, ,

I am excited to have a Nurse Practitioner with Dr Nancy Snyderman from NBC to guest post today – they have a new company called CarePlanners.

When I was a Nurse Practitioner, many of my patients worried that they wouldn’t be able to get health insurance coverage with a preexisting condition. But, while it is more difficult to find coverage, it is still possible.

Dr. Nancy Snyderman, Chief Medical Editor of NBC News and co-founder of CarePlanners, gave me the following advice for obtaining coverage with a preexisting condition.

Technically, a preexisting condition is an illness you had prior to the effective date of your health insurance policy and is often grounds for denying insurance. But if an insurer rejects you, you do have some recourse.

  1. Go insurance shopping.

Insurers vary in whether they will cover certain medical conditions. Some may reject you if you have dia­betes; others may accept you if you control it through nutrition and medicine. Some insurers charge higher rates for certain medical conditions, so you have to do some homework. A good resource is eHealthlnsurance.com, or call 800-977-8860 for in­formation on which insurers might cover your condition.

  1. Stick with COBRA.

This is a federal law that requires employers with twenty or more employees to let them retain their coverage for up to eighteen months after they leave their jobs. You pay a higher premium than you did as an employee because you have to pay both the employer and employee’s share of the cost. But you can’t be rejected or have to change your coverage because of your health.

  1. Check out state high-risk pools.

More than thirty states have “high-risk pools,” which must accept people with medical condi­tions who have been rejected elsewhere. And a few states, such as New York, New Jersey, and Massachusetts, are required to cover everyone regardless of their medical condition—a type of policy called guaranteed issue. There are downsides to high-risk pool coverage. For example, it is always more expensive than a regular individual policy, and there are waiting lists in some states to get into the pools. Ultimately, the cost of being unin­sured can be far greater than the cost of your premiums. The rules and strategies vary greatly from state to state, but you can get a lot of information at your state insurance department web­site. Or go to the National Association of Health Underwriters’ website (www.nahu.org). It can tell you if your state has a high- risk pool.

  1. Fight back.

If an insurer rejects you, find out why. Often you can reverse the decision by providing additional information, includ­ing data from your doctor, or by clearing up any errors that might exist in your medical record.

If you’re still concerned about coverage and need more answers, then have a professional take an objective look at your healthcare situation. Organizations like CarePlanners will help you understand your options so you can make the best decisions for you and your family.

  Crystal Fornes is a nurse practitioner and patient advocate with over 10 years of experience. She is also helping Dr. Nancy Snyderman, Chief Medical Editor of NBC News, start CarePlanners, a company that gives patients and caregivers better decision-making tools as they navigate the healthcare system with one-on-one support and personalized technology.