Celiac Testing And Insurance

[Water Street]

I thrive to ask the questions that don't get asked. In pre-diagnosis or testing, a question that I might want to know is:

How is celiac going to affect my insurance?

Once it is confirmed that you do have celiac, has anyone had any significant increases in their premium?

A lot of people linger on the edge of "should I really get tested?" and one thing that I have seen come up with loved ones is "I don't know that I want to get tested and have my premiums increase next year if I do have celiac, perhaps I should go gluten free all by myself and not let the doctor confirm it". After all the pre-existing condition clause does not prohibit insurers from raising rates for higher risk patients.

My immediate concern is the other problems and allergies that occur with celiac should be confirmed so you know it is not another more serious problem.

What are your thoughts and experiences?

 





 

[SMRI]

Health insurance?  It won't affect your premiums at all, nor will any other disease or condition. 

[Gemini]

It depends on what type of insurance you purchase on whether your premiums increase because of pre-existing conditions. You correctly stated this in your post.

If you have insurance through the company you work for (private), then you won't notice any increases, other than the yearly, across the board increases that occur these days. Mine went up 2.4% this year.

If you purchase insurance through the "new" insurance exchange that the government is running, insurers have the right to charge you up to 3X the rate they charge for a normal, healthy younger person. I am not trying to start an argument here, just stating what the law actually says. This new system does not quite work the same way as health care in Canada or other countries with NHA type insurance.

People with pre-existing conditions can be charged a lot more, which is very unfair to those of us with genetically based conditions we have no control over getting.

So, I would say that obtaining an official diagnosis is sometimes desirable and sometimes not, although if your doctor adds to your chart that you have a gluten problem like NCGI, it probably wouldn't affect rates as damage does not occur to your small intestine and associated conditions are far less likely. You just feel bad when you ingest gluten. You will have to weigh the pro's and con's of obtaining a diagnosis yourself, depending on your personal situation. Having a doctor check into other problems you may be having should not be an issue, whether Celiac related or not. If you ask a doctor to check into something else and they refuse, I would say it's time to find another doctor.

Good Luck!

[SMRI]

It depends on what type of insurance you purchase on whether your premiums increase because of pre-existing conditions. You correctly stated this in your post.

If you have insurance through the company you work for (private), then you won't notice any increases, other than the yearly, across the board increases that occur these days. Mine went up 2.4% this year.

If you purchase insurance through the "new" insurance exchange that the government is running, insurers have the right to charge you up to 3X the rate they charge for a normal, healthy younger person. I am not trying to start an argument here, just stating what the law actually says. This new system does not quite work the same way as health care in Canada or other countries with NHA type insurance.

People with pre-existing conditions can be charged a lot more, which is very unfair to those of us with genetically based conditions we have no control over getting.

So, I would say that obtaining an official diagnosis is sometimes desirable and sometimes not, although if your doctor adds to your chart that you have a gluten problem like NCGI, it probably wouldn't affect rates as damage does not occur to your small intestine and associated conditions are far less likely. You just feel bad when you ingest gluten. You will have to weigh the pro's and con's of obtaining a diagnosis yourself, depending on your personal situation. Having a doctor check into other problems you may be having should not be an issue, whether Celiac related or not. If you ask a doctor to check into something else and they refuse, I would say it's time to find another doctor.

Good Luck!

 

Nothing you have said is even remotely close to true.  Smokers can be charged a higher rate, that is it.  The law precludes insurers from charging more for pre-existing conditions.  The exchanges are simply a "shopping mall" for health insurance plans.

[notme]

Nothing you have said is even remotely close to true.  Smokers can be charged a higher rate, that is it.  The law precludes insurers from charging more for pre-existing conditions.  The exchanges are simply a "shopping mall" for health insurance plans.

maybe, but if you have a pre-existing condition, they will 'get' you in other ways.  my son (type 1 diabetic) has a heck of a time getting good insurance - that will pay for his labs, that doesn't have outrageous co-pays and deductibles combined with paying for his insulin and testing supplies.  if you think he pays the same as a 'normal' healthy 28 yr old, you're bats.

[SMRI]

maybe, but if you have a pre-existing condition, they will 'get' you in other ways.  my son (type 1 diabetic) has a heck of a time getting good insurance - that will pay for his labs, that doesn't have outrageous co-pays and deductibles combined with paying for his insulin and testing supplies.  if you think he pays the same as a 'normal' healthy 28 yr old, you're bats.

 

Sorry, but they can not rate him, period, end of story.  It is illegal and if they are you need to report them to the state insurance commissioner.  His diabetes supplies should be covered under any plan that is not grandfathered....not sure where he is trying to get insurance...

[Gemini]

SMRI......I made the point of saying I was not trying to start an argument but I knew someone would. My information is 100% true. You haven't read the law because it's in there. It is illegal to refuse insurance to anyone but like it or not, those with pre-existing conditions WILL BE charged more than healthy, younger people. I am sorry that you have a problem with the truth but the truth it is. That is part of the reason so many people are unhappy with the law, as it stands. It is not going to work like insurance in other countries with a single payer system. You have to buy a policy and how much you are charged depends on many factors, one of them being age and pre-existing conditions. The only people who will not pay more are those with very limited income, which is as it should be. I have no problem subsidizing Americans with limited income.

[SMRI]

SMRI......I made the point of saying I was not trying to start an argument but I knew someone would. My information is 100% true. You haven't read the law because it's in there. It is illegal to refuse insurance to anyone but like it or not, those with pre-existing conditions WILL BE charged more than healthy, younger people. I am sorry that you have a problem with the truth but the truth it is. That is part of the reason so many people are unhappy with the law, as it stands. It is not going to work like insurance in other countries with a single payer system. You have to buy a policy and how much you are charged depends on many factors, one of them being age and pre-existing conditions. The only people who will not pay more are those with very limited income, which is as it should be. I have no problem subsidizing Americans with limited income.

 

Please show me exactly where it says that in the law.  The law in fact says exactly OPPOSITE of what you are claiming.  I HAVE read the law, I deal with this day in and day out for my job.  What you are saying is illegal and not true.  They can not charge someone with a preexisting condition more than someone else, end of story.  You are confusing subsidies with ratings and how they charge premiums.  They are not the same thing.

 

Clearing up blatant misinformation is not arguing.  Open Original Shared Link 

[notme]

Sorry, but they can not rate him, period, end of story.  It is illegal and if they are you need to report them to the state insurance commissioner.  His diabetes supplies should be covered under any plan that is not grandfathered....not sure where he is trying to get insurance...

 

obama.

[notme]

You are confusing subsidies with ratings and how they charge premiums.  They are not the same thing.

you just said:  money, money, and paying money.   you can call it something different, it is costing more $$....

 

my kid bought into the *dream* of getting affordable health insurance.  he was confident that he could get health insurance if he switched jobs.  he can't afford it - month 3 it was insurance or rent, because all of his necessary care wasn't covered, so his out of pocket was too expensive.  

[Gemini]

You are correct, Arlene! What is being done is the shell game. Older adults will be charged up to 3x more for insurance because of all the pre-existing conditions that happen by then and any health problem is considered a pre-existing condition. It appears you don't even have to be older, from what I have seen. Younger people with good jobs will also be charged higher premiums to subsidize everyone else. They have to or the whole system will go bankrupt long before it really will. This is all simple math and anyone can find this out if they try to purchase insurance through the ACA. This is why the majority of people that have signed up are those over 50 with health issues who cannot get insurance so the push is on to recruit young buyers. Many young people go to college today and eventually find a good job with good insurance so they aren't going to purchase it from the government, where they will have higher premiums and huge deductibles. It's the large deductibles that are the show stopper.

Like it or not, this is the way it works and if you have a pre-existing condition, it will cost you more for insurance through the ACA. No...they cannot refuse you but many are finding the coverage unaffordable.

[SMRI]

obama.

 

The president does not offer health insurance.  If he is looking through plans on the exchange, that is simply a shopping mall for health insurance plans.

 

you just said:  money, money, and paying money.   you can call it something different, it is costing more $$....

 

my kid bought into the *dream* of getting affordable health insurance.  he was confident that he could get health insurance if he switched jobs.  he can't afford it - month 3 it was insurance or rent, because all of his necessary care wasn't covered, so his out of pocket was too expensive.  

 

Without specifics it's hard to answer this but what kind of plan did he buy?  Did he apply for subsidies?  What else is he spending his money on?  Too many variables to say that his insurance is too expensive.  

You are correct, Arlene! What is being done is the shell game. Older adults will be charged up to 3x more for insurance because of all the pre-existing conditions that happen by then and any health problem is considered a pre-existing condition. It appears you don't even have to be older, from what I have seen. Younger people with good jobs will also be charged higher premiums to subsidize everyone else. They have to or the whole system will go bankrupt long before it really will. This is all simple math and anyone can find this out if they try to purchase insurance through the ACA. This is why the majority of people that have signed up are those over 50 with health issues who cannot get insurance so the push is on to recruit young buyers. Many young people go to college today and eventually find a good job with good insurance so they aren't going to purchase it from the government, where they will have higher premiums and huge deductibles. It's the large deductibles that are the show stopper.

Like it or not, this is the way it works and if you have a pre-existing condition, it will cost you more for insurance through the ACA. No...they cannot refuse you but many are finding the coverage unaffordable.

Health insurance rates have ALWAYS been age banded, way before the ACA, since the dawn of health insurance.  It has nothing to do with "pre-existing conditions".  Older people are just more expensive to insure.  If you have always been on group plans, you don't see these age bandings relative to your own costs but if you work for a company that has an older population, you have always paid more for your insurance vs a group that has a younger population.  The ACA had nothing to do with that at all.  A healthy 60 year old will pay the same as a 60 year old with 100 different diseases.....

 

Those young college students getting "good insurance" will pay more for their premiums in a company with a lot of older people than they would at a company with a lot of younger people.  It also has to do with their claims experience given most companies are self-insured.  It is simple math, if they have $2,000,000 in claims and only collected $1,500,000 in premiums, your rates are going up next year.  

[SMRI]

maybe, but if you have a pre-existing condition, they will 'get' you in other ways.  my son (type 1 diabetic) has a heck of a time getting good insurance - that will pay for his labs, that doesn't have outrageous co-pays and deductibles combined with paying for his insulin and testing supplies.  if you think he pays the same as a 'normal' healthy 28 yr old, you're bats.

 

He could buy a plan that pays 100% for everything if he wanted, the premiums are outrageous for that, but he could.  Everyone's definition of "outrageous" is different however.  Some people thing a $20 co-pay is outrageous.  His rates are exactly the same as a "healthy" 28 year old--and the plans a healthy 28 year old can buy are exactly the same plans your son can buy.  Now, if your son bought a plan on premiums alone, yep, he is probably looking at $6000 out of pocket before the plan kicks in.  If he investigated costs for both premiums and out of pocket costs, knowing he had medical expenses each year, he could have gotten a plan that was more affordable overall.  

[notme]

yup - thank you for bolstering my point.  you don't understand it either, but you are a big fan?

 

the bottom line is:  if you lie on your application, you are in violation of the LAW.  if the insurance program was actually not discriminating, your application would consist of 2 questions:  your age and if you are male or female.  any further questions are SUPPOSEDLY not applicable.  yet illegal if you are not forthcoming.........  <WHAT???

 

obviously, obama doesn't personally offer health insurance.  i'm sure he's not on an ACA policy even if he did...  

 

apologies to the original poster.  celiac isn't going to cost your insurance company any $$ because the only treatment (so far) is the gluten free diet.  but it might cost you more, because, just like banks, insurance companies are going to charge whatever they can get away with.

[SMRI]

yup - thank you for bolstering my point.  you don't understand it either, but you are a big fan?

 

the bottom line is:  if you lie on your application, you are in violation of the LAW.  if the insurance program was actually not discriminating, your application would consist of 2 questions:  your age and if you are male or female.  any further questions are SUPPOSEDLY not applicable.  yet illegal if you are not forthcoming.........  <WHAT???

 

obviously, obama doesn't personally offer health insurance.  i'm sure he's not on an ACA policy even if he did...  

 

apologies to the original poster.  celiac isn't going to cost your insurance company any $$ because the only treatment (so far) is the gluten free diet.  but it might cost you more, because, just like banks, insurance companies are going to charge whatever they can get away with.

 

Everyone that has health insurance is "on an ACA policy"..ACA is legislation, not an insurance policy.  I understand it very well, thanks.  I'm sorry that you can't open up and read the correct information and learn about the policies vs just passing along more misinformation. It helps no one.  Pricing policies is a very sophisticated and complicated process and each and every premium has to be approved by your state before an insurance company can "Get away with" anything.  The industry is highly regulated.  Again, MOST people are covered under a self-insured plan.  That means, your employer dictates your coverage and the insurance company simply does the paperwork.  What your company collects in premiums is what they use to pay the claims.  If they collect less in premiums then their claims for that year, your premiums will go up.  

 

I guess what I don't understand is what you are saying??  Again, without specifics on his plan, it's anyone's guess whether it's affordable or not.

 

As for the OP, the correct information is that having a Celiac diagnosis, or ANY diagnosis other than being a smoker, does absolutely NOTHING to your premiums.

[kareng]

And while we arguing about the current laws and regs - 5, 10, 50 years from now..... Who knows?

[oni]

For what it's worth, my diagnosis did not change my rates or coverages.

One caveat, I have insurance through my employer, a state run university. It's blue cross (which has plans in the market place) if my employer didn't pay as much as it does for insurance I couldn't afford as good of a plan as I have now.

[Gemini]

Oni.......I have the same situation as you do. I have Blue Cross, provided by the university I work for. It is good insurance and I am lucky that the university picks up about 75% of the cost because if they did not, the alternative would not be good. Your rates would not go up as a result of a diagnosis under a group plan, except for the yearly increases that happen to everyone now.

Like you, if I had to buy directly through the exchange, which is not something I would do, I would end up with much more expensive insurance with far less coverage because of my age and the fact that with age come more medical issues. The deductibles are ridiculous and if you want insurance with smaller deductibles, the premiums are really high. The title "Affordable Care Act" is a joke.....I don't know who they think they are fooling.

[SMRI]

Oni.......I have the same situation as you do. I have Blue Cross, provided by the university I work for. It is good insurance and I am lucky that the university picks up about 75% of the cost because if they did not, the alternative would not be good. Your rates would not go up as a result of a diagnosis under a group plan, except for the yearly increases that happen to everyone now.

Like you, if I had to buy directly through the exchange, which is not something I would do, I would end up with much more expensive insurance with far less coverage because of my age and the fact that with age come more medical issues. The deductibles are ridiculous and if you want insurance with smaller deductibles, the premiums are really high. The title "Affordable Care Act" is a joke.....I don't know who they think they are fooling.

 

The plans are more affordable than before IF you had to buy a private policy...since your employer has to pay at least 50% of your premiums for a group plan at work, you don't see how much your plan really costs.  The plans on the exchange are a similar cost with similar out of pocket costs if you compared apples to apples, however, you pay the full premium, not the subsidized cost through your employer.  Those making under $95.000/year getting subsidies ARE saving money if they have to buy a plan on the exchange.  Those that had "cheaper" plans had very limited coverage and they were not a full medical plan....but people will argue otherwise because it makes for a good news story....

[oni]

I wasn't trying to make it a pro or against affordable care act post. I helped my mom get insurance this year for the first time ever, which is great. I was trying to get across that I wasn't sure what happens when an employer isn't involved. I know they have contracts and other professionals that the general population doesn't get.

[SMRI]

I wasn't trying to make it a pro or against affordable care act post. I helped my mom get insurance this year for the first time ever, which is great. I was trying to get across that I wasn't sure what happens when an employer isn't involved. I know they have contracts and other professionals that the general population doesn't get.

 

What do you mean by "contract" and "professionals" that the general public doesn't get?

[Gemini]

The plans are more affordable than before IF you had to buy a private policy...since your employer has to pay at least 50% of your premiums for a group plan at work, you don't see how much your plan really costs.  The plans on the exchange are a similar cost with similar out of pocket costs if you compared apples to apples, however, you pay the full premium, not the subsidized cost through your employer.  Those making under $95.000/year getting subsidies ARE saving money if they have to buy a plan on the exchange.  Those that had "cheaper" plans had very limited coverage and they were not a full medical plan....but people will argue otherwise because it makes for a good news story....

I know you obviously think the ACA is the greatest thing since sliced bread and will continue to discount the obvious but what you have said is not true. You can't keep bulldozing over other people's experiences with it because you don't like what is being said.

I know what my employer pays for their share because they tell us every year. They actually are pretty transparent about it, unlike the government. If I bought a policy on the ACA directly that was the equivalent of what I have now, it would not be the same....not even close. My out of pocket expenses would be much, much higher and so would the premiums. This is why people who actually work for a living and make decent money hate it....they know they are getting screwed. I know people who have opted to get a part time job at Starbucks because they have good insurance coverage for their employees and it's better than what the government is offering. The government has made the mistake in thinking that every American out there is stupid and can't do math....not so.

So keep on trying to pretend that people will receive low cost, quality health care because there is no such thing. Looks like many will find out the hard way.

ONI...don't worry about your post.....you did nothing wrong. I'm glad you have good health care so hang onto it as long as it lasts. Being covered under an employer has it's benefits, especially if they offer Blue Cross. I've had Blue Cross for 35 years and it's good insurance.

I do pay for that privilege though........not like I get it for free.

[oni]

By 'contracts' I mean that my employer negotiates with insurance companies to develop plans for their employees. The employer has a say in what kind of plan and coverages are offered.

By 'professionals' I mean benefit coordinators and compliance officers.

At this point I think we've hijacked the thread. I'm out.

[kareng]

By 'contracts' I mean that my employer negotiates with insurance companies to develop plans for their employees. The employer has a say in what kind of plan and coverages are offered.

By 'professionals' I mean benefit coordinators and compliance officers.

At this point I think we've hijacked the thread. I'm out.

 

 

I understood what you meant.  

[SMRI]

I know you obviously think the ACA is the greatest thing since sliced bread and will continue to discount the obvious but what you have said is not true. You can't keep bulldozing over other people's experiences with it because you don't like what is being said.

I know what my employer pays for their share because they tell us every year. They actually are pretty transparent about it, unlike the government. If I bought a policy on the ACA directly that was the equivalent of what I have now, it would not be the same....not even close. My out of pocket expenses would be much, much higher and so would the premiums. This is why people who actually work for a living and make decent money hate it....they know they are getting screwed. I know people who have opted to get a part time job at Starbucks because they have good insurance coverage for their employees and it's better than what the government is offering. The government has made the mistake in thinking that every American out there is stupid and can't do math....not so.

So keep on trying to pretend that people will receive low cost, quality health care because there is no such thing. Looks like many will find out the hard way.

ONI...don't worry about your post.....you did nothing wrong. I'm glad you have good health care so hang onto it as long as it lasts. Being covered under an employer has it's benefits, especially if they offer Blue Cross. I've had Blue Cross for 35 years and it's good insurance.

I do pay for that privilege though........not like I get it for free.

 

Even if my company negotiated the exact same plan as your company, our rates would not be the same.  That is the point you are missing with this.  Have you actually priced out a comparable plan?  You might be surprised.  You can keep believing what you want, but I deal with this day in and day out and I see the numbers on all sides and what you are saying just is not true.  Also, just because you have Blue Cross and it's "good" doesn't mean someone else is going to get the same plan or the same service.  

 

By 'contracts' I mean that my employer negotiates with insurance companies to develop plans for their employees. The employer has a say in what kind of plan and coverages are offered.

By 'professionals' I mean benefit coordinators and compliance officers.

At this point I think we've hijacked the thread. I'm out.

 

You have access to insurance brokers just like your company does.  You can find them at most banks, financial institutions, some private brokerage companies, etc.  They are probably the same people that negotiate your contract at work.  Usually in the private market there are pre-packaged plans, but you still have a little say  in your coverage in those plans or you just simply have the option of picking plans that suit your needs.  The broker fee is already figured into your premium whether you use one or not so you might as well use one, let them do the plan comparisons/shopping for you each year, just like your benefits administrator does at your company.

 

Hijack or not, it was a good question by the OP and by the responses here, there is still so much misinformation out there....companies have been shifting costs (employers, not health insurance companies) to employees little by little each year, employees may or may not know that but the blame automatically goes to the "insurance company", who only has so much control over how employees use their plan.  Low cost to you isn't the same as "low cost" insurance.