The Texas Risk Pool, Preexisting Condition - Believe it, or not

  • Posted by a hidden member.
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    Oct 01, 2009 5:20 AM GMT
    [url]http://www.txhealthpool.org/01012009%20Outline%20Web%2011-24-08.pdf[/url]

    In Texas if you have a pre-existing condition you're fucked.

    If you can't get insurance from anywhere else, which is the case with the roomie, flex89 / Logan, who is a type 1 diabetic, you can only get insurance via a group, or via The Texas Risk Pool.

    Now, you may already know that the Texas Risk Pool, by statute, has to be higher priced than most other insurance. It's deliberately not allowed to compete, for fear of dipping into shareholder profits.

    Here is the exact language taken from the policy declaration:

    "Preexisting Condition Limitation
    During the first 12 months following Your effective date of coverage, the Policy will not pay benefits for any charges or expenses
    for a Preexisting Condition. A Preexisting Condition is a disease or condition: for which the existence of symptoms would cause
    an ordinarily prudent person to seek diagnosis, care or treatment during the six month’s before an Insured Person’s effective date
    of coverage; or for which medical advice, care or treatment was recommended or received during the 6 months prior to an Insured
    Person’s effective date of coverage."

    What this says it that you have to pay them for a year before you get anything. Pardon my language, but, how fucked up is that? What if you're sick? What if you're injured?

    This is what the GOP has supported for decades.

    A 20 year diabetic can't afford The Risk Pool, which isn't allowed to compete.

    It's dirty, rotten, stinky, RACKET, that makes money off of sick people.

    We should treat each other better.

    If we call the fire department, they put the fire out. If you're sick, or injured, you're fucked.

    How nuts can defend the current system astounds me. What if flex89 was your kid? What's amazing is that folks have taken it lying down for so many years.
  • NickoftheNort...

    Posts: 1416

    Oct 01, 2009 1:27 PM GMT
    Those Texans (generalized off of the association of Texan politicians and claims to Christian identity) sure practice an odd form of Christianity. I'd dare say, they're not practicing it at all; rather they seem to practice a form of legalism (where the moral is that it's immoral to not get away with as much sh*t as you legally can for personal gain) and then dub it "Christianity."
    A racket in and of itself.

    I'm curious, do private health insurers, including the Texas Risk Pool, cover the nausea and illness their customers experience from having to deal with them? Or is that a pre-existing condition as well?
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    Oct 01, 2009 2:24 PM GMT

    People with health issues face a similar situation in New Hampshire, where a high risk pool operates under rules similar to those in Texas. Plus there are only two companies that offer health insurance in New Hampshire. Since my son and I both have longstanding cardiac issues, it made sense for me to establish residence in Massachusetts, which has a mandatory health insurance law. In return for requiring everyone to have insurance, the insurers are not allowed to deny coverage or raise premiums due to your health or to refuse coverage for pre-existing conditions. The result: I pay $1,400 per month less in Massachusetts for vastly better coverage than we got in NH. Our coverage is still expensive (because it makes sense for us to have a plan with low drug co-pays, etc), but the security of knowing everything is covered can't be beat.
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    Oct 01, 2009 2:55 PM GMT
    Illinois has a comprehensive health insurance plan opition (ICHIP) for those who can not get insurance otherwise. It is a bit costly, but dosn't limit pre-existing conditions.
    http://www.chip.state.il.us/
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    Oct 01, 2009 3:28 PM GMT
    It's a cynical ploy intended to do two things:

    Fatten the pockets of the biggest political donors: insurance companies...

    and

    Perpetuate socioeconomic engineering whereby workers gravitate towards the largest businesses (who offer plans with the most security and fewest restrictions), effectively limiting or eliminating the ability of smaller and more innovative companies to hire healthy workers.

    Big businesses have far more rights and receive more welfare in TX than do small businesses, entrepreneurs and individuals.

    But the tea partiers don't understand this. They only understand the hysterics and straw-men put out there by Glenn Beck. Because their minds are lazy, ignorant, and hateful.

    Suckers. Every last one of them
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    Oct 01, 2009 5:20 PM GMT
    NickoftheNorth saidThose Texans (generalized off of the association of Texan politicians and claims to Christian identity) sure practice an odd form of Christianity. I'd dare say, they're not practicing it at all; rather they seem to practice a form of legalism (where the moral is that it's immoral to not get away with as much sh*t as you legally can for personal gain) and then dub it "Christianity."
    A racket in and of itself.

    I'm curious, do private health insurers, including the Texas Risk Pool, cover the nausea and illness their customers experience from having to deal with them? Or is that a pre-existing condition as well?


    You nailed it.

    I call it selective ethics / selective morals.

    Hypocrisy to the n'th degree.
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    Oct 01, 2009 5:23 PM GMT
    RuggerATX saidIt's a cynical ploy intended to do two things:

    Fatten the pockets of the biggest political donors: insurance companies...

    and

    Perpetuate socioeconomic engineering whereby workers gravitate towards the largest businesses (who offer plans with the most security and fewest restrictions), effectively limiting or eliminating the ability of smaller and more innovative companies to hire healthy workers.

    Big businesses have far more rights and receive more welfare in TX than do small businesses, entrepreneurs and individuals.

    But the tea partiers don't understand this. They only understand the hysterics and straw-men put out there by Glenn Beck. Because their minds are lazy, ignorant, and hateful.

    Suckers. Every last one of them


    The irony here is that the GOP makes claims they are for small business. They aren't. They're hurting it over the insurance issue. Folks work in jobs they can't stand in incompetent big corp America and the small business can't compete. I'm amazed to see small business defend the GOP. It's insane. The GOP is about moving more wealth to the top / preserving that wealth. It's not really about empowerment, nor DEMOCRACY.

    Your insight is good. They really ARE suckers to buy up mumbo jumbo very small picture politics. Weak-minded might be another way to say it.
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    Oct 01, 2009 6:06 PM GMT
    NickoftheNorth saidThose Texans (generalized off of the association of Texan politicians and claims to Christian identity) sure practice an odd form of Christianity. I'd dare say, they're not practicing it at all; rather they seem to practice a form of legalism (where the moral is that it's immoral to not get away with as much sh*t as you legally can for personal gain) and then dub it "Christianity."
    A racket in and of itself.

    I'm curious, do private health insurers, including the Texas Risk Pool, cover the nausea and illness their customers experience from having to deal with them? Or is that a pre-existing condition as well?


    icon_biggrin.gif Congratulations, you have won the RJ "Post of the Day" award. icon_biggrin.gif
  • Posted by a hidden member.
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    Oct 01, 2009 6:47 PM GMT
    Isn't it a hoot that the guy posting it is in NORWAY? Where, of course, like all regular countries, THEY HAVE UNIVERSAL HEALTH CARE.
  • NickoftheNort...

    Posts: 1416

    Oct 01, 2009 7:49 PM GMT
    chuckystud saidIsn't it a hoot that the guy posting it is in NORWAY? Where, of course, like all regular countries, THEY HAVE UNIVERSAL HEALTH CARE.

    Mind you, when we got universal health care back in the 1920s / '30s, Norwegian big business wanted it and encouraged the Social democratic government's plans (Norwegian business didn't want the responsibility or costs for maintaining healthy workers).

    If we're (being a US citizen myself) going to get universal health care, we need the pressure and support of US business (because few elected officials are willing to commit possible political suicide). It needs to a big amount of businesses too, as they have to outweigh the influence of private health care companies.

    ***
    I still don't get the resistance to a good public option health care for those who might want or have use for it. Ensuring the health of its citizens should not only be an obligation of a responsible state, but part of state- and national security. What state is secure with untreated sick and vulnerable inhabitants?

    Acceptable health care cannot and should not be run by a for-profit motive. For health care providers to focus their resources toward denying their customers what they pay dearly for (instead of, you know, helping them) is one of the sickest contraptions our species has made.
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    Oct 02, 2009 12:02 AM GMT
    Some other states with a high risk pool deny claims for pre-existing conditions during the 1st year. In some (all?) states that is waived if a person is previously insured with no lapse in coverage. I paid for my previous employer's group plan through COBRA as long as possible (18 months) then enrolled in Wyoming Risk Pool during the final month. Within a few months I had surgery (hernia) that was unrelated to my pre-existing condition (hiv) and it was covered. Even if I had a lapse in coverage when I enrolled, that surgery would have been covered because it was unrelated to my pre-existing condition.

    In wyoming the risk pool is prevented from cutting into private insurance profits not only by the higher rates, but also by law: You have to prove you got rejected by a private insurance company to enroll. It only took blue cross 3 days to reject my application!

    In Logan's case, if he got hurt he should be covered immediately. However, they would probably try to weasel out of it. For instance if he fell and broke his arm they might try to say the fall was from passing out due to diabetes and thus still a result of his pre-existing condition.
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    Oct 02, 2009 2:16 PM GMT
    Thus we do need a national public health insurance that covers everyone.
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    Oct 02, 2009 10:23 PM GMT
    It's disgusting that so much money is being made from sick and injured people, to the point that it's 16% of GNP, yet, rated 37'th in The World.

    We GIVE Big Insurance 30% to 35% profit, even when they DENY 1/5 of all claims and 1000's die daily because greed is placed before care.

    It makes a lot more sense to give a federal agency 3.5% to take proper care of the people in a non-profit way.
  • jarhead5536

    Posts: 1348

    Oct 02, 2009 10:30 PM GMT
    Virginia is, or was, the same way. When I got out of the military, I got insurance through my new job, and was flat out told that my HIV was a preexisting condition that would not be covered for 24 months, period, and that my medications would not be covered (thank goodness I never went on meds!). Even my own doctor thought that was highly fucked up...
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    Oct 07, 2009 3:01 AM GMT
    here's some more info about high risk pools
    http://www.pbs.org/newshour/updates/health/july-dec09/highrisk_10-05.html

    at least one of the plans currently being proposed in the senate injects tons of money into the high risk pools to brings premiums in range of other insurance policies
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    Oct 07, 2009 3:21 AM GMT
    chuckystud said



    If you can't get insurance from anywhere else, which is the case with the roomie, flex89 / Logan, who is a type 1 diabetic, you can only get insurance via a group, or via The Texas Risk Pool.


    To make matters worse for type 1 diabetics, there is really no incentive for the private sector to find a cure. Health care providers and drug companies make billions a year off type 1 diabetics. Why end this with a cure? I have had type 1 diabetes since I was just a kid. I'm lucky, I've had insurance most of my life. Without it I'd be broke.
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    Oct 07, 2009 5:16 PM GMT
    theantijock said


    The danger of hanging on to COBRA is that you can develop a condition during that time which can then be considered pre-existing to your post COBRA coverage.

    FWI: http://en.wikipedia.org/wiki/HIPAA




    One of us is misunderstanding how "creditable coverage" and "significant break" apply to exclusions to restrictions on pre-existing conditions under Title 1 of the wiki you linked.

    Title I also limits restrictions that a group health plan can place on benefits for preexisting conditions. Group health plans may refuse to provide benefits relating to preexisting conditions for a period of 12 months after enrollment in the plan or 18 months in the case of late enrollment.[1] However, individuals may reduce this exclusion period if they had group health plan coverage or health insurance prior to enrolling in the plan. Title I allows individuals to reduce the exclusion period by the amount of time that they had "creditable coverage" prior to enrolling in the plan and after any "significant breaks" in coverage.[2] "Creditable coverage" is defined quite broadly and includes nearly all group and individual health plans, Medicare, and Medicaid.[3] A "significant break" in coverage is defined as any 63 day period without any creditable coverage.[4]