Pre-existing health conditions - health coverage in the US

[jenlou]

My fiance lives in the UK and I am in the US. He has been diagnosed with cancer and is currently receiving treatment in the UK. My question is, because he is covered in the UK, once he comes here would the US healthcare system be able to deny him coverage for any cancer treatment in the future because it was a pre-existing condition he had while in another country (even though he was covered when he lived in that country)?

I have looked all over the internet for information on this and cannot find anything. We want to be here in the US, at least for a while, but it doesn't make sense to do so if he could be denied treatment/coverage in the future.

Has anyone had any experience with this?

Thank you in advance for your help

[yankeegirl]

I'm really not sure, but some plans could deny the treatment. It depends totally on the insurance company and the and the particular plan.

It will be very difficult to find solid info on this. You might want to try to contact the American Cancer Society or a similar organization. Or even a social worker at your local hospital. Part of their job is to help patients and their families navigate the healthcare system so they might be able to help get you the info you need.

I haven't been in your particular situation, but my father had cancer, and even with insurance, some treatments were denied and those that were approved had huge co-pays. The social workers had helped him tap into various community resourses and got him into a drug trial since he couldn't afford the chemo. I don't really have much in the way of specific info, though, sorry.

Best of luck to you both!

[sakura]

I don't know much about the US healthcare system, but I am quite certain that companies will ask about current health and/or family related illnesses. If he falls into either one of these, it is likely they know he will claim - especially if he needs current and urgent treatment - and they might refuse him coverage. Since they are private companies, it is probably in their right to refuse coverage to people with pre-existing illnesses.

Healthcare in the UK is covered under the National Health Service (NHS)...most people use this and not insurance companies. If he is with a private provider, I don't know whether or not they cover people internationally...even if it is an international company.

Do be aware that, just because he has coverage in the UK (by this I think you mean the NHS?), it would not be of any use in the USA. The argument might be that, since he can have treatment in his own country - by and large free of charge - why should they pay for it for him in the US? If he cannot afford it in the USA, there is absolutely no risk for him to return to the UK for treatment there....

I don't know about public healthcare in the US (other than it doesn't exist much...), but yankeegirl's suggestion is very good...contact cancer organisations and ask them about it.

[jenlou]

yankeegirl and sakura, thank you both for such quick replies. I will contact the American Cancer Society today to start.

As for the additional details on his insurance. He had been using the NHS but switched to private for a preliminary surgery he had done when they had found a mass in his bowel (when the cancer was only suspected and not for sure). After that he continued to use the private plan for all his cancer treatments. Don't know if that would count any more towards saying he had previous coverage, but I appreciate any and all feedback.

Thank you both again. Means alot.

[sakura]

yankeegirl and sakura, thank you both for such quick replies. I will contact the American Cancer Society today to start.

As for the additional details on his insurance. He had been using the NHS but switched to private for a preliminary surgery he had done when they had found a mass in his bowel (when the cancer was only suspected and not for sure). After that he continued to use the private plan for all his cancer treatments. Don't know if that would count any more towards saying he had previous coverage, but I appreciate any and all feedback.

Thank you both again. Means alot.

He should contact his private insurers and ask them what type of coverage, if any, they provide if he were to move to the US.

[jenlou]

yankeegirl and sakura, thank you both for such quick replies. I will contact the American Cancer Society today to start.

As for the additional details on his insurance. He had been using the NHS but switched to private for a preliminary surgery he had done when they had found a mass in his bowel (when the cancer was only suspected and not for sure). After that he continued to use the private plan for all his cancer treatments. Don't know if that would count any more towards saying he had previous coverage, but I appreciate any and all feedback.

Thank you both again. Means alot.

He should contact his private insurers and ask them what type of coverage, if any, they provide if he were to move to the US.

GREAT suggestion! Thank you!

[Marco 72]

There is no single health care system in the US. There are various federal and state government programs, and there is private insurance. In the UK on the other hand there is the "National Health Service" (NHS), which in theory is supposed to provide "free" medical care to everyone who needs it.

The role of private insurance is different in the US and the UK. In the US the insurers are supposed to be the main provider of medical care, in the UK that role belongs almost exclusively to the NHS. In practice the NHS can be slow and inefficient, even sometimes for lifesaving treatment. So some people sign up with a private insurer (e.g. BUPA or AXA) which allows them to "jump the queue" and see a specialist or get treatment right away, rather than in a few months or a year. So I am not surprised that your fiance had to rely on his health insurance after he was diagnosed with cancer.

Do you have your own private medical insurance in the US? If so, you should ask them if they include coverage for existing conditions for spouses.

[jenlou]

There is no single health care system in the US. There are various federal and state government programs, and there is private insurance. In the UK on the other hand there is the "National Health Service" (NHS), which in theory is supposed to provide "free" medical care to everyone who needs it.

The role of private insurance is different in the US and the UK. In the US the insurers are supposed to be the main provider of medical care, in the UK that role belongs almost exclusively to the NHS. In practice the NHS can be slow and inefficient, even sometimes for lifesaving treatment. So some people sign up with a private insurer (e.g. BUPA or AXA) which allows them to "jump the queue" and see a specialist or get treatment right away, rather than in a few months or a year. So I am not surprised that your fiance had to rely on his health insurance after he was diagnosed with cancer.

Do you have your own private medical insurance in the US? If so, you should ask them if they include coverage for existing conditions for spouses.

Marco, thank you for the help. Yes, I do currently have medical coverage through my employer. However, I am a little hesitant to ask them as I'm concerned about putting unnecessary information out there which could hurt our case later. Is that silly? I've posted a question to the discussion forum on the American Cancer Society's page as well, however, judging by other posts from US citizens battling with their insurance companies in their own country, it does not look promising...

[Marco 72]

He should contact his private insurers and ask them what type of coverage, if any, they provide if he were to move to the US.

The answer will almost certainly be "none". Some UK insurers offer basic travel insurance, but that's not what the OP's fiance is looking for. I don't want to sound discouraging, but I don't think they have any chances of getting treatment for his cancer from a US private insurer either. Best thing might be to move to the US after he has made a full recovery.

[jenlou]

He should contact his private insurers and ask them what type of coverage, if any, they provide if he were to move to the US.

The answer will almost certainly be "none". Some UK insurers offer basic travel insurance, but that's not what the OP's fiance is looking for. I don't want to sound discouraging, but I don't think they have any chances of getting treatment for his cancer from a US private insurer either. Best thing might be to move to the US after he has made a full recovery.

Our plan right now is not to move until treatment is complete and he is clear. However, there is always a chance the cancer will recur, and that's really my concern with the insurance situation.

[Marco 72]

Marco, thank you for the help. Yes, I do currently have medical coverage through my employer. However, I am a little hesitant to ask them as I'm concerned about putting unnecessary information out there which could hurt our case later.

I don't think there's any reason for you not to ask. They'll most likely allow him to join your policy, just like my wife joined mine when she moved to the UK. However, it's almost certain that they won't cover him for any pre-existing conditions for a certain time. You should find out how long this is.

Our plan right now is not to move until treatment is complete and he is clear. However, there is always a chance the cancer will recur, and that's really my concern with the insurance situation.

It might be possible for him to retain some kind of residence in the UK, which would allow him to use the NHS in case his cancer recurs before the time he becomes eligible for treatment in the US.

[jenlou]

Marco, thank you for the help. Yes, I do currently have medical coverage through my employer. However, I am a little hesitant to ask them as I'm concerned about putting unnecessary information out there which could hurt our case later.

I don't think there's any reason for you not to ask. They'll most likely allow him to join your policy, just like my wife joined mine when she moved to the UK. However, it's almost certain that they won't cover him for any pre-existing conditions for a certain time. You should find out how long this is.

Our plan right now is not to move until treatment is complete and he is clear. However, there is always a chance the cancer will recur, and that's really my concern with the insurance situation.

It might be possible for him to retain some kind of residence in the UK, which would allow him to use the NHS in case his cancer recurs before the time he becomes eligible for treatment in the US.

great information! thank you! I will call them tomorrow and see what they say!

[sakura]

He should contact his private insurers and ask them what type of coverage, if any, they provide if he were to move to the US.

The answer will almost certainly be "none". Some UK insurers offer basic travel insurance, but that's not what the OP's fiance is looking for. I don't want to sound discouraging, but I don't think they have any chances of getting treatment for his cancer from a US private insurer either. Best thing might be to move to the US after he has made a full recovery.

I agree but I meant in terms of whether they were an international insurance company, if they offer tranfers, reduced rates, etc...

I also don't think it is possible, but better to ask and get an answer from them.