If you get a job that has health insurance knowing that you need surgery, will the health insurance cover?

Question

My father is self employed. He was in negotiations with a company to become an employee when he found out he needs heart bypass surgery. He currently pays for his own insurance, but the coverage is only 70%. His out of pocket expense will be in the tens of thousands. If he takes the job will the insurance cover the surgery? Please only answer if you know.

Answer 1

Some plans do cover pre existing conditions - but as companies try to reduce their expenses this is becoming less common.

Answer 2

Not if they found out that the condition was pre-existing. That's pretty standard.

Answer 3

He will need to indicate that he has this preexisting condition which depending on the insurance co will either mean they will flat out refuse to insure him or charge him an exhorbitant premium since he is a risk to cost them money with the condition.  Also, depending on the insurance company will determine how long he will need to be covered before they actually pay for surgeries.  Perhaps he should call this particular company and ask them what their policies are to see if it is worthwhile to switch, it's quite possible that it could be more costly to change companies since he needs surgery.

Let's face it all insurance co's are just out for money, they couldn't care less about the actual health of the people who pay them.

Answer 4

Under HIPPA laws, a group insurance may impose a pre-existing exclusionary period (up to 12 months) for any new employee that enrolls on the insurance as soon as he is eligible. However, some group insurance do not exclude for pre-existing, so your father needs to find out if his new employer will and when his coverage will be effective. There is usually a waiting period of 60-90 days (usually the probabtionary period).

If the insurance does have a exclusionary period of 12 months, the amount of time he had his individual insurance could count toward this exclusionary period. So if he had his individual coverage for 12 months, the exclusionary period would be met. HOWEVER, there can not be a break of more than 63 days between coverages.

Hopefully, your father can wait until his group insurance is in effect.

Good luck!

Answer 5

Assuming he's had his coverage for at least 12 months, and hasn't had a lapse in coverage more than 63 days, then yes, the new employer's policy should cover the surgery, up to the limits, in accordance with the policy terms.

If you're asking, is it 60% or 80%, well, no one here has ANY way of knowing.