Thursday, May 28, 2009 Sal asks

Q: Topomax -great product with disqualifying effects

I am in the process of applying for SS Disability for my bi-polar condition, which by the way is entering its third appeal. I am no longer able to work due to bi-polar, which is complicated by my migraines for which I take Topomax. I am trying to get individual health insurance coverage but have been turned down by every company that I contact. My COBRA will run out at the end of June and I am desperate to find medical/pharmacy coverage.

If I had known that Topomax would disqualify me for future medical coverage I would never have started its use. It's unfortunate that a medication which had helped to control my migraines (with little or no side-effects) has caused a side-effect that will follow me for a life-time........no medical coverage.

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Answers (2)

Nancy Harris Bonk, Health Guide

6/ 1/09 2:35pm

Hi Sal,

Why does Topamax disqualify you? I'm a bit confused here. I was just approved for SSDI after one denial and a hearing.

If you can give me some more details, I'd be happy to help.

Nancy

Sunflower

6/ 3/09 8:49am

Good morning Nancy: SSDI is different from indemnity insurance (regular major medical/basic medical coverage). I was just approved by SSD for benefits last Friday, (good news) it took nearly 18 months to get this. Now that I will be receiving my Award Letter (hopefully) in the next two weeks, I will be able to continue my COBRA for another 18 months. After 24 months I will be able to receive Medicare.

As for being disqualified by an indemnity insurance company: When speaking with them, the first question they asked was, "what medications are you taking?" My first reply was Topomax and then the agent stopped me and told me that Topomax was the first one listed on her list as a disqualifying medication. And then she informed me that stopping the medication wouldn't help at this point, because the insurance company looks back 10 years.

All I can tell you is that this one insurance company was not the only one to tell me it was a drug listed as a disqualifier for indemnity insurance.

Teri Robert, Health Guide

6/ 2/09 6:21am

I've never heard of being denied insurance coverage based on taking a particular medication. Ask them to end you a letter with their reasons for denying you coverage. It's likely to find that they're denying you based on bipolar disorder rather than the Topamax.

You might also check with your doctor's office to see if anyone there has any information on this. You can also look at your state's web site for a regulatory body that covers insurance. In my state it's the state insurance commission. They might be able to answer your question and give you some guidance since you're so close to the end of COBRA.

If I remember right, even after you're approved for disability, you don't automtically qualify for Medicare for a couple of years.

Please let us know what you find out?

Good luck,

Teri

Sunflower

6/ 3/09 9:31am

Hi Teri: I can only tell you what information was supplied to me by an insurance agent at the company(s) I contacted. Indemnity insurance companies are legally allowed to deny coverage for pre-existing conditions which they decide are disqualifying, each company has there own list. Unless you are receiving insurance through a group plan with an employer or as a dependent under your spouses insurance, pre-existing conditions are reviewed, as far back as 10 years in one insurance company's case.

I can only tell you what I've experienced in my search for a medical plan. Our state does have an insurance pool, however the cost of coverage is high...for someone my age it is close to $900 a month.

I have spent many weeks researching all sorts of plans, making many phone calls and inquiries, including contacting my state....I hit a brick wall on the subject.

Fortunately, I was approved for SSD last week and will be receiving my Award letter in the next few week, which will allow me to continue my COBRA for 18 months more.

I will then have 6 months without coverage until Medicare kicks in.

My intent, in calling attention to the disqualifying effect that Topomax has caused me, was to alert users of the chance they may experience the same problem when searching for insurance. I have found Topomax to be a miracle drug for me, but the unintended consequence was something I didn't expect.

Nancy Harris Bonk, Health Guide

6/ 3/09 11:25pm

Hi Sunflower,

Please keep us posted on this will you? I'm glad Topamax is working so well for you, but goodness, what will these insurance companies think of next to deny people of their benefits that they have paid for? I just don't get it....

Hang in there

Q: Topomax -great product with disqualifying effects

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