years back are insurance companies allowed to check medical records in the state of California? I know each state is different.

- Should I just say screw it and just apply for the open-enrollment through the California marketplace so that I don't even have to worry about the whole pre-existing condition thing?


Searched the net forever- couldn't find my answer. Figured this is the best place to ask.

Thank you!
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Old 09-15-2013, 05:59 PM
 
Location: So Ca
26,735 posts, read 26,820,948 times
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Quote:
Originally Posted by bigkahuna84 View Post
Should I just say screw it and just apply for the open-enrollment through the California marketplace so that I don't even have to worry about the whole pre-existing condition thing?
I'd say yes. You'd probably have to have another ankle x-ray anyway, before surgery is recommended, since it's been a few years.

And why stay with Cigna if they're not going to be part of the state insurance exchange?
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Old 09-15-2013, 06:46 PM
 
2 posts, read 2,129 times
Reputation: 10
Quote:
Originally Posted by CA4Now View Post
I'd say yes. You'd probably have to have another ankle x-ray anyway, before surgery is recommended, since it's been a few years.

And why stay with Cigna if they're not going to be part of the state insurance exchange?

Mostly due to the monthly cost of the plans on the exchange, as the plans seem about $100 a month more for an equivalent plan if I'm not mistaken. However I've always been a fan of BlueCross / BlueShield due to national recognition and PPO plans, and they are on the exchange.

Maybe my best bet is to just stay with Cigna until the new year (just so I have insurance until then) and then switch over to the exchange so I can be guaranteed to have my surgeries taken care of.
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