Health insurance hell info resources?

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JohnCT
Regular Member


Date Joined Mar 2008
Total Posts : 202
   Posted 3/30/2008 8:31 AM (GMT -7)   
Hi all,
I've entered into health insurance hell. My agent has made three major mistakes and I'm looking for info on my health insurance options in CT.
I had COBRA coverage that expired in Dec 2007; in Oct 2007, I became disabled under a private policy; my agent said that since I was disabled, COBRA would continue - mistake 1 - it didn't since it was private and not Soc Sec disability.
I have chronic Hep C and a liver transplant MELD score of 13 (16 gets one on the active liver transplant list); under COBRA I had pre-certified for transplant at Yale-New Haven and Westchester Medical Center.
Second mistake - agent put me into CT Anthem Blue Cross, which doesn't work with any transplant centers in CT and only one in NY (only NYU in NYC and somewhere in Boston) so I lost both of my transplant teams.
Third mistake - Anthem Blue Cross only covers medicine to $1,000 ($500 / mo for my pharm) so I now can't afford my medications.
Question: does anyone know of web or other resources where I can learn about impact of pre-existing conditions on insurance purchase?
Thanks for any direction you can give me.
John
If I weren't having so much fun with you guys,
I'd love to be out sailing on Long Island Sound
Woodmont on the Sound, Connecticut


Mischa
Regular Member


Date Joined Mar 2008
Total Posts : 47
   Posted 3/30/2008 8:41 AM (GMT -7)   
when I first learned of my husbands disease I started looking for insurance and what I found across the board is that preexisting conditions are not covered during the first 2 years the policy is in effect.
Have you asked for a review rather than take the word of your insurance agent who has made multiple mistakes? I would appeal the decision and if no satisfaction go to the next step ( insurance review board) before I threw in the towel and started looking into another insurance company, Its your money, you paid it in for just this reason, fight to keep your benefits :)
Therese

CaryF
Veteran Member


Date Joined Nov 2007
Total Posts : 505
   Posted 3/30/2008 9:04 AM (GMT -7)   
I would definitely appeal the deciisions. When on treatment I auto matically appealed every negative decision by my ins. co. and did win some of them. I also live in a state MN that has low(er) cost medical insurance for people without ins. - or can't afford it.
 
I've been on state subsizded insurance for almost a year now and its alot better coverage than I expected. It pays for all pre-exisitng conditions. 

JohnCT
Regular Member


Date Joined Mar 2008
Total Posts : 202
   Posted 3/30/2008 9:23 PM (GMT -7)   
Hi again and thanks for the feedback,
Hi Therese - I definitely will appeal and try to get some 'official' info on the coverage. The carrier is supposed to be one of the top insurers so I have been surprised by their policies at every turn. Thanks for the advice.
Hi dansbrother - I recently received info on health insurance from the AARP special interest group so I will see what they have to say, in addition to contacting my Congressional delegates. Thanks.
Hi CaryF - I hadn't thought that there may be subsidized insurance but I will check into it. I should qualify, being on a small monthly disability income, half of which goes to health insurance. BTW, I grew up in MN and have fond memories. If it just were closer to the sea. Thanks
I appreciate your thoughts and advice -- Thank you all very much!!
John
If I weren't having so much fun with you guys,
I'd love to be out sailing on Long Island Sound
Woodmont on the Sound, Connecticut


1Shelly1
Veteran Member


Date Joined Oct 2007
Total Posts : 502
   Posted 3/30/2008 10:41 PM (GMT -7)   
John, although expensive (as you would have to retain a specialized attorney) you may be able to get medicade. My neighbor just got it last year for her husband. It is a process but it definately paid off for them.
 Shelly
 

“Life is not the way it's supposed to be. It's the way it is. The way you cope with it is what makes the difference."

 


JohnCT
Regular Member


Date Joined Mar 2008
Total Posts : 202
   Posted 3/31/2008 8:40 AM (GMT -7)   
Hi Shelley,
Again, thanks!!! So much to do and remember. Trust me, that's not a complaint. Sometimes we just have fight on multiple fronts. Unfortunately, the medicine that I can't afford is Xiafaxan, which both keeps my acites from going to sepsis and reduces my ammonia levels to minimize the brain-fog. Being a computer engineer, the brain-fog is most frustrating.
Thanks and be well,
John
If I weren't having so much fun with you guys,
I'd love to be out sailing on Long Island Sound
Woodmont on the Sound, Connecticut


1Shelly1
Veteran Member


Date Joined Oct 2007
Total Posts : 502
   Posted 3/31/2008 10:09 AM (GMT -7)   
John, please have your Dr intervene and see if he is willing to call the Drug company that makes you medicine. If he doesn't then do it yourself. Alot of times the drug companies will give the medicine to you either free or at a minimal cost. But first speak with the Dr. Ask for samples and if he doesn't have any then please ask him to call. Let me know what happens.

 Shelly
 

“Life is not the way it's supposed to be. It's the way it is. The way you cope with it is what makes the difference."

 


Pink Grandma
Veteran Member


Date Joined Nov 2006
Total Posts : 2445
   Posted 3/31/2008 5:33 PM (GMT -7)   
Hello JohnCT, Can you email me. My email is in my profile.
Have a good day.
Pink Grandma
Forum moderator-Hepatitis

When the going gets tough....the tough get going! Don't always know where I going but I get there anyways.


Pink Grandma
Veteran Member


Date Joined Nov 2006
Total Posts : 2445
   Posted 4/1/2008 5:49 PM (GMT -7)   
John please email me. I have an idea about your medication.

thoughts and prayers.........
Pink Grandma
Forum moderator-Hepatitis

When the going gets tough....the tough get going! Don't always know where I going but I get there anyways.


JohnCT
Regular Member


Date Joined Mar 2008
Total Posts : 202
   Posted 4/2/2008 10:28 PM (GMT -7)   
Hi Shelley,
Thanks for the suggestion on the samples and to check on the drug company. In the interim, my Dr. has put me on to Lactulose for the ammonia. I haven't tried it yet so don't know what the side effects for this one are -- but it is 1/15th the cost.
I'll check to see if the drug company has an abundance of humanity and generosity.
Be well, John
If I weren't having so much fun with you guys,
I'd love to be out sailing on Long Island Sound
Woodmont on the Sound, Connecticut


1Shelly1
Veteran Member


Date Joined Oct 2007
Total Posts : 502
   Posted 4/3/2008 4:03 PM (GMT -7)   
John, did you email Pink Grandma? I know she can help you with her idea so please email her ASAP. AS for the lactulose it should help with the ammonia. Look it up online for all the details because you will get a full description of how it works etc. Let us know what the dr is willing to do to help with the drug company. There is no reason he doesn't do it. I am not sure how old you are but if you are over 62 I believe that there are agencies locally that may be able to help too.

 Shelly
 

“Life is not the way it's supposed to be. It's the way it is. The way you cope with it is what makes the difference."

 


hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 4/3/2008 11:00 PM (GMT -7)   

John, are you on long-term disability from work?  Have you applied for SS Disability?  If not, perhaps you should.  If accepted, you will have to wait 2 years for Medicare.  However, in my case, they took 2 years to finally approve my claim, so I got Medicare immediately, as well as a lump sum back payment that was in the thousands.  I also have limited Medicaid coverage.  It pays for my Medicare Part B premium (which is now around $90 or so) and the premium for my Part D Prescription Drug Coverage.  Everyone usually gets turned down for SSD the first time, after which you should retain a lawyer.  The lawyer will get 25% of your lump sum payment when you are finally approved.  By law, they cannot charge more than that, and should charge nothing if you do not win your case.  Given that you are a computer engineer with brain fog, it seems to me that you should be able to get SSD.  It counts from the time you apply...so do the paperwork and get that in the pipeline!  Medicaid will pay for transplants, but Medicare will not.  You have to practically be a pauper before you will qualify for Medicaid.  I am considered low-income, have no property and few savings, but still only have limited Medicaid.

Good luck with the insurance problems!  Keep us informed of your progress.

Connie


JohnCT
Regular Member


Date Joined Mar 2008
Total Posts : 202
   Posted 4/6/2008 10:13 PM (GMT -7)   
Hi Shelly,
Thanks for the follow-up.
Yes, I have e-mailed Pink Grandma but have not yet heard back. If I don't hear in a day or two, I'll follow up in case the e-mail got lost or filtered out.
The Lactulose hasn't been too bad as far as side-effects - just the expected from an anti-constipation drug.
I have an appointment with my doctor so I'll soon know how helpful he can be with the Xifaxan and the drug manufacturer. I'm 57 so I can't work any simple (lol) options with agencies.
I have a couple of other responses to write and I'm hoping to find some sleep tonight so I'll close now.
It is my considered opinion that this forum rocks! I had not imagined that any virtual group could be so vital, caring and supportive. In reading past posts, the insights and helpfulness has obviously helped so many. God Bless.
Be well, John
If I weren't having so much fun with you guys,
I'd love to be out sailing on Long Island Sound
Woodmont on the Sound, Connecticut


JohnCT
Regular Member


Date Joined Mar 2008
Total Posts : 202
   Posted 4/6/2008 10:24 PM (GMT -7)   
Hi Connie,
Thanks for the SS info. It is all a blur to me at this time. I'll be 58 this Nov. so I haven't yet had any interaction with SocSec. I did have to apply for SS Disability as requirement from my disability carrier. They turned me down since I have private disability income but I see that I should find an attorney to give me some guidance.
My MELD score is still relatively low (13) so I probably won't be seeing a transplant this year. But I should build my plan of how to survive on this tiny fixed income.
Thanks again and be well, John
If I weren't having so much fun with you guys,
I'd love to be out sailing on Long Island Sound
Woodmont on the Sound, Connecticut


JohnCT
Regular Member


Date Joined Mar 2008
Total Posts : 202
   Posted 4/6/2008 10:33 PM (GMT -7)   
Hi dansbrother,
I can see that I need an attorney and a lot more understanding of SocSecDis and Medicaid, etc. Sorry about your brother. I can't imagine what it would be like, being with a loved one who has these Hep and liver disease paths to walk.
I'm thinking that I may get some sleep tonight so I'll say goodnight.
Be well, John
If I weren't having so much fun with you guys,
I'd love to be out sailing on Long Island Sound
Woodmont on the Sound, Connecticut

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