Insurance refuses to pre-certify my 4-year old saying AVM is congenital, what should I do?

General
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Hi everyone. My 4 year old son had a hemorrhage 2 months ago, and was diagnosed AVM. We live in China and I have got an international insurance for him, covering the US, and is supposed to cover up to $ 5 mln. We’ve been offered a MRI, angiogram, embolization and surgery by the Boston Children’s Hospital. However, I was informed that IMG (the insurance company) has refused to cover any of the above mentioned treatment. The customer service lady told me “because what your son have is a congenital defect.” (She may not mean it, but I felt so discriminated and almost burst out in tears.)

My son is a US citizen (we’re not) so I’m thinking about getting a local insurance for him. But do all insurance companies say no to congenital disease? How have you managed to have your surgery bills covered?

I feel so sad and helpless.

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Hi findjia, I think technically the AVM is something people are born with. I would get the details of your insurance policy and look at that very closely. Typically insurance policies have issues with pre-existing conditions. In your case this is not a known pre-existing condition as your son was just diagnosed while having the insurance coverage in place. I am not an expert, however, I would not give up and you should find someone in china that can help you navigate the policy. Hang in there and don’t give up.

jeff

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Many people in the US have their treatment covered by their insurance. It is true that an AVM is considered mostly a congenital condition.

So I am sure that by shopping around, you should be able to find health care cover in the US that would cover an AVM.

I’m in the UK so I can’t give you specifics.

Very best of luck,

Richard

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In medical language most every AVM is a congenital condition. It happens during pregnancy. I don’t know how one could acquire an AVM post birth.

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Get local insurance NOW. I say now because it is currently “obamacare” open enrollment which only takes place 6 weeks a year. US insurance cannot discriminate based on pre existing (congenital) conditions anymore. Goto healthcare.gov and sign up for a platinum(most expensive) plan

Hope this helps. Good luck

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My unsurance (Axa) first rejected the claim for embolization saying AVM is a congenital desease. However, my surgeon argued that this is in no way proven as some AVMs develop later in life. Axa paid all treatments in the end. Good luck:-)

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@findjia I am so sorry you have to deal with this - Like you dont have enough to worry about-
Contact the hospital for a social worker to help you- also the suggestion to sign up for Obama care is a good one you have until the end of the month but dont wait until the end of the month
also it wont cover everything so also call the hospital finance dept and see if you can sign up before for financial aid- Good luck and dont stop fighting! Let us know how it goes!
hugs
Angela