Needs Coverage with Krohn's Disease

[Newby]

My wife is age 40. Never sick, never missed a day's work, 5'2" 110lbs, runs 5-miles every other day, hasn't eaten meat in over 10-years and takes no meds. But she was diagnoised (can't spell) with Krohn's Disease about 8-years ago.

Is there any way she can get any kind of health insurance other than group? We don't mind high deductables. Actually a health savings account would be great. We just want coverage for catastrophic stuff.

We are in Southern Indiana.

 

[CHUMPS FROM OXFORD]

Crohns. Gee...I don't know of any company. I guess...maybe the dreaded UA.

 

[Dave020]

Check the underwriting guidelines for your carriers. Some will write this possibly with rating, it is usually in the guide you can download from the carrier site.

Dave

 

[somarco]

I haven't seen a one that will write Crohn's. GR says they will if they have been treatment free for 2 years; World is 3 yrs, Time & Aetna is a decline.

Hard to find someone who is treatment free that long. Most are taking some kind of med as a prophylactic.

 

[Guest]

My wife is age 40. Never sick, never missed a day's work, 5'2" 110lbs, runs 5-miles every other day, hasn't eaten meat in over 10-years and takes no meds. But she was diagnoised (can't spell) with Krohn's Disease about 8-years ago.

Is there any way she can get any kind of health insurance other than group? We don't mind high deductables. Actually a health savings account would be great. We just want coverage for catastrophic stuff.

We are in Southern Indiana.

Why does she want to leave group?

Does she work for a large company, one that falls under the COBRA regs (20+ employees)? If so, if she gets a choice of plans, have her pick out a HDHP HSA plan. Then she can terminate her employment and take COBRA for the plan she is on (I believe) and later transition into a HIPAA plan. My bet is that there will be some HDHP HIPAA plans available 18 months from now (and in some states you can get 36 months of COBRA, but I've never understood who does and who doesn't get the extention.)

Maybe in Indiana there is an alternative for her to start a business with someone, pay wages for a couple of quarters and apply for guarantee issue group (if you have that in IN. If not move to CA!).

No one with means needs go without insurance. There is always a way. You may have to move, you may have to spend down, dispose, or hide (offshore) some assets. Some ways may bend, break, or shatter the rules, laws, norms, etc., of our system, but the system was not designed for sick people and if you are sick you have to do what you have to do to get coverage.

The only analogy I can make is this. I own a gun. Even if in doubt, I'd use it. I'd rather be judged by 12 then carried out by 6. YMMV.

Yeah, I'll take a lot of crap here for advocating that you not roll over and accept the system as it is. But that's OK. Bring it on.


Al

 

[Newby]

She has been treatment free the whole time. They discovered it during a colon exam about 8-years ago. Prescribed some pills at first but she never took them more than a few weeks. No problems, no symptoms, no treatments. She wouldn't know she had it if they hadn't told her.

Bad part is, she is a CPA and could make more money working for herself but works for less just so she can have health coverage. I don't know anything about health insurance or HIPPA or any of that. How does it work. We were on Cobra a while ago and I asked a health agent (Dave Ramsey's local paid provider) and he said no way no how no one with Crohn's could EVER get health insurance except group.

Is there a better answer.

PS. We have plenty of assets. A spend down is NOT an option.

 

[Guest]

She has been treatment free the whole time. They discovered it during a colon exam about 8-years ago. Prescribed some pills at first but she never took them more than a few weeks. No problems, no symptoms, no treatments. She wouldn't know she had it if they hadn't told her.

Are you sure the diag. was correct? Crohn's is usually a chronic ailment and if it can go into remission, I've never heard of it doing so. Has she been to a good gastro doc and had another exam, opinion?

Bad part is, she is a CPA and could make more money working for herself but works for less just so she can have health coverage.

http://www.spiris.com/indiana-small-group-health-insurance.htm

From what I read from this random Indiana site, it looks like your state has either guaranteed or simplified issue for small group. So if your wife quits her job and starts a new biz and can afford to hire an assistant who works 20 or 30 hours (not sure the minimum) she can apply for group coverage. However the rate adjustment factor may be 5 times the standard rate. (In CA by law it is 1.10 times).

I don't know anything about health insurance or HIPPA or any of that. How does it work.

You contact a good agent and he or she TELLS you how it works in your state. That's their job.

We were on Cobra a while ago and I asked a health agent (Dave Ramsey's local paid provider) and he said no way no how no one with Crohn's could EVER get health insurance except group.

That may be true. It may not be true. It all depends on the carrier and their underwriting guidelines. Again a good agent will know for sure.

The question you should be asking: DOES SHE REALLY HAVE CROHNS? I'm not a doctor but I've never heard of anyone having this disease without recurrent problems.

Is there a better answer.

Yes. A good agent who knows your state law and the carriers will give it to you.

PS. We have plenty of assets. A spend down is NOT an option.

Well, that puts you in a better position than most. If worst comes to worst you can take COBRA and then transition into the HIPAA State Risk Pool. http://www.in.gov/idoi/consumer_services/hipaa.html#highrisk

Al

 

[K-Dub]

I actually had a case like this about 5 months ago, spoke to an underwriter at World and he said if she is NOT taking any meds and it has been over 5 years then it would probably be a 40% rate up. They would also consider a waiver instead of the rate up.

Problem is this particular plan is not available in all states, and of course underwriting varies from plan to plan with all companies.

Colitis — Inflammation of the large intestine
a) Irritable bowel syndrome, spastic colitis or
mucous colitis.
• Present........................................................... ER = Waiver
• fully recovered
- 0-3 years.................................................... ER = Waiver
- Over 3 years............................................... STD
b) Ulcerative or Ischemic colitis, Crohn's
Disease 0-5 years.............................................. RNA
c) Ulcerative Colitis, Crohn's Disease
• >5 years since last treatment or symptoms... RMD = Underwriter decision

 

[somarco]

I asked a health agent (Dave Ramsey's local paid provider

That was your first mistake.

Ramsey's harem are folks who are mostly inexperienced and are willing to drink the Kool Aid.

Do a pre-screen with some of the carriers I suggested and see which one is willing to bite. Then submit an app. If you get the offer you like then you can tell her to leave & hang out her own shingle.

 

[Newby]

That was your first mistake.

Ramsey's harem are folks who are mostly inexperienced and are willing to drink the Kool Aid.

I agree. I enjoy listening to his radio show but most of the callers are just brainwashed. And every time he gets a caller that talks sense but is counter to what he says, he hits the mute button and keeps on talking to them making it seem like they are agreeing with him.