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Dealing with Outstanding Medical Bills and Coverage for Screening Procedures, and Preexisting Conditions

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Last Modified: November 1, 2001

Dear OncoLink "Ask the Experts,"
I am a 33 y/o white male with a history of testicular cancer treated with chemotherapy followed by lymph node dissection. I have been in remission since Dec. 1993. At the onset of my disease, I did not have insurance and was treated as an indigent patient. Currently, I am left with a large number of unpaid bills. I would like to obtain information/advice in the following areas:

1. how to deal with medical bills, and more importantly

2. is there any way to obtain a medical insurance which covers my screening costs for my pre-existing condition.

I would appreciate any comment or information.  
Thank you.

1. How to deal with outstanding medical bills

Many hospitals and physician offices have policies and/or funds set aside to assist indigent patients with outstanding bills. We suggest that you make arrangements to personally discuss your circumstance with both the hospital's and physician's business offices. In many cases, hospitals and physicians are very willing to work out significant discounts and/or very reasonable long term payment arrangements. In attempting to negotiate a discount, we suggest you use the amount that they would have received through your state's Medicaid program as the target. In addition, if you received coverage through your state's Medicaid program, then both physicians and hospitals are subject to certain restrictions regarding the collection of fees over and above the amount paid by Medicaid. These restrictions will vary by state, and we suggest you contact your state's medicaid office to determine the applicable policy.

2. Coverage for screening costs:

Insurance coverage for screening costs will vary by insurer. Contact the provider relations department of any insurer you are considering to determine their policy regarding coverage for screening exams and tests. Make sure you get the information in writing.

3. Pre-existing condition:

On August 22, 1996, President Clinton signed the Health Insurance Portability and Accountability Act of 1996, also known as the Kennedy-Kassebaum Bill. A major provision of the act calls for the limits on preexisting condition exclusions. Insurers may not deny coverage or impose preexisting condition exclusions for more than 12 months for any condition diagnosed or treated in the preceding 6 months. (1) This 12 month exclusion is a lifetime limit: no new preexisting conditions may be imposed on anyone who maintains continuous coverage (i.e., no more than a 63-day gap in coverage).