What do I do???

[Gnusgal]

I'm at a total loss! I thought everything was going so well. I had a job lined up to start in August in a library, I checked to make sure that the insurance they had was comparable to what I was leaving (and that my cardiologist was on the Prefered Provider List) and everything seemed to be falling into place. However, today as I looked to see if maybe Texas Children's Hosptial was on the Provider list (since it looks like I'll be having surgery down there in the future) I came across a piece of information that has brought the world crashing down around me!

Apparently they have somehow exept themselves from the HIPPA statement that says that preexisting conditions are covered if you've had prior coverage. I didn't know that was even possible! It doesn't make sense to me! I called to verify and the person I talked to said that I would have to go untreated for my preexisting condition for 30 days (including medications) in order to start recieving benifits for it. HA! Try making me go 30 days without my meds. I dare you! You won't have an employee to push around anymore, because I'll be DEAD (or very nearly). So if I can't go 30 days without treatment, I have to wait one full year before I can have anything concerning my heart covered by insurance! How the H*&^ am I supposed to cover a full year of my heart bills?!? The lady on the phone suggested I sign up for COBRA with my pervious district. Yeah, that sounds like fun. Let's pay the high fees for cobra PLUS the premiums on the worthless health plan for your district so that I can finally have coverage in October of 2006! That sounds just peachy. Obviously she's never had to pay for cobra before.

I'm at my wits end. I just don't know what to do. I'm supposed to go on vacation to Disney World tomorrow and I'm not sure if I'll be able to have any fun worrying over this situation. I've started submitting applications to other districts. I'm getting out if I can. I just can't deal with insurance (or what they're CALLING insurance) like this. Can it even be legal???

Sorry to rant. I'm just SO frustrated! I've been crying off and on all day long. I've always been so careful about insurance and I can't believe this one slipped by me! Thanks for listening...

 

[Guest]

*sits in stunned silence*

Niki, I've no idea what to tell you.

Did they, by chance, explain how they are exempt from the HIPPA regulations? I don't see how they could've done that, but I suppose there is "red tape" to get out of anything.... And that scares me, since I accepted the job offer ... and will have to get COBRA to continue my health insurance until the health insurance at my new job kicks in next month. I can't imagine paying for any of my medications or procedures (will have to have the pacemaker replaced within 12 months ... not to mention regular visits to the cardiologist) without insurance .

*shakes head*

Untreated for 30 days? Sounds like they are trying to kill you. Literally.

Very sorry you are experiencing this right before you go on vacation. Sure hope you can relax a bit and enjoy that trip....

Thoughts/prayers coming your way....


Cort, "Mr MC" / "Mr Road Trip", 31swm/pig valve/pacemaker
'72,6,9/'81,7.hobbies.chdQB = http://www.chevyasylum.com/cort/
MC Guide = http://www.chevyasylum.com/mcspotter/main.html
"Something's wrong in the world today" ... Aerosmith ... 'Living On The Edge'

 

[Karlynn]

That's insane!!! Do they mean if you can go without filing a claim for 30 days?? There would be no point at all for the new law. Is it the insurance company that is claiming this exemption? I would call the state office in Texas that deals with regulating insurance.

If that is actually the case it's like they're setting someone up so they can say "See, you went 30 days without treatment, we're not going to approve the treatment now because it's obvious it's not necessary for you."

Good luck Niki. Please try to not let it ruin your vacation, then the idiots would be winning.

 

[Gnusgal]

My mother is a member of TSTA (Texas State Teacher's Association) and has a call in to try and find out if what they are doing is legal. I can't imagine that it is. What the heck is the point of the HIPPA laws if they can exempt out of them?? If we find out that I can fight it through TSTA she'll be signing me up ASAP (I'm not a member because the dues are so high). If we find out that what they are doing is within their rights, I'm looking for somewhere else to work. I don't care if I have signed a contract. I'll back out and go work for sane people! Why, oh, why did I quit my other job???

 

[geebee]

Something is against the law here. I know of no reason they can refuse you coverage if you have had continuous coverage via another company or Cobra (or state continuation coverage).

You need to fight this tooth and nail. This is a federal law and no one can opt out or get around it.

There has to be a federal office somewhere you can contact to get things straightened out.

Keep your chin up as I am sure you will find out everything will be OK. However, it sounds like there are questionable activities at the place you are going to work.

 

[Guest]

My mother is a member of TSTA (Texas State Teacher's Association) and has a call in to try and find out if what they are doing is legal. I can't imagine that it is. What the heck is the point of the HIPPA laws if they can exempt out of them??

Amen!

I'm really interested to find out what your Mom learns, Niki. Please keep us posted.

 

[perrybucsdad]

I can't believe this would be remotely legal. When did you quit your previuous job? That might be the catch. I thought it had to do something with seamless coverage. Meaning, your last day of work at COmpany A is Friday, Julu 8th, and your first day of work with company B is Monday, July 11. Now if it is last day at Company A, July 1, first day company B, Aug 1, then I think they could make you be exempt.

I'm not a laywer, so I may be wrong.

- John

 

[perrybucsdad]

Check this link out.

http://www.cms.hhs.gov/hipaa/online/group/hipaarights/PreexistingConditionExclusions_content.asp?record=430042

The question was "Do you have at least 12 months of continuous creditable coverage, or 18 months if you are a late enrollee?"

- John

 

[Gnusgal]

Oh, I've always made sure I have continuous coverage at least with Cobra if nothing else. Here's the exact wording from their benefits book:

"As a non-federal governmental plan, the ***** ISD health plan is exercising its privilege to opt-out of the health insurance portability and accountability act (HIPAA) effective January 1, 1998, as it relates to recognizing creditable coverage under a previous medical plan and all other HIPAA requirements as stated above."

One of the "stated above" statements is "Limits exclusions for pre-existing conditions." As a matter of fact, it's the first one.

Anyway, I'm trying my best to put it out of my mind, but it just isn't working. I know there's nothing I can do about it today (or even until Tuesday for that matter) even if I weren't going out of town, so hopefully that can help me to enjoy the first part of my vacation? After all, Disney is the happiest place on Earth, right?

Thanks for your words of encouragement. At least I'm not alone in thinking this is completely wrong!

 

[Nancy]

You cannot "opt out" of something unless you were included in the first place, so if they were included in the HIPAA act, and it is a federal mandate, they cannot "opt out" of it.

Sounds like some sleazy "pulling wool over the eyes", tap dancing and baffling them with bull ****.

 

[Harrybaby666]

I don't know too much about what your going through....

I don't know too much about what your going through....

Hi Nikki,
Even though I don't know much about what your going through, I am sure sorry that you are having to deal with this, and I am praying hard that you get through this asap, and I know how important it is that you do. Meanwhile, I hope to goodness that you can go on your vacation and try and have a good time. I just wanted to show my support...Your in my thoughts and prayers as always. Harrybaby

 

[Marguerite53]

Nikki

Nikki

Hi kiddo. Hopefully you're already smiling and on your way to Disney World. I don't know how any of this really works, but do you suppose they just mean that you can't make any claims for 30 days? Would you be able to pay for one month's worth of medication by yourself? Could it be as simple as that? Just trying to be optimistic. GOOD LUCK! You've got lots of help and tons of brains so I know you will work this out. Hang in there!

Marguerite

 

[gijanet]

Oh, Niki...........

Oh, Niki...........

I am so sorry to hear this..............and it scares me to death, too. If we ever get surgeries behind us, we would like to move..............at least to the outskirts of the metroplex................I don't see how they can do this. Try not to think about this right now...............yeah, right!

Have faith. Let your mom do some checking and find out what she can find out through TSTA. I belong to TFT and will check with them if your mom strikes out. This just doesn't seem right. What school district is this? I don't see how they can just make their own rules like that..............even during the open enrollment period? Make sure, too, that it is just not for claims during that thirty day period and not taking meds..........how could they prove that anyway?

Enjoy your vacation - you can't do anything about this right now. Everyone is shut down for the fourth anyway. Come back refreshed and ready to fight if you have to. And have a magical day...........you will get sick of hearing that one, I promise you. Many hugs and please keep us posted. Hugs. Janet

 

[catwoman]

Niki:
So very sorry you're in this dilemma. I thought ALL school districts in TX had almost identical insurance through the state, but obviously not.
Sounds like joining TSTA or some other teachers' organization (TAPE, I think is one) that has a lot of clout could help.

 

[McCln]

Hate to tell you all but waiting 30 days for insurance to kick in is not unusual. Used to be that you had to wait a year to use insurance, if others here remember years ago. There is nothing that I know of to change that. It is just a waiting period for the insurance to kick in, not to kill you. Before the other insurance runs out, have the doctor up the med supply to cover the 30 day wait. That is all I can advise. Thirty day waiting period is pretty standard nowadays. Good luck and hang in there.

 

[azpam]

maybe your doctor can give you some free medicine samples so on record you are not buying medicines for a whole month.

 

[Karlynn]

Hate to tell you all but waiting 30 days for insurance to kick in is not unusual. Used to be that you had to wait a year to use insurance, if others here remember years ago. There is nothing that I know of to change that. It is just a waiting period for the insurance to kick in, not to kill you. Before the other insurance runs out, have the doctor up the med supply to cover the 30 day wait. That is all I can advise. Thirty day waiting period is pretty standard nowadays. Good luck and hang in there.

I think it's the "untreated" part that concerns Niki. She wrote:

I called to verify and the person I talked to said that I would have to go untreated for my preexisting condition for 30 days (including medications) in order to start recieving benifits for it.

She is taking this literally, while some feel the interpretation is that she cannot file a claim in that 30 day period. But no one knows for certain. There can sure be some screwie ways to wiggle out of insurance coverage.

I hope she's having a good time in D-World and forgetting about this for a bit.

 

[Christian]

Here's an accurate summary of the law on the subject:

http://www.cms.hhs.gov/hipaa/hipaa1/content/hinonfed.asp

I'm a lawyer who has some experience with HIPAA (mostly its privacy regulations). I believe all the linked information is current. I hope it at least helps you work through some of the uncertainties.

All the best.

 

[Christian]

Well, here's a searchable database of those entities that have:

http://www.cms.hhs.gov/hipaa/hipaa1/NonFed/default.asp

I know of none personally either -- there appears to be only two in my state.

My HIPAA expertise relates to the privacy rules rather than the coverage rules, so I'm really nothing more than an adept researcher when it comes to coverage. I checked into all of this a while back when my wife (who's about to schedule a mitral valve procedure) changed jobs and was hired by a governmental agency.

 

[Guest]

Christian - I'm an HR director and have NEVER heard of any entity being able to opt out of HIPPA or include a pre-existing clause in their policies anymore, unless you don't have seamless coverage of less than 30 days (at least here in CO and I think in CA).

...unless you don't have seamless coverage of less than 30 days? Curious as to what that means....because there will be about 3 weeks between the time that my Sears benefits end (2nd week of July) and my new employer's benefits begin (1st week of August) ... and the deadline for signing up for COBRA isn't until September....

Hmmm...unless, of course, your company is hiring, Pam .