Diagnosis Causes Insurance Discrimination?

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mmaestro
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24 Oct 2007, 4:41 pm

Silver_Meteor wrote:
When the insurance salesman came to my house for the health insurance. I took a look through the underwriters manual. A diagnosis of Autism was one of those ailments for being excluded from any of their insurance coverage they were selling. No major medical, no life insurance. I simply kept my mouth shut about me being diagnosed on the Autism Spectrum for almost all of my life. I don't have the luxury of fighting the insurance company and their lawyers in court. Believe me my life has been hard enough already.

You have to be really, really careful with that, though - witholding information on a medical condition could be grounds for them dropping you immediately, possibly even turning around and trying to claw back all the money they'd paid out to you because you lied on the application.

FWIW, there is insurance out there that covers autism, especially in children, but it seems like it's rare. BC/BS are getting notorious for denying people coverage for any reason they can manage. If you can find a not for profit insurance company, they're the ones to go for from what I can tell. I think Kaiser in California are one, here in New Mexico I'm insured with Presbyterian Health - they're expensive, but they're good, and would cover some autism related services if I decided to go the route of a formal diagnosis.
IMO, the problem is that for some, paid healthcare is better. Mine may be expensive, for instance, but the coverage is good and fast. I had an elective operation in April, and from the point where we decided it was necessary to having the proceedure was only a few weeks. Had I been in the UK on the NHS I would have waited months, possibly years. There are definitely those patients who benefit from the current system, but I think their numbers are dwindling with the spiralling costs of US healthcare, which is why you're seeing the pressure to find another solution (FWIW, I think John Edwards has the best policy for this, but YMMV).


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Silver_Meteor
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24 Oct 2007, 6:23 pm

Mr. Mark Says: I don't know. I'm certain that Capital Health Plan specifically excludes treatment for autism and autism related conditions. My personal concern is that "autism related conditions" could be so broadly intrepreted as to exclude treatment for depression, for example.
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If the insurance company says " we cannot cover treatment for autism because it could cost many thousands dollars per patient and would not be able to properly spread the cost over a large population that's one thing.

What I am referring to is a person with Autism/Asperger's Syndrome should be able to get medical insurance to cover those same conditions or illnesses that they would cover NTs under. If the insurance companies are flat out refusing to do this because people with Autism are blacklisted as uninsurable, I cannot understand why this has not been brought before the EEOC on the grounds that this contitutes a violation of the ADA. It seems to me this would be a pretty darn good case.


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Silver_Meteor
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24 Oct 2007, 6:38 pm

mmaestro says: You have to be really, really careful with that, though - witholding information on a medical condition could be grounds for them dropping you immediately, possibly even turning around and trying to claw back all the money they'd paid out to you because you lied on the application.
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If I had a medical condition but I kept it from the insurance company and simply never filed any claims about it and did not put it on my adult medical record, I don't know if they could let you go or not. They can let you go for filing a fraudulent claim. But this is not about filing a fradulent claim. This is simply wanting something that is private kept private and totally out of the picture.


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makelifehappen
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29 Oct 2007, 12:47 am

In that movie sicko a woman was let go because of an undisclosed yeast infection 15 years (or something mad like that) ago...and that is FAR from AS.......


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ghostgurl
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29 Oct 2007, 12:55 am

If that's true then that's not good. I've been trying to decide whether or not to get a diagnosis. It seems like there are so many pros and cons about it.


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alliegirl
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29 Oct 2007, 7:11 am

makelifehappen wrote:
I don't have the answer, but if Michael Moore accurately displayed the realities in the USA in his more recent film Sicko...I can't even begin to imagine the hell one must feel dealing with medical insurance over there. I was near physically ill no more than 20 minutes into that film... 8O

I hope for your sake, it is not true.



Michael Moore is a sicko and uses scare tactics. I doubt his movies are true. Try not to watch them.



monty
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29 Oct 2007, 9:26 am

alliegirl wrote:
makelifehappen wrote:
I don't have the answer, but if Michael Moore accurately displayed the realities in the USA in his more recent film Sicko...I can't even begin to imagine the hell one must feel dealing with medical insurance over there. I was near physically ill no more than 20 minutes into that film... 8O

I hope for your sake, it is not true.



Michael Moore is a sicko and uses scare tactics. I doubt his movies are true. Try not to watch them.


The fact that Michael Moore says that US healthcare has serious problems doesn't mean it is not true.