Insurance Poll

[kevin21]

Hi Everyone,

My wife is having our son soon and she is thinking about staying home until he is older, like 1 1/2 to 2. Then we can send him to pre-school or something else. Problem is that she is the one with health insurance since I'm self employed.

I know you can be on COBRA for up to 18 months. So I'm okay for that long.

Problem is that I can't find a carrier that will do an individual policy and cover my heart issues.

Has anyone had any success finding an individual plan either before or after surgery for valves?

Are most people here on employer group plans?

Are there any small business or self employed persons that have small group plans that cover their cardio issues??

Thanks in advance!! This is becoming a real nightmare.

 

[Peggy in Alaska]

Insurance Woes

Insurance Woes

Hi:

I do not envy your task at hand. I thank my lucky stars that I was in with the Feds. long before my heart defect was diagnosed, but I worry daily about what will happen if my boss retires early and I have to leave federal service before I am eligible for full retirement benefits. So you can see I am in an employer health plan and luckily my husband has an employer plan [both Blue Cross] so we are pretty much covered. My girlfriend's federal job was abolished effective Oct. 1, 2004 so she has been in cobra to maintain her federal health insurance coverage, and it is extremely expensive.

You have to juggle the pros and cons - wife stay home with the child for an extended period of time, or have her take a shorter time off to maintain her insurance coverage. I would opt for the coverage. But I am extremely practical, and paranoid.

Good luck. Maybe there is someone here that has found individual plans that will work for you.

Take care.

 

[kevin21]

I'm with you on the coverage. She doesn't really like her job and I think she thinks that she can go and get another job before the COBRA would run out.

My problem really isn't the high cost (about $1000 a month) it's the insurability of my heart. United health care couldn't tell me for sure if they'd exclude my heart issues or if they'd have a 2-5 year waiting period or if they'd even insure me period.

I just worry that come that 18th month I'll be SOL.

I might have to finagle a group plan through my business... Heck, I might have to go work at Wal Mart just to get me some insurance!!

It sucks that even if you're willing to pay $1000 a month that you can't get coverage!!

 

[kevin21]

Check out Humana.

I just called them but it looks like they would exclude me from my heart coverages... The Aetna rep told me that if you haven't had surgery in the last 10 years then they might consider me. Problem is that they'll do a medical history and I'm sure they'll see that I need surgery soon. I also don't want to apply now since I really don't need the coverage yet...

This sucks!!

I think I'm going to have to go the group route, somehow...

 

[Peggy in Alaska]

It does suck!

It does suck!

It does suck that even if you are willing to pay $1,000 a month, you can't get someone to cover you. I have not heard of a 2-5 year waiting period to get pre-existing conditions covered. That is outrageous! I would say 6 months or maybe 1 yr., but not 2-5 years!

It drives me crazy the way insurance coverage works. Blue Cross won't pay for my vaccination for hepititis before I go to Mexico, but they'll pay for all the costs associated if I do contract the illness after the trip! Doesn't make sense to me.

I'm sorry, I hate the insurance companies, and smile everytime they get hit with a bad faith insurance claim, and I've seen plenty because my hubby is an atty. Any time his firm makes an insurance cough up money, I celebrate [even though it most likely means an increase in my premiums] because I hate them! It takes them months sometimes to pay my benefits, they lose claims all the time, they send checks to the doctors when I've paid and the benefit check should have been sent to me! This is a very sore spot with me!
Crooks, that's what they are.

 

[tobagotwo]

The answer may lie in the HIPAA laws. The key is the "P," which is supposed to stand for "Portability."

There are a number of HIPAA sites, and at least one run by the government. The point is that you should be able to bridge from the COBRA to the next insuror. The problem is that I'm not sure how that works for you, if the insurance was your wife's. If you purchase insurance, it may have to be in your wife's name to qualify.

This government site has FAQs and a pretty good breakdown of the laws - and I believe there is a place for questions: http://www.cms.hhs.gov/hipaa/

Best wishes,

 

[MelissaM]

Sorry you are having such a hard time with insurance. Group insurance might be the way to go.

I had invididual converage while self-employed, which I've kept in place, even though I am now working FT for a company (didn't want to be 'locked in' to their insurance). BUT I didn't have disability insurance. When I started looking into it post-op, I was told that I couldn't get it as an individual, but if I hired someone at least part-time, I would qualify for group insurance, some of which don't have any sort of pre-existing condition clause.

Do you have a friend/relative/wife that could help you on a PT basis? That might be your best bet.

Melissa

 

[LUVMyBirman]

The key is not to let your coverage lapse. As Bob pointed out...the new law put in place for portibility will cover you in that regard. We have moved ins cos. many times since my surgery and never had an issue rolling from one to the next with my pre-exsisting.

 

[Gnusgal]

The key is not to let your coverage lapse.

I wanted to stress Gina's and Bob's point one more time. From my understanding, if you have not had a lapse in coverage, insurance companies are not allowed to put a waiting period on your pre-existing conditions. I've had to worry over this my entire semi-adult life (starting in college) and had to direct my career goals towards fields which would have good insurance plans. While it would have been fun to go into acting or stage managing professionally, I knew that teaching would provide me with the insurance coverage I needed. Unfortunately, that's our reality... My husband has also started thinking this way and it is part of the reason he has decided to go into nursing. He knows he will have a steady job with insurance if/when the time comes that I cannot work and cover myself. He wasn't as sure of that when he was working in computer programming.

 

[McCln]

I agree with those saying best to stay with group. At least, not having to change doctors. It is expensive, but worth it to get care. Good luck and hang in there, adn welcome. I did cobra a few years ago, long before surgery. It is harder to get individual insurance with a pre-existing condition anyway. Hang in there.

 

[karenm]

Another option

Another option

I have to echo the "don't let it lapse" comment. Even if that means COBRAing for a few months while you get coverage.

As far as finding coverage for self employed, I work for a four person business and researched this in July of 2004. I found two places that might be interesting for you as a self employed person - NASE, National Association of the Self Employed has a plan that you can buy a level that you want (kid of a cafeteria package.) Be careful to pick carefully as a person I know that had them ended up a little under covered. Another option is Costco, which has insurance policies for their corporate members. This might be an option if you have a business license. Please feel free to e-mail me or send a private message if you want me to find more details.
~Karen

 

[Guest]

This is becoming a real nightmare.

*nods*

That certainly is one way to put it.

*sighs*

Insurance is a hot-button topic for many people. Currently, I'm in one of my employer's plans ... of course, it is the most expensive plan, but it's the only one in which both my main doctors (PCP and cardiologist) participate. It's a PPO, not an HMO. On the plus side, it does allow for out-of-network benefits, if so needed.

UInfortunately, health insurance (and other benefits) are keeping me from some of my more desired jobs with other companies. I've debated just taking the chance, but I just don't want to do that...that would certainly cause more frustrations and stress than needed.

I hope you are able to find an acceptable and workable option for you. It's tough...and, of course, it's toughest for those that need insurance the most .


Cort, "Mr MC" / "Mr Road Trip", 31swm/pig valve/pacemaker
'72/'6/'9/'81/'7, train/models = http://www.chevyasylum.com/cort/
MC Guide = http://www.chevyasylum.com/mcspotter/main.html

 

[Susan BAV]

My husband changed employers several years ago and we went on the COBRA plan for eighteen months and then I went directly on to the HIPAA plan, by myself. BE SURE YOU DO NOT ALLOW A LAPSE IN COVERAGE; THIS CAN RUIN YOUR CHANCES OF REMAINING INSURED. So my insurance is separate from the rest of my family. And we pay quite a puddle of money for it, but it has been well worth it. I recall that I had to provide a letter of denial to the HIPAA people from another insurance company -- no problem getting that...

 

[kevin21]

Well,

Looks like insurance companies can't deny a person in "group" coverage due to pre-existing or health issues. They can raise the rates but only a max of 67% from base rates.

The real issue is "are you a proper group?". Looks like this is where underwriters try to mess you over and deny it because of the "group" deal.

If my wife comes to work for me, at 30 hours a week, and I put her on a w-2 with the state and fed. gov. then we are a "group." This is something that I guess I'll have to get help on and fortunatley we have friend that specializes in selling health insurance.

I'll keep everyone posted on how it works in case you need some help!

Keep any recomendations coming in here so we can all learn.

I'm going to try to find the state risk pool but I'm scared that the coverage is crappy and that my docs might not take it! BOOOOO!!!

 

[Susan BAV]

Hi Kevin -

I replied to your private message but just had a few extra minutes to look up that information for you and will post it here:

HIPAA is health insurance reform called "Title I of the Health Insurance Portability and Accountability Act of 1996." You can access information at the following link: http://www.cms.hhs.gov/hipaa/

I hope this helps!

 

[kevin21]

Looks like I can get into the state insurance pool. It is underwritten by Blue Cross/ Blue Sheild and is pretty much an 80/20 plan, PPO.

It looks like it's about $400 a month for a $500 deductible plan.

It pays up to 1.5 million lifetime. I guess that's okay, if it's my only choice.

I'm going to stay on my wife's coverage and COBRA thereafter and then go to the risk pool if I need to.

I'm just happy that we can actually get coverage if we need and pay for it.

 

[Gnusgal]

Yes, it is the law.

Congratulations on the prospective new job.