When Jay and I got our Humana policy, Jay had a pre-existing lipoma on his back. So his policy has a lipoma exclusion. A couple years ago, he decided to get the lipoma removed, which was a relatively simple procedure, but a billing circus. We paid for it ourselves, since it was excluded on our policy. We would have paid for it ourselves anyway, since we have a high deductible HSA qualified plan and the charges would have been less than our deductible. But since it was excluded, the money we paid didn’t count towards our deductible at all.
We spoke with an underwriter at Humana who said that we had to wait at least 12 months after having the lipoma removed, and then have a doctor write a letter stating that it was gone. We finally got around to having that done last week. Jay got a note from a doctor here in Broomfield that says that the lipoma is gone. We also have a copy of the receipt from the original removal procedure. Tomorrow we’ll submit the paperwork to Humana, and hopefully the lipoma exclusion will be deleted from our policy soon.
It’s a lot of hoops to jump through, but if you have an individual health insurance policy in a state like Colorado that allows pre-existing condition exclusion riders, you might want to double check to see if your rider can be re-evaluated. Most carriers in Colorado require that the condition be resolved (treatment and symptom free) for at least a year before you can request a review of the rider. Some exclusions will never be removed, like the internal fixation rider on Jay’s arm. He has a titanium rod in his arm from a snowboarding accident years ago, and as long as the rod is in his arm, the exclusion will remain. Since the rod is permanent, so is the exclusion.
But other exclusions can be subject to review once a condition is resolved. The same applies to someone who quits smoking. If you pay tobacco rates on your individual health insurance policy and then quit smoking, you can request that your rates be reduced. Most carriers in Colorado require that you be smoke-free for 12 months before the rate can be lowered, but it can make a significant difference in the premium, and is definitely worth pursuing.