Ok, TheLION’s company is changing insurance carriers, to THIER own plan ! Gad, it just sucks.
Because of this change I will not be able to afford to have a liver biopsy that I need badly, so therefore will most likely be unable to start the combo. treatment for hepitias C.
They are offering no alternitive plan, no better coverage. Nothing.
They say I can even use Cobra to keep the HMO we have now.
I am afraid this new plan may well cost me my life people. We (Lion and I) have tried to explain this to his employer, the basic responce is, tough.
No I don’t want sympathy, just advice or answers or something
“Ayesha, Who can bend minds with her spoon” sig. by WallyM7 profile by UncleBeer, thanks guys.
What kind of plan are they offering, that doesn’t pay for liver biopsies? What’s the reason they’re giving that the biopsy won’t be covered? In what state do you live, and have you spoken with the Office of the Commissioner of Insurance? I’d be careful about relying on COBRA, because a) I’m not sure that you’d be eligible if his employer is offering a “comparable” plan and b) if you can go on COBRA you’ll be limited to 18 months of coverage (for which you’ll be paying full premium) and you may be unable to then go on the new insurance plan or at least be subject to a waiting period.
I was hoping to find a solution for you under HIPAA (Health Insurance Portability and Accountability Act of 1996). Unfortunately this law doesn’t seem to be helpful in your situation. HIPAA is federal, though, and your state may offer additional protection. As Otto says, you need to contact your state’s Commissioner of Insurance (or whatever department name your state has.
Here is some relevant information about HIPAA from
[urlhttp://webmd.lycos.com/content/dmk/dmk_article_5962879
In a situation like this, post however upset you want to. No one is going to give you grief over a typo. I hope someone can offer you some assistance in dealing with this problem. Good luck to you.
I will be covered, but the way this insurance (see , I did learn to spell one new word right this week, of course I forgot how to spell others ) works I won’t be able to afford it. I would have to come up with, $1,500.00 deductable, then a $100.00 copay, then 20% of the cost of the proceedure, hospital drugs ect… Man this truely stinks, on ice even .
I was hoping someone could tell me a way to be able to keep my HMO, but there is just no way.
“Ayesha, Who can bend minds with her spoon” sig. by WallyM7 profile by UncleBeer, thanks guys.
Most such plans have an out-of-pocket maximum, a maximum amount (either per year or per procedure) that you are required to shell out, and then the plan picks up 100% of costs thereafter. So, check to see if there is an out-of-pocket maximum.
Assuming there is, you’ll have some fixed amount – usually a couple thousand – that you might have to come up with. If you can’t afford that, it’s usually possible to find a loan, perhaps from the employer, perhaps from the 401(k) plan if nothing else. (Loans from the 401(k) plan are a bad idea financially, in the long run, but if all else fails, it’s a resource.)
Don’t despair.
Or you could move to Canada or the UK where this would all be covered under the provincial/national health care programs.
On an individual plan she would have to pay a lot more in premium and would still probably have a deductible and copays. But probably not as much as the new plan. $1500 deductible? Jesus! With the pre-existing condition, I know the HMO I used to work for wouldn’t have put her on an individual plan, but she would have been eligible for what we called a “conversion” plan. Larger deductibles and copays but still not approaching $1500.
I can only speak for Wisconsin, and I don’t know if this is based in federal law, state law or regulation, but the general rule is that the only time the former plan is required to pay after the plan terminates is if the member is in the hospital. The former plan is responsible for costs until the date of discharge. Check with the plan you’re on to see if this is the case, and if so, try to get admitted before the term date of your existing plan. Be careful, though. If you transfer from one facility to another, even if transported by ambulance for reasons of medical necessity, your old plan may be off the hook.
Do NOT under any circumstances rely on what the hospital tells you regarding your insurance coverage. Hospitals deal with dozens of different insurance companies and each company can have hundreds of different variations on their plans. There is simply no way that hospital personnel can keep track of it all. Your current HMO should have a customer service department. Call there.
CKDextHavn, uh the maximum for this company is {gulp} 4,500 .
See this isn’t a regular insurance company.
It is a plan Lions company put together themselves. And there is no plan A, plan B or plan z, type thing to pick from.
And I did call the old HMO, no chance of going with them alone.
So I am going to go with the flow, and pray for the best. That is all I can do.
I guess I could go into the hospital, but I would have to hurt myself really bad to do that. And I like me to much for that.
OK enough for my soap opera life. I am done whining.
“Ayesha, Who can bend minds with her spoon” sig. by WallyM7 profile by UncleBeer, thanks guys.
<< CKDextHavn, uh the maximum for this company is {gulp} 4,500 . >>
Look, I know that’s a big hit, but it’s not the end of the world. You can get a reasonable interest loan to pay for such an amount. Heck, you could probably put it on a credit card, but I don’t suggest that because their interest rates are outrageous. Check with your bank, your employer, your union, your credit union, whatever resources are available.
But if you’re talking about needed medical care (and your initial post implied a potentially life-threatening situation), don’t let this amount stop you.
Yes, it’s steep. Yes, the change in plans by your employer is aggravating and costly for you. But your initial post made it seem that you’d have to come up with hundreds of thousands of dollars. A total out-of-pocket of $4500 is certainly on the high end, but it’s not out of reach. Please, don’t confuse frustration and aggravation with affordability, don’t fail to get the health care you need.
) works I won’t be able to afford it. I would have to come up with, $1,500.00 deductable, then a $100.00 copay, then 20% of the cost of the proceedure, hospital drugs ect… Man this truely stinks, on ice even .