Hypertension and Insurance Coverage

[rexall]

Hi all,

I would love to hear from you guys who have similar situation to me with these criteria

1. Have hypertension
2. Signed up for Aetna, and disclosed your hypertension on the application.

3. Got the exclusion “any treatment of high blood pressure and it’s complications.”

4. Years later developed some heart or coronary artery disease that required treatment.

 

It is unimportant that Aetna excludes hypertension specifically because the direct treatment for that involves affordable medication and lifestyle modification.  What I am concerned about is the “and it’s complications” which could be interpreted very broadly.

 

QUESTION:  If you meet the above criteria and needed treatment—say angioplasty or a stent—did Aetna deny coverage based on the hypertension exclusion?   I should have dealt with this more aggressively when I signed up with BUPA 11  years ago, but I was racing to get in before my age excluded me from getting a non-cancellable policy. However, now I am concerned that I may have screwed myself.  At the time, no one was willing provide more than vague answers about how broadly the exclusion is applied.

If these criteria don’t apply to you, but you generally have knowledge about how the insurance industry works, in your experience is the “and ‘its complications” is used to deny treatment for heart disease?

 

Thanks everybody for your feedback.

 

 

[ozimoron]

It's why I don't bother with health insurance. Anything likely to put me in hospital is going to be connected somehow to hypertension unless it's an accident.

[Tom H]

Forget health insurances. Save the money and use it later :).

 

Edited December 29, 2022 by Tom H

[scubascuba3]

Good chance they will deny claim hence the vague exclusion, have money on standby to pay, stent at govt hospital less than 100k i think

[Sheryl]

Cardiovascular disease is a known complication of hypertension. As is kidney failure.

 

Pretty much any insurer with an exclusion so worded, would exclude treatment of coronary artery disease, stroke, kidney failure.

 

If at the time of application your BP was well controlled on medication it is possible (but not 100% sure) you could have avoided such an exclusion by going with an international insurer like Cigna.

[Celsius]

Here's a direct answer to your question with no guesswork. Had insurance with Aetna with pre existing condition(nothing serious). Got denied a procedure which was in no way even remotely connected to the pre existing condition. Since then I don't bother with insurance at all. Even if I could fight it is it even worth the stress lying in a hospital bed hoping for these bloodsuckers to pay?

[rexall]

3 hours ago, ozimoron said:

It's why I don't bother with health insurance. Anything likely to put me in hospital is going to be connected somehow to hypertension unless it's an accident.

Yeah, hence my black hurmor:  Better pray for cancer.

[rexall]

Thanks guys.  Unfortunately, it is what I expected and am getting conformation of elsewhere.  I only had an initial diagnosis last year.  Next month, will go to Sirikit heart center in Khon Kaen to see how far the thing as progressed, and what the treatment options are, if any.  OP said stent (assuming that is even an option) at govt horsepitaal less than B100K.  Will have to investigate.

Any Americans travelled to Guan so to use Medicare coverage?  That's an option, but I hear the medical care there is <deleted>, and all the Guamanians go the the Philippines for serious medical stuff.

I guess Hawaii would be the next closest.  That was the last place I lived in the U.S.  although more than 20 years ago. That is an option, but I don't have cash reserves otherwise I would just go to Banglumung or some other fancy-schmancy place and pay for it out of pocket. 

[internationalism]

you don't have to have treatment at the top private hospital. You can do all at the governmental hospital where you were diagnosed.

 

[Sheryl]

3 hours ago, Celsius said:

Here's a direct answer to your question with no guesswork. Had insurance with Aetna with pre existing condition(nothing serious). Got denied a procedure which was in no way even remotely connected to the pre existing condition. Since then I don't bother with insurance at all. Even if I could fight it is it even worth the stress lying in a hospital bed hoping for these bloodsuckers to pay?

 

if in fact your pre-existing condition was not a risk factor for what was denied coverage, then yo ushould appeal this to the Insurance Commission.

[Sheryl]

5 hours ago, rexall said:

Thanks guys.  Unfortunately, it is what I expected and am getting conformation of elsewhere.  I only had an initial diagnosis last year.  Next month, will go to Sirikit heart center in Khon Kaen to see how far the thing as progressed, and what the treatment options are, if any.  OP said stent (assuming that is even an option) at govt horsepitaal less than B100K.  Will have to investigate.

Any Americans travelled to Guan so to use Medicare coverage?  That's an option, but I hear the medical care there is <deleted>, and all the Guamanians go the the Philippines for serious medical stuff.

I guess Hawaii would be the next closest.  That was the last place I lived in the U.S.  although more than 20 years ago. That is an option, but I don't have cash reserves otherwise I would just go to Banglumung or some other fancy-schmancy place and pay for it out of pocket. 

Stent cost will depend on number of stents involved (if stent is required -which you will not know until angiography, if indicated, is perfromed). In a government hospital, the main cost is for the stent device itself.

 

BTW Banglamung is a government hospital and hardly "fancy-schmancy". Also probably does not do stents as it is just a district  hospital.

 

Sirikit Heart Center is very good. I doubt it would cost more than care under Medicare taking onto account air fare etc.

[Liverpool Lou]

3 hours ago, Celsius said:

Here's a direct answer to your question with no guesswork. Had insurance with Aetna with pre existing condition(nothing serious). Got denied a procedure which was in no way even remotely connected to the pre existing condition.

"...no way even remotely connected to the pre existing condition".

Without anything detailing that, you have not given a "direct answer" that has any credence.   Reads more like an "insurance-bash" and sure isn't evidence of anything.

[BigStar]

23 hours ago, Tom H said:

Forget health insurances. Save the money and use it later :).

 

Just use a GoFundMe, as we often see here.

[Celsius]

17 hours ago, Liverpool Lou said:

"...no way even remotely connected to the pre existing condition".

Without anything detailing that, you have not given a "direct answer" that has any credence.   Reads more like an "insurance-bash" and sure isn't evidence of anything.

 

What does it matter? I could make up a a few unrelated conditions on the spot. Would that make me more credible? Would that pass as evidence?

 

However, the Thai insurance story is mine and completely 100% correct. I know I could appeal it, but why would I waste time on this nonsense? I would rather self insure. This way I am in control and everything is 100% on me.