Pre-existing Condition Insurance (Oba...

Pre-existing Condition Insurance (Obama Care) PCIP

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Since: Apr 10

Paris

#1 Dec 19, 2010
I can't get normal health insurance at age 57 due to a pre-exiting condition and my only choice is Texas Risk Pool or PCIP (Federal)Health coverage. In researching the provider list, I find that Paris Regional Medical Center in Paris is not listed as a preferred provider. Hospitals in Bonham, Clarksville, Sulphur Springs, Tyler, Greenville and Dallas are all listed as providers.

--Anyone know why Paris Regional is not in the network?
--As you would expect,some Doctors are not signed up.Can someone
share some pros & cons about the federal PCIP coverage?
--The rate for the PCIP coverage, male, age 57, with a 5k
deductable, 20% co pay, is $557 per month.
Just wonder how the cost compares to a standard risk male,age
57? The Texas risk pool is about $100 more.
Any Comments??
Help

Paris, TX

#2 Dec 20, 2010
two kiss wrote:
I can't get normal health insurance at age 57 due to a pre-exiting condition and my only choice is Texas Risk Pool or PCIP (Federal)Health coverage. In researching the provider list, I find that Paris Regional Medical Center in Paris is not listed as a preferred provider. Hospitals in Bonham, Clarksville, Sulphur Springs, Tyler, Greenville and Dallas are all listed as providers.
--Anyone know why Paris Regional is not in the network?
--As you would expect,some Doctors are not signed up.Can someone
share some pros & cons about the federal PCIP coverage?
--The rate for the PCIP coverage, male, age 57, with a 5k
deductable, 20% co pay, is $557 per month.
Just wonder how the cost compares to a standard risk male,age
57? The Texas risk pool is about $100 more.
Any Comments??
The Texas Risk Pool is sold at rates that are 150%-200% of standard. The Federal Risk Pool (PCIP) is sold at standard rates. PCIP has a terrible network and I doubt if it will get better, since they will be paying medical providers a reimbursement set at Medicaid levels. States will be required to have insurance exchanges in place by 2014 that will replace most risk pools. However, states can opt out of this under certain conditions. PS: You can only get PCIP if you have gone uninsured for six months!

http://txhealthpool.com/
http://www.pciplan.com/
two kiss

Paris, TX

#3 Dec 20, 2010
So you doubt if Paris Regional will sign up for Obama Care?
Wondering

Paris, TX

#4 Dec 20, 2010
two kiss wrote:
I can't get normal health insurance at age 57 due to a pre-exiting condition and my only choice is Texas Risk Pool or PCIP (Federal)Health coverage. In researching the provider list, I find that Paris Regional Medical Center in Paris is not listed as a preferred provider. Hospitals in Bonham, Clarksville, Sulphur Springs, Tyler, Greenville and Dallas are all listed as providers.
--Anyone know why Paris Regional is not in the network?
--As you would expect,some Doctors are not signed up.Can someone
share some pros & cons about the federal PCIP coverage?
--The rate for the PCIP coverage, male, age 57, with a 5k
deductable, 20% co pay, is $557 per month.
Just wonder how the cost compares to a standard risk male,age
57? The Texas risk pool is about $100 more.
Any Comments??
A pre-existing condition means you didn't have insurance when you were diagnosed. Any reason you didn't? All I can say is, you took a risk and you got caught. Now you expect the taxpayer to subsidize your lack of planning. That's what's wrong with the whole Obamacare mess.
Help

Paris, TX

#5 Dec 20, 2010
two kiss wrote:
So you doubt if Paris Regional will sign up for Obama Care?
I think PRMC probably will. I doubt if many local docs will. I think there are only two currently. This will be just like Medicaid or Chips. No docs, but hospitals would rather have something rather than nothing.
Incredulous

Paris, TX

#6 Dec 20, 2010
Wondering wrote:
<quoted text>
A pre-existing condition means you didn't have insurance when you were diagnosed. Any reason you didn't? All I can say is, you took a risk and you got caught. Now you expect the taxpayer to subsidize your lack of planning. That's what's wrong with the whole Obamacare mess.
And YOU are what is wrong with this country--you arrogant, self-righteous, ignorant, pos. To assume that everyone who is denied the benefit of healthcare vis a vis a pre-exisiting condition or because of some willful decision on their part is the most screwed up presumptuous thinking that I have heard in a while. Have you, or anyone in your very small circle of operation, ever been laid off or had a business close or a grant run out, or number of other likely scenarios in the current economic climate? Sometimes things happen in your life that are beyond your ability to control--like being laid off and discovering you have a heriditary illness that you didn't find out about until your COBRA than out. I feel more sorry for people like you than I do the person whose situation I just described. How much did you get for your heart?
BBHC

Spring, TX

#7 Dec 20, 2010
Incredulous wrote:
<quoted text>
And YOU are what is wrong with this country--you arrogant, self-righteous, ignorant, pos. To assume that everyone who is denied the benefit of healthcare vis a vis a pre-exisiting condition or because of some willful decision on their part is the most screwed up presumptuous thinking that I have heard in a while. Have you, or anyone in your very small circle of operation, ever been laid off or had a business close or a grant run out, or number of other likely scenarios in the current economic climate? Sometimes things happen in your life that are beyond your ability to control--like being laid off and discovering you have a heriditary illness that you didn't find out about until your COBRA than out. I feel more sorry for people like you than I do the person whose situation I just described. How much did you get for your heart?
Oh, but he/she is good churchgoing Christian folk, I'm sure.

Since: Apr 10

Paris

#8 Dec 20, 2010
Help wrote:
<quoted text>I think PRMC probably will. I doubt if many local docs will. I think there are only two currently. This will be just like Medicaid or Chips. No docs, but hospitals would rather have something rather than nothing.
From what I see, there are ample Doctors that currently accept the plan, but of course not all. I just wonder if PRMC will. Anyone with PRMC have any info?
Wondering

Paris, TX

#9 Dec 20, 2010
Incredulous wrote:
<quoted text>
And YOU are what is wrong with this country--you arrogant, self-righteous, ignorant, pos. To assume that everyone who is denied the benefit of healthcare vis a vis a pre-exisiting condition or because of some willful decision on their part is the most screwed up presumptuous thinking that I have heard in a while. Have you, or anyone in your very small circle of operation, ever been laid off or had a business close or a grant run out, or number of other likely scenarios in the current economic climate? Sometimes things happen in your life that are beyond your ability to control--like being laid off and discovering you have a heriditary illness that you didn't find out about until your COBRA than out. I feel more sorry for people like you than I do the person whose situation I just described. How much did you get for your heart?
Hit a nerve with you? A lot of people don't have insurance because their priorities are messed up -- not because they can't afford it. I'm sick of paying for my own and for those who would rather have a big screen tv, a cellphone and computer with all the latest gizmos, and a big house than pay an insurance premium.
Government Mule

Dunn, NC

#11 May 6, 2011
Wondering wrote:
<quoted text>
Hit a nerve with you? A lot of people don't have insurance because their priorities are messed up -- not because they can't afford it. I'm sick of paying for my own and for those who would rather have a big screen tv, a cellphone and computer with all the latest gizmos, and a big house than pay an insurance premium.
I've been a type 1 diabetic for 34 years. I've been covered by insurance most of that time. I started my own business in 2004 and and stayed on COBRA until it expired. After that, the only policy available was through a high risk pool. It was a pretty good policy, but it went from around $600/month to $1400/month over five years. Then I had to buy another policy for my wife and kids for about $600/month. That's a lot of money to me, and when the economy collapsed I could no longer afford the insurance. I went without insurance for 6 months to get a PCIP policy through Obamacare. That policy costs $507/month, but it will not pay out a dime until after I meet a $2500 medical deductible. There is also a $1000 deductible for diabetic supplies. After both deductibles, I still pay 20%. The line on well care being free is BS. Nothing I need qualifies. That's over $9000 per year before coverage even begins (premiums don't count as an out of pocket expense). It only covers 42% for my insulin which is $130+ per vial. Hell, I can get it from Canada for a %60 discount. Looks like the government will be making money on me until something really bad happens. Thanks to Obamacare, that will probably happen sooner than later.
Wow

Paris, TX

#12 May 6, 2011
I wonder if I can forego insurance on my car and then have covered repairs by purchasing insurance AFTER I wreck it?
Questions

Paris, TX

#13 May 6, 2011
Wondering wrote:
<quoted text>
A pre-existing condition means you didn't have insurance when you were diagnosed. Any reason you didn't? All I can say is, you took a risk and you got caught. Now you expect the taxpayer to subsidize your lack of planning. That's what's wrong with the whole Obamacare mess.
You got that right!
Questions

Paris, TX

#14 May 6, 2011
Incredulous wrote:
<quoted text>
And YOU are what is wrong with this country--you arrogant, self-righteous, ignorant, pos. To assume that everyone who is denied the benefit of healthcare vis a vis a pre-exisiting condition or because of some willful decision on their part is the most screwed up presumptuous thinking that I have heard in a while. Have you, or anyone in your very small circle of operation, ever been laid off or had a business close or a grant run out, or number of other likely scenarios in the current economic climate? Sometimes things happen in your life that are beyond your ability to control--like being laid off and discovering you have a heriditary illness that you didn't find out about until your COBRA than out. I feel more sorry for people like you than I do the person whose situation I just described. How much did you get for your heart?
I'll just bet the poster had internet service, cable tv, a nice car, cellphones, and assorted other unnecessary gadgets while he/she was risking going without insurance before he/she discovered he/she had a hereditary illness. And a hereditary illness makes you double dumb -- if you know you have a chance of a dire illness because it runs in the family, why would you not keep your insurance and let other unnecessaries go? Lack of insurance is most often a matter of misplaced priorities.
Questions

Paris, TX

#15 May 6, 2011
two kiss wrote:
<quoted text>
From what I see, there are ample Doctors that currently accept the plan, but of course not all. I just wonder if PRMC will. Anyone with PRMC have any info?
Here's a novel idea. Call PRMC and ask.
Questions

Paris, TX

#16 May 6, 2011
Government Mule wrote:
<quoted text>
I've been a type 1 diabetic for 34 years. I've been covered by insurance most of that time. I started my own business in 2004 and and stayed on COBRA until it expired. After that, the only policy available was through a high risk pool. It was a pretty good policy, but it went from around $600/month to $1400/month over five years. Then I had to buy another policy for my wife and kids for about $600/month. That's a lot of money to me, and when the economy collapsed I could no longer afford the insurance. I went without insurance for 6 months to get a PCIP policy through Obamacare. That policy costs $507/month, but it will not pay out a dime until after I meet a $2500 medical deductible. There is also a $1000 deductible for diabetic supplies. After both deductibles, I still pay 20%. The line on well care being free is BS. Nothing I need qualifies. That's over $9000 per year before coverage even begins (premiums don't count as an out of pocket expense). It only covers 42% for my insulin which is $130+ per vial. Hell, I can get it from Canada for a %60 discount. Looks like the government will be making money on me until something really bad happens. Thanks to Obamacare, that will probably happen sooner than later.
Knowing that insurance was vital to your well-being, why did you take the risk of starting a business until you were sure you could afford insurance? My spouse and I are retirement age, and we had planned on being retired now. But I have a chronic illness, and we've determined we better keep working so we can keep the insurance. We're not going to risk being uninsured when we know we're going to need it.
Questions

Paris, TX

#17 May 6, 2011
Wow wrote:
I wonder if I can forego insurance on my car and then have covered repairs by purchasing insurance AFTER I wreck it?
Yeah ... I think I'll drop my homeowners and run down and sign up when I see a dark wall cloud headed this way.
notmychoice

Mckinney, TX

#18 Jul 15, 2011
I am a type one diabetic. I was insured when I was diagnosed. I have always had insurance. I was laid off. My new employer does not offer insurance. I paid for cobra until it ran out. I do not qualify for insuance. What am I to do? I have no choice but to go for PCIP or the Texas plan. I am waiting the 6 months required with no insurance. I am a responsible person. I paid my premiums no matter how high...and still would, but I am an automatic denail. I repeat...I was insured when diagnosed and have never had a lapse in coverage.
curious

Blossom, TX

#19 Jul 15, 2011
hope and change????i'd rather have an enema at least you'd feel clean
curious

Blossom, TX

#20 Jul 15, 2011
once was enough dabit
AgentX

Paris, TX

#21 Jul 15, 2011
notmychoice wrote:
I am a type one diabetic. I was insured when I was diagnosed. I have always had insurance. I was laid off. My new employer does not offer insurance. I paid for cobra until it ran out. I do not qualify for insuance. What am I to do? I have no choice but to go for PCIP or the Texas plan. I am waiting the 6 months required with no insurance. I am a responsible person. I paid my premiums no matter how high...and still would, but I am an automatic denail. I repeat...I was insured when diagnosed and have never had a lapse in coverage.
Check and see if you have a six month Texas continuation right with the plan your Cobra was with. This is available if your plan was fully insured, not self funded. It alows for six more months of same coverage you had. Also, check with the Texas Health Insurance Risk Pool. Their rates are higher than the Obamacare plan, but you don't have to wait six months. No pre-existing if you had coverage with no lapse longer than 63 days.

http://txhealthpool.com/

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