Cover mental disorders? Golden Rule insurance

[pentagon]

I have just recently purchased the "Plan 100" from Golden Rule including the prescription card.

I was reading through the brochure and noticed on page 27 under "General Exclusions and Limitations"

Covered expenses will not include, and no benefits will be paid for any charges which are incurred:

(AA) For treatment of mental disorders, ... except as expressly provided for by the policy

I have an anxiety disorder and would like my insurance to cover these expenses. I purchased the "prescription card" as well to help with the cost of medication, but this being a mental disorder I am not sure if they will cover anything at all now. Does anyone here know anything about this? I guess I will have to call them if no one knows.

Thanks!

 

[Crabcake Johnny]

What state are you in?

 

[Crabcake Johnny]

In MD this is the mental benefit clause:

"All diagnoses or treatments of mental disorders, as defined in the policy, including substance abuse, will be limited to a lifetime maximum benefit of $3,000 (not covered in Saver Plans, subject to state variations). Covered expenses for outpatient diagnosis or treatment of mental disorders will be further limited to $50 per visit. As with any other illness or injury, inpatient care which is primarily for educational or rehabilitative care will not be covered."

Saying that, I'm quite familiar with Golden Rule's underwriting and normally your anxiety would be "ridered" or excluded. Did you note on the application that you had anxiety and were on medication? And if you did, check your policy since you might have rider that you didn't even notice.

 

[somarco]

The Rx card is an added expense that I would never put on a GR policy. Plan 100 is fine just like it is.

I have to agree with John. If you listed anxiety & your meds on the application then chances are good the condition is ridered so no coverage. Other carriers will cover anxiety with as much as a 50% surcharge to your premium.

Did your agent assist in completing the application? Did you fully disclose everything to your agent and to GR?

 

[pentagon]

Florida

I am not on medication at the moment, but would like to be. I did not list this on my application, because I have not been officially diagnosed, nor have I ever taken the medication.

I wasn't sure about the prescription card addition, I am new to health insurance and I applied for insurance over the internet, so I did not speak with an agent. Is it easy to have this prescription card removed from my policy? I don't completely understand what it even does...could someone enlighten me? I was under the impression that it would bypass my $1500 deductible on medications...but I'm probably wrong.

Thanks again.

 

[J.R.]

Florida

I am not on medication at the moment, but would like to be. I did not list this on my application, because I have not been officially diagnosed, nor have I ever taken the medication.

I wasn't sure about the prescription card addition, I am new to health insurance and I applied for insurance over the internet, so I did not speak with an agent. Is it easy to have this prescription card removed from my policy? I don't completely understand what it even does...could someone enlighten me? I was under the impression that it would bypass my $1500 deductible on medications...but I'm probably wrong.

Thanks again.

Out of curiousity, how do you know you have an anxiety disorder because you have not been diagnosed? BTW, there are alternative treatments for anxiety depending on the severity of the condition.

 

[Crabcake Johnny]

Florida

I am not on medication at the moment, but would like to be. I did not list this on my application, because I have not been officially diagnosed, nor have I ever taken the medication.

I wasn't sure about the prescription card addition, I am new to health insurance and I applied for insurance over the internet, so I did not speak with an agent. Is it easy to have this prescription card removed from my policy? I don't completely understand what it even does...could someone enlighten me? I was under the impression that it would bypass my $1500 deductible on medications...but I'm probably wrong.

Thanks again.

Once you get your policy, if you go to a doctor and request anxiety medication Golden Rule will most likely immediately rescind your coverage and refund any premiums you paid. You do indeed have a condition that you didn't make Golden Rule aware of whether you've seen a doctor or not - so basically you don't have a policy. You absolutely cannot get insurance and plan on using it to seek treatment on a condition you didn't note on the application.

 

[K-Dub]

What John just said is completely true! Why do so many people self diagnose themselves? They see something on TV and say, I've got that!

Another thing....drugs are not good for you! I'd recommend what SalPro said and do the alternative method. Go outside, look at the sunshine, smile...sure beats taking meds that kill you! Of course all this is just my opinion!

 

[somarco]

You can ask GR to remove the Rx card if you are still within the 10 day free look (or whatever FL requires) period.

Q 23 (on the GA application) asks:

In the last 10 years, has any applicant had any KNOWN INDICATION, signs, symptoms, diagnosis or treatment of:

. . . . mental, emotional or behavorial disorder.

Either you answered that question truthfully, or you did not.

Sounds to me like there was a material misrepresentation of the facts.

FWIW, you can go back to GR and plead your case and maybe they will place a rider on the plan retroactively. Most likely they will suspend coverage until you have a diagnosis.

Or . . . you can apply to another carrier with FULL DISCLOSURE and they will reject your application pending a diagnosis.

Did you misunderstand the question on the application, or did you intentionally choose to manufacture an answer to get coverage? A good agent (and we have one on this board from FL) would have helped you through the process, assuming you were honest with him. You do not pay extra for the services of an agent. You may have made a big mistake by submitting a false application, or you may be able to work it out by paying for your treatment out of pocket.

 

[Crabcake Johnny]

Well, I don't want to get into whether or not someone needs medication. There are physiological, not just phychological, mental/nervous disorders that need to be treated with medication.

When you fill out any application there's a question about whether or not you're having any symptoms:

The answer to this question should have been yes. Here are your options:

1) You say nothing and think you'll just get away with seeking treatment for a condition you didn't note on the app. 100% chance your policy is rescinded.

2) You call Golden Rule and tell them the truth. They will cancel your policy and hold off on re-issuing it until you get a formal diagnosis.

3) You apply to another insurance company and tell the truth and they won't underwrite you until you get a diagnosis.

You cannot diagnose yourself with a medical conditon - you're not a doctor. If you know something's not right you simply need to see a doctor first - not run off and get health insurance.