Declined healthcare coverage based on PDD?

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ROFLWTF....

I had to wait two months for information to be sent from a doctor back to a major healthcare provider with questions related treatment. I see a PCC-S for counceling, originally it was just for potential life-coaching insight, now I go in and shoot the bull about rapid early-30's changes just because I've had a row of major domino changes cascade from a standstill (not in a bad way but highly active nonetheless), I probably go in more just because I sign up to go in every couple months and procrastinated cancelling the meetings.

I really had no idea that PDD would be something that insurers would look at and say "Wow, this guy's a risk". It was for a really high deductible plan, ie. something they wouldn't have to pay a dime on unless I have some kind of organ failure, severe accident, etc. and get hostpitalized for whatever reason.

Is this just a side-effect of the affordable care act or has this been going on for a long time? Just what kinds of uninsurable health problems do they associate with PDD?

This is too bizarre.

I tried getting health insurance here in Washington. When they got a whiff of me having Asperger's they ran to the hills. This was about a year ago. They told me I'd be eligible for federally-protected guaranteed insurance, but at my age, that's $941/month. Waaaaay out of my price range.

With Obamacare, my pre-existing condition doesn't matter. It'd still cost me around $200/month. I'm on Medicaid, but if I wasn't, that's what it would be close to.

I thought PDD didn't even exist as a diagnosis anymore, per the new DSM? Anyway, this really doesn't seem right to me. And, I don't mean 'right' in a moral sense, but more that I almost wonder if it was some sort of clerical error. Have you called them?

Hope you don't mind my answering this with a quote however I'm quoting their response somewhat (involved parties and insurer name left out):



'In accordance with our guidelines'. The only thing I can think of is that there were apparently some major mandates passed in 2012 involving 48 states with regard to healthcare coverage for autistic individuals and that some rather heavy-handed 'thou shalts' might have been pushed at the insurers. If that's the cause of this my only hope for coverage, aside from having the federal government taking hold of my health and perhaps right to live as I'd chose, is to get another job and fall in line with the group plan. If it turns out to be such a sour pill that it would jump the group rate up however and my employer refused to cover me - I'm not sure what I'd do, just pay the Affordable Healthcare Act fines as they escalate?

Looking at their response form I have the particular underwriter's name and phone number at the bottom. I'm going to give them a call tomorrow if not Monday and see if I can find out just what's going on here.

Lol, the only times I've complained about you doing that in the past were when it was done in a snarky manner. Anyway, ugh, I hope you can get this straightened out.

apply for insurance under the affordable care act to start jan. 1, 2014. you won't be denied again.

I did talk to the underwriter - any treatment for pre-existing conditions treated within ten years of applications filed before 1/1/14 are subject to refusal based on pre-existing condition criteria.

For some reason the information that was sent over by the doctors office may have been very minimal but to the extent that I was being treated for 'PDD', and the problem with that language is it's horrifically vague.

There's a lady some relatives know who I could call, my parents would just need to find her phone number and I think she handles multiple lines of coverage. I'd really like to get her opinion though on what I need to do or whether I was just going with an insurer whose been above the crowd with respect to flightiness. Worst comes to worst I either talk to the counselor to have the code related to the visits lightened, or, worst case scenario if what I got diagnosed with - ie. PDD-NOS, over 20 years ago is making me radioactive to insurance I might have to see if I can get the diagnosis overturned.

I won't plan on any of the later two just yet but I am curious to see what kind of input I'll get when I talk to the friend-of-the-family to see what she has to offer on the matter.


edit: some good news, the 1/1/14 figure was reiterated by someone else I talked to, ie. I can resubmit any request on or after 1/1/14 and can't be refused coverage. Sounds like plans will skyrocket in price however. I suppose we'll see how far that goes.

Obamacare is requiring a certain percent of premiums to be used to provide healthcare instead of insurance execs using the premiums to make crazy profit so I don't think the rates will go up too much. I think the federally-protected guaranteed insurance plans that are in effect rite now will disappear next year due to Obamacare but the people on those plans will be able to browse & select a new plan under federal site or state(if the state cares; I know Vermont has one) & lots will be able to receive a subsidy to help cover the cost.