Insurance Denial due to PANDAs

[Gibster]

Just wanted to give you guys a heads up. My son was diagnosed with PANDAs in 2006 (Dr. Latimer) and has been successfully treated since then with various medications. Currently he is being successfully treated with clonidine (he is a sudden tic onset). In 2006 we were all covered under my employer health insurance. In 2008 I decided to stay home and my husband started a consulting business. At that time we secured our own health insurance -- going through the entire underwriting process with no problems -- but were paying $1400 a month. In 2009 we decided to figure out a cheaper way to insure our family, went to underwriting again. This time the insurer did a rider to exclude our son's PANDAs including doctor visits, medication, etc. -- basically everything related to his condition. We were ok with that and in addition it cut our costs down to $700/month. Since his clonidine is only $15 a month and he doesn't require more than 1 visit to the neurologist a year this saved our family quite a bit every month even paying out of pocket.

 

Fast forward to March 2010. Our current insurer notified us that they were going out of business and we had 30-45 days to secure new coverage. We have searched in vain to get new insurance. Not only for our son with PANDAs but for the rest of the family. We have currently been denied by three companies due to son's PANDAs. Each have reviewed his medical records and gave us some bogus reason (Tourette's, anxiety, ADD -- clearly they are diagnosing him with these things since no one in the medical community has!). The biggest change from before is that now they are denying our entire family instead of excluding just his condition.

 

We have 1 more insurance company to work with before we have to toss him into the uninsurable pool by himself while we all trot off into regular insurance. At what cost we don't know.

 

I can give you more details if you need (yes, the pre-exisiting kids coverage is coming in Sept as long as you don't have a two month gap in your insurance!) but I just wanted you all to be aware of what is going on out there if you find yourself trying to buy insurance.

[memom]

Gibster,

 

Thanks for the heads up. I am so sorry this is happening for your family.

This is why we need to fix the healthcare insurance crisis. I am worrying about being cancelled with our insurance. The healthcare bills have been mounting because of the Pandas. Good luck. Keep him insured any way you can until the new laws go into effect. Also, make sure you get someone who knows about the new laws to give you advise.

 

Ellie

[tpotter]

I don't care what others say, but this is exactly why this country needed health care reform. Unless you find yourself in these kinds of problems, you can't even begin to imagine what it's like! And, I know my children are going to be very difficult to insure when they are adult. They'll be able to get insurance (because of reform), but, again, at what cost?

 

Good luck. Keep is informed.