New Jobs/Careers-New Insurance and Pre-Existing Conditions

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Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2448
   Posted 1/5/2010 8:57 AM (GMT -6)   
In the last couple of days there has been conversations about job/career changes because of the effects of PCa treatments.

The question was raised about pre-existing conditions and the ability to have coverage at the new job. I personally went through this on December 31. My wife was forced to retire because of disabilities and to continue insurance coverage we would have to utilize the aspects of COBRA to continue coverage. We must have insurance coverage as we are both dealing with cancer.

Fortunately I am a prior management employee of a large national corporation and have been offered the opportunity to enroll in their plan every year for the last 10+ years. We always turned it down because we had good insurance with my wife's company.

As I contacted the new insurance plan one of my first worries was that of pre-existing conditions. I was informed very quickly "No Problem, No Exclusions".

It seems that one of the primary reasons that the HIPAA laws were put into place was to prevent and/or limit just such a scenario. And here I was thinking all the time that the only reason for this law was to drive me nuts having to sign the forms constantly and/or being told I could not have that information without signed authorizations. You've all been there.

I am posting here a link to the FAQ sections of the HIPAA site that addresses this issue in detail;

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

Just trying to do my part and give back to HW. I hope this information helps answer the questions and fears that some may have about their ability to change jobs and still receive good medical care.

FWIW,

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative
da Vinci 9/17/09
Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
NERVES SPARED-positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT scheduled to begin Nov 30,2009 (74 days post surgery)


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 1/6/2010 11:41 AM (GMT -6)   
Sonny,
 
Thank link covers it all.
 
Most importantly, remember the 63 day rule! Also, be aware that ALL states are mandated to have at least one plan (either private or public) that an individual can "roll" into, without pre-existing condition limitations AS LONG AS the rollover occurs within 63 days of losing qualifying (creditable) coverage. IN PA, that plan is offerred by the Blues and costs about $8,000 a year for an individual (includes drugs).
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined (T2B)
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Steady at 0.7 (7/09) (Pomegranate???)
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2448
   Posted 1/6/2010 6:33 PM (GMT -6)   
Joey,

I thought the link answered the pre-existing questions very well. As long as you don't have a gap in coverage it is not a problem. And all this time I though HIPAA was just to aggravate the poop out of me.

As an interesting aside, the one thing you have to look carefully into is how the plans differ as regards co-pays, deductibles and out of pockets.

Our old plan had co-pays for everything even after we had me the deductibles and out of pocket maximums.

The new plan co-pays do not kick in until after the annual deductible has been met and then go away once we meet the annual out of pocket max.

We got a call the other day from the new plan's pharmacy about my wife's cancer fighting maintenance drugs. We need to fill a new script this month.

She was sure surprised when she told us the drugs would be about $6000. I chuckled and said "Wonderful, That's Great!!". And I was not being sarcastic.

She didn't know how to react. I went on to explain that our annual out of pocket for the plan is $5500. So we would meet that the first month and then not have to lay out a dime for scripts or medical treatments or anything for the rest of the year. We have set it aside and were hoping to use it all up in one month so we didn't have to juggle the co-pays and 10%-20% stuff any more for the year.

She just didn't know what to say. She said that was the first time she had ever had anyone tell her they were happy to spend that much on prescriptions before. She thanked us for the laughter and a new experience for her.

Once again, all is well in the land of Oz and "Every Day is Still A Bonus.

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative
da Vinci 9/17/09
Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
NERVES SPARED-positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT scheduled to begin Nov 30,2009 (74 days post surgery)


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 1/6/2010 8:05 PM (GMT -6)   

Greetings, Sonny.  Glad it is working out well for you.  Medical insurance is a complicated thing but we have to have it.  Group plans are usually relatively easy to get in as long as you meet all the timing rules and as you have indicated they have fairly straight forward rules on exclusions or lack thereof. My wife is a nurse who worked for an insurance company so she knows the ins and outs of medical insurance pretty well.

We are both 57 now and have thought about retiring early.  The big kicker is medical insurance if you have to buy an individual plan that can make some exclusions until you qualify for medicare at 65.  Fortunately, I really enjoy my work and since my wife has retired and she can travel with me, I will just hang in there for a few more years.  I'm grateful for a good job with good benefits.  David


Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted 1/6/2010 9:44 PM (GMT -6)   
 
So sad that the greatest nation on this planet does not just provide full medical coverage for everyone all the time...no questions asked.
 
Where did we go wrong?
PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Very Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8 with no extension or invasion
no long term continence problems
Post surgery PSA continues to be "undetectable"
One side nerves spared
Bi-Mix for ED 
born in 1941


FLHW(David E)
Regular Member


Date Joined Nov 2007
Total Posts : 201
   Posted 1/6/2010 9:54 PM (GMT -6)   
lifeguyd said...
So sad that the greatest nation on this planet does not just provide full medical coverage for everyone all the time...no questions asked.

Where did we go wrong?


I think for one that we need to ask questions. We are the most obese society on earth and why should my tax dollars pay for some obese person to be treated for diabetes, joint issues, heart disease etc and so on while at the same time they stuff another double cheese burger into their face.
Dx'd 2/18/05
PSA 271, bone mets, lymph node involvement
Gleason Score: 7
Been on Lupron since beginning
Was on Casodex, then HDK, the Nilandron
Finished 12 rounds of Taxotere on January 26th

Current (10-12-09)
PSA: 101
Treatment: Lupron, Zometa, HDK+HC
~~~~~~~~~~~~
Personal Blog:
prostatecancerat42.blogspot.com
Facebook Profile:
www.facebook.com/david.e.emerson


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 1/6/2010 10:38 PM (GMT -6)   
My, that was a pretty cold remark there. In the right kind of system, they could incorporate preventative care, and health education.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 1/6/2010 11:38 PM (GMT -6)   

FLHW:

 

For the same reason your auto insurance pays for the guy who blows a red light and has an accident.

That's what insurance is.

 

The sad part is the cheeseburger guy can probably get insurance but some poor slob who gets PC might be unable to get new insurance.

Mel

 


63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

5 out of 12 cores positive. Gleason 4+3. More specifically: 2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 1/7/2010 5:36 AM (GMT -6)   
FLHW(David E) said...
lifeguyd said...
So sad that the greatest nation on this planet does not just provide full medical coverage for everyone all the time...no questions asked.

Where did we go wrong?


I think for one that we need to ask questions. We are the most obese society on earth and why should my tax dollars pay for some obese person to be treated for diabetes, joint issues, heart disease etc and so on while at the same time they stuff another double cheese burger into their face.


David,
Things are never as simple as they appear at first glance. Straight out political opposition to a system of universal cover should be set aside and what is best for a society looked at in the cold light of day. Many of those evil so called "socialist" health systems deliver, in the countries that have them, a longer life expectancy and a lower infant mortality rate than does the US system and at a much lower cost. Preventative medicine, albeit publicly funded, will deliver long term benefits and savings. But that's another story smilewinkgrin
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01
PSA August 09 (2 year mark), <0.01
PSA December 09 <0.01

My Journey: www.yananow.net/Mentors/BillM2.htm

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