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#1 Irishhh

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Posted 02 July 2009 - 08:02 PM

Sooo I have a pre existing condition, right? I have two, technically three. Anyway... I signed up for insurance through the temp agency, which had an annual enrollment. My coverage started July 1st. In the past I was diagnosed with depression and took medication. Although it was pre existing, I was still able to receive prescription coverage. Since, I was without insurance for over a year, I don't know that I'll receive prescription coverage for the N medications.

The only N medication I've taken was Ritalin, and that didn't work. I need something better, something... Just something. Anyway, my question is, does anyone know if pre existing means for prescriptions too or is it more like for procedures? I know that it could vary, but I'm wondering from other peoples exp. I tried to call, but had to wait forevvv and ended up hanging up because I needed a nap!

N medications are really expensive. The insurance covers like 80% of prescription costs for brand name, so that would be very helpful. I'd still pay quite a bit, but it's still better than not having any, at least for me to try. It may not even work... and I also need to find a new Somnologist. Mine decided he should stare at my boobs a little too obviously so I don't want to go back to him! lol

I'll try to call again, just wondering in the mean time. Thanks in advance!

#2 Mike M

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Posted 02 July 2009 - 11:11 PM

I signed up for insurance through the temp agency, which had an annual enrollment. My coverage started July 1st. In the past I was diagnosed with depression and took medication. Although it was pre existing, I was still able to receive prescription coverage. Since, I was without insurance for over a year, I don't know that I'll receive prescription coverage for the N medications.

Anyway, my question is, does anyone know if pre existing means for prescriptions too or is it more like for procedures?


Technically, you should be covered for your narcolepsy medications. "Pre-existing" conditions are usually problematic when you are signing up for an individual insurance policy (and I think it is more of a procedures issue). Because you signed up during an annual "open enrollment" period through an employer, your medications for narcolepsy should be covered. That being said, I would guess that the insurance company will attempt to "fight" your claims, but it is hard to dispute PSG and MSLT results. Once they get the data, they should have to cover you. Don't be afraid to contact your HR person at the temp agency (or even the Attorney General in Kentucky) to make sure the health insurance is doing what it should.

N medications are really expensive. The insurance covers like 80% of prescription costs for brand name, so that would be very helpful. I'd still pay quite a bit, but it's still better than not having any, at least for me to try. It may not even work... and I also need to find a new Somnologist. Mine decided he should stare at my boobs a little too obviously so I don't want to go back to him! lol


I hope you can find somethings that work for you. The 80% coverage will definitely be a good thing. As for the doctor, I am so sorry. How pathetic is it that he is not necessarily helping you anyway (since the Ritalin does not seem to work), AND he is more focused on your chest than on your medical condition. Yikes! Good luck.