Get email alerts Get Celiac.com E-mail Alerts  




Celiac.com Sponsor:
Celiac.com Sponsor:




Ads by Google:






   Get email alerts  Subscribe to FREE Celiac.com email alerts

Maintaining Your Medical Insurance
0

6 posts in this topic

I am beginning a new thread, because there have been several inquiries regarding maintaining medical insurance after a diagnosis of Celiac Disease.

Please contribute your situation or professional information. :)

Thanks!

0

Share this post


Link to post
Share on other sites


Ads by Google:

I am beginning a new thread, because there have been several inquiries regarding maintaining medical insurance after a diagnosis of Celiac Disease.

Please contribute your situation or professional information. :)

Thanks!

As I understand the Affordable Care Act, if the Supreme Court upholds some or part of it in June, insurance companies will not be allowed to exclude people with pre-existing conditions. Currently, the way insurance companies make money is by only insuring healthy people. Under the ACA, the mandate will require everyone to buy coverage, or pay a maximum penalty of $665, which will be deducted from a tax return. You cannot be jailed for not paying the fine, no can any liens or wage garnishments be levied upon you, so the mandate is actually pretty weak. The provision was made thus to ensure the insurance companies cooperation, one argument in favor of single-payer, medicare for all type health care.

Although one might expect this to be a huge giveaway to insurance companies, the growth in health care spending in the U.S. has slowed. This can be explained partially by the recession (no employer based health insurance), but also by new models of cost sharing with employees, and more encouragingly, by new global payments systems.

Global payment systems work by focusing on health outcomes rather than fee for service. It focuses on preventive medicine, and standardizing costs between hospitals for large bills like imaging and surgeries. For celiac and gluten sensitive patients, who need consistent testing over their lifetimes, this will result in huge cost savings to the individual, the employer, the government, and the insurance company.

In Massachusetts specifically where I live, everyone HAS to have insurance by state law, and there are high risk pool exchanges for those with pre-existing conditions. Those with low incomes are subsidized, and you pay on a sliding scale according to your income. The goal as I understand it is basically to have people pay 10% or less of their income for health insurance. The ACA is modeled off the Massachusetts system. B)

ETA: The Diane Rehm Show had a great hour long discussion about the near future of the healthcare system. You can listen to it at

thedianerehmshow dot wamu dot org

0

Share this post


Link to post
Share on other sites

My problem is not insurance denial. It's a rate up. They will not reduce the rate unless there have been no symptoms for a year. But with 3 little children it's nearly impossible to avoid accidental exposure. It's frustrating because our health is great and we hardly spend any money on health care. We applied for a $12,000 deductible plan and they still rated us up 133%. It is more than I can bring myself to pay because we just don't use that much health care.

0

Share this post


Link to post
Share on other sites

My problem is not insurance denial. It's a rate up. They will not reduce the rate unless there have been no symptoms for a year. But with 3 little children it's nearly impossible to avoid accidental exposure. It's frustrating because our health is great and we hardly spend any money on health care. We applied for a $12,000 deductible plan and they still rated us up 133%. It is more than I can bring myself to pay because we just don't use that much health care.

That sucks. It just leads to a heads I win, tails you lose situation with the insurance company. What you've done of course is take the option they wanted you take, and not bought their product because they've priced you out of the market. If you HAD, though, they could have claimed any minor claim was evidence of continuing disease process. Get a cold? Definitely celiac. Have headaches? Celiac. Sinus infection? Celiac again. Then they could have jacked up your rates again, where you most likely would have dropped out or they would have bilked you for even more money. Awful system.

Granted, you KNOW you have Celiac, and thus are probably taking care of yourself. But I personally would not want to go without monitoring for years at a time, not that it is in any way your fault.

0

Share this post


Link to post
Share on other sites

We actually do not even have Celiac. Testing was negative and genetic testing showed gluten intolerance but no Celiac as well. But the insurance doesn't care. It's all the same to them. But no insurance doesn't mean we would go without monitoring anything. It was a high deductible so we planned to pay for routine care and minor problems with cash. (And honestly I wish more people would do that). I prefer it that way. My only worry with not having insurance is if something large and unpredictable were to come up. That's what insurance is supposed to be for.

Anyway, I would just say be careful how you fill out insurance applications. Be honest, but don't put every little symptom that may not be connected with the disease. I think that's what got us and now we have to go back and prove that they aren't related in order for them to even consider reducing the rate.

That sucks. It just leads to a heads I win, tails you lose situation with the insurance company. What you've done of course is take the option they wanted you take, and not bought their product because they've priced you out of the market. If you HAD, though, they could have claimed any minor claim was evidence of continuing disease process. Get a cold? Definitely celiac. Have headaches? Celiac. Sinus infection? Celiac again. Then they could have jacked up your rates again, where you most likely would have dropped out or they would have bilked you for even more money. Awful system.

Granted, you KNOW you have Celiac, and thus are probably taking care of yourself. But I personally would not want to go without monitoring for years at a time, not that it is in any way your fault.

0

Share this post


Link to post
Share on other sites




We actually do not even have Celiac. Testing was negative and genetic testing showed gluten intolerance but no Celiac as well. But the insurance doesn't care. It's all the same to them. But no insurance doesn't mean we would go without monitoring anything. It was a high deductible so we planned to pay for routine care and minor problems with cash. (And honestly I wish more people would do that). I prefer it that way. My only worry with not having insurance is if something large and unpredictable were to come up. That's what insurance is supposed to be for.

Anyway, I would just say be careful how you fill out insurance applications. Be honest, but don't put every little symptom that may not be connected with the disease. I think that's what got us and now we have to go back and prove that they aren't related in order for them to even consider reducing the rate.

I work within the life insurance industry so not myself an expert on how health insurance is viewed by carrier underwriters. But there is someone with my firm who deals with this and I asked her about how gluten intolerance and celiac are viewed in her realm.

First, she suspected that your insurance is not a group plan because she said that individual plans are much more stringent in collection of information than the underwriting criteria for groups. But whether group or individual coverage, she agreed with me that you should be forthcoming on insurance applications about things that will pop up on MIB, the Medical Information Bureau, because chances are they will find out if you have divulged it prior. Otherwise you may have some explaining to do about why you did not divulge. Now, don't stop reading just yet!!!!

MIB sounds like something relating to James Bond, but it's actually a data exchange that insurers use to trade medical info back and forth. It's legal (part of the disclosure you signed on the application) and has been going on for a long time among life and health insurers. They all share info with each other. Here's how it works: You go to your doctor and divulge that you went to a neurologist because you were dizzy. This may pop up on MIB. Or you tell the doctor you have Celiac. Whether they tested you or not, they write a note in their file and this could certainly pop up on MIB, especially if you have divulged this on a prior insurance application. The carriers are rather tight with info on how MIB info is derived, and if there is anyone reading this who actually underwrites and is willing to share it would be great, but I'd be surprised.

I cannot counsel anyone on whether or not they should decide to withhold info from a doctor, I certainly wouldn't if a symptom could be life threatening, MIB or not. But here's the short of it in your case: If you have not divulged to a physician, or provided info on any application, that you were treated for symptoms of gluten intolerance for that year or any year, then it shouldn't "exist" in the eyes of the insurer. I was really astonished that you had been rated for an intolerance to gluten, and while that means the medical world may be taking notice of the importance of that disorder, it doesn't bode well for others who are undiagnosed Celiacs, like me, who are extremely intolerant. But if you have cross contamination issues and do not need medical intervention or consultation, then this will not be on MIB.

In the meantime I am wondering if you could request a review of the rate decision, given that you test negative for Celiac. I'm not sure how feasible that is for you but it may be worth a try. Or, if it is individual coverage, I am wondering if you could just shop around. The fact that you were rated for gluten intolerance sounds extreme to me, but again, I'm not directly related to the health insurance underwriters.

I hope his all made sense.

0

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now
0

  • Forum Statistics

    • Total Topics
      104,665
    • Total Posts
      921,656
  • Topics

  • Posts

    • You're welcome! Yes, I too, hate waiting for lab results. Ugh!
    • I understand this is not a doctor's office and that I need proper testing done to rule out Celiac disease, however, I am stuck waiting until November to even see a GI doctor. So I need some suggestions soon on which test to go for first and what to do as I wait. Also do note, I am 28 years old.

      Right now, the most suspecting culprits to my symptoms have been Gallbadder, Celiac disease, and IBS. I have also been recently diagnosed with pre-diabetes and I am obese.  My Ultrasound and CT scan have all come up as normal and no signs of gallstones. However, I was in extreme pain as my upper abdomen was examined during the ultra sound. My white blood cell count also seems to be high at 12,000 but all blood work came back normal for liver and everything else.

      Symptoms included are: diarrhea
      yellow-stools (Sometimes foul smelling but always sink)
      light gnawing pain in area a few inches above belly button
      burning in chest
      sometimes pain below upper right rib cage.
      Tenderness all around the upper abdomen, but more so on the right and center.
      burping frequently after meals
      Gassy
      bloating in abdomen The pains used to come and go for the past few years as something very mild, but then the yellow stools happen at least four months ago and at a constant rate. Everyday it is either yellow or orange.  Sometimes the stools are lose and other times they are not. Two months in, I was finally diagnosed with pre-diabetes and have been having a strict low calorie and non fatty diet.

      So far the upper right pain has subsided but the pain above my belly button would continue. The gassy and bloated feeling would come and go as well. I get severe heart burn after almost every meal. But I felt it especially after eating whole wheat sandwiches or whole wheat pasta. I however don't feel it when I eat a Nature Valley granola bar, or pack of peanut butter crackers. I also had a chicken and vegetable stir fry with soy sauce cooked in that also had little effect on me. A bowl of cereal also made the heart burn act up pretty bad. I sometimes feel numb or light headed after various meals. Especially larger ones. In fact, it seems the more I eat, the worse I feel. But the less in the stomach, the more the pain above my belly button starts to act up.

      It is usually in the morning and afternoon I feel the most with gas and bloating. Especially after any large meals from the previous day. Despite the diet and work outs I have had, nothing has changed the stools. However, taking fish oil pills has greatly reduced the pain in my upper abdomen as well as the pain  in the the area above my belly button. My question now is, is there a very likely chance of this being celiac disease? Should I go on a gluten free diet to test since I Have to wait so long? Also, which test should I ask the doctor for first, as it will take a GREAT deal of time to pay off each one. Colonoscopy, HIDA scan, or endoscopy. 

      Again, I understand this isn't a site to get compete medical advice or to know exactly what my illness is, but I am trying to narrow down the possibility or what is most likely. If this has a chance of being celiac disease, I would rather know sooner than later.
    • Thank you very much for all the info Squirmingitch. The doctor told me as we were talking he was going to order some tests with urine so I don't know why he didn't mark that. Maybe he forgot as we were talking? Duly noted about the bladder Cancer to watch out for too. Doctor said it will take about a week to get the lab results back usually from this lab. The wait will seem like forever I'm sure. Yes I will press to have the other tests done too if this one comes back negative.
    • http://www.cureceliacdisease.org/screening/ Was your hubs tested for total IgA to see if he's IgA deficient? Read this thread: http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/83660
    • Yes, bone density problems are all part of the celiac "umbrella" so to speak and yes, osteoporosis tends to happen more rapidly and at earlier ages than normal when malabsorption is happening. At age 43, it's not normal to have osteoporosis as you describe so that's another part of the jigsaw puzzle. Time to receive blood test results back from the doc are entirely dependent on the particular lab they were sent to. Yep, it's time for you to start keeping a very close check on the PSA in light of your father having had prostrate cancer. I would think you should get a PSA every year. I really would have liked to see him do a urinalysis. With the prostrate cancer your father had, it would seem a close watch should be kept on you for bladder cancer as well. The first symptom of that is blood in the urine but it's generally microscopic before you're ever able to actually see it. That happens to be the 8th most common cancer in men & it's moving up in the rankings. I know this because my hubs had it. The good news is that it's also one of the easiest and most successfully treated provided it's caught early. Certainly starting @ age 50, men should see a urologist every year. BTW, in the last year before I found out I was celiac, I turned up with microscopic blood in my urine. I got it checked out thoroughly since I know about bladder cancer & all tests, ultrasounds, cystoscopy, CT scan etc... turned out fine. The docs were stumped & finally said, "apparently that's just what your body does". Guess what? That's not "just" what MY body does. Once I went gluten-free, I have had no more microscopic blood in my urine. Interesting eh? Before now I didn't realize you are in Canada. The doc didn't do the full celiac panel but I understand the initial screening protocols in Canada only order the TTG but if that comes back negative be sure & press for the full panel as cyclinglady said. We have several here who tested like cyclinglady so it's not a rare thing, it's just not the norm. I'm glad he's doing the B-12 & Ferritin -- those can be big clues.
  • Upcoming Events

  • Blog Entries

  • Recent Status Updates

  • Who's Online (See full list)

  • Member Statistics

    • Total Members
      61,663
    • Most Online
      3,093

    Newest Member
    Steph0903
    Joined