what about insurance?-USA

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slimcook
Regular Member


Date Joined Sep 2007
Total Posts : 43
   Posted 6/4/2008 12:45 PM (GMT -7)   
Where do you go to get coverage for this pre-existing condition? I currently am self-employed and covered but a plan that is pretty pathetic. It's pretty frightening cause the lifetime benefits of this current plan are low and when I look ahead thinking of possible remicade or surg..and life in general. Any thoughts. I realize plans differ from state to state.
Slimcook
dx:2003 Pancolitis
current meds:
Colazol 1500 TID, Imuran 100mg, Healthy Trinity Probiotic, Grape Seed Ext. Biotin, Vit. E., Selenium, Flax Oil, Calcium, Zinc and Emergen-C


Beth75
Veteran Member


Date Joined Jul 2007
Total Posts : 2148
   Posted 6/4/2008 1:03 PM (GMT -7)   
Hi Slim,

My husband is pretty much self employed and his benefits before we got married were pretty minimal.

My friend in MA is self insured it is $800pp not including prescriptions. It is pretty expensive. I pay $160 a month at work and coverage is pretty good for my husband and I. My company contributes approx. additonal $800 a month to the plan (this is for two of us).

The whole pre-existing condition thing scares me, b/c I will be carrying the benefits and I don't want universal healthcare but if I can't get insured if/when I leave my current co. that will really stink.
Beth, 32 ~ small flare - hoping caused by aspirin - hydrocortisone e's
Major Flare Sept/Oct 07
UC dx'd 03/00 (Proctosigmoiditis); Pancolitis since 09/07
Azathioprine 200mg 1xday nightly; Calcium and Vit D 500mg 3xday, Multi Vit, Folic Acid 400mg 2xday, Prilosec, Probiotics.
Minimal Change Disease (Kidney Disorder) dx'd 09/07 - partial remission since 03/08
Prednisone 5mg 1xday (tapered from 60 = ), Simvastatin 20mg 1xday, Diovan 160mg 2xday. Enalapril 20mg 1xday, Fosomax 70mg 1xweek. MCD may be from hypersensitivty to 5ASA drugs.  Do you have edema? If so, check your blood protien level!
 


jujub
Forum Moderator


Date Joined Mar 2003
Total Posts : 10407
   Posted 6/4/2008 1:31 PM (GMT -7)   
I'm lucky to have health insurance throught my job, but when I applied for long-term care insurance I was denied. I think a lot of companies won't cover us and those that do will probably be very expensive for not-so-good insurance.
Judy
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Asacol, Rowasa, Pentasa, Prednisone, Entocort, Azathioprine
Avascular necrosis in both shoulders is my "forever" gift from steroid therapy.
Colazal,  Remicade, Nature's Way Primadophilus Reuteri. In remission since April, 2006.
 
Co-Moderator UC Forum
Please remember to consult your health care provider when making health-related decisions.


KaseyF
Regular Member


Date Joined May 2008
Total Posts : 65
   Posted 6/4/2008 1:49 PM (GMT -7)   
I'm a little scared because I'm covered by my boyfriend's insurance as a domestic partner (we've been living together for over five years now.) I'm freelance, which means no health insurance on my own.

The thing is...on Friday he just got a notice that we're being audited and have to prove we're really domestic partners. We can do this, obviuosly we have the proof...but the timing is a little suspicious. I JUST had the colonoscopy and got diagnosed with UC. I have to imagine that we're being audited because of my recent diagnosis. I mean, I've been covered under his plan for over four years now...it's fishy.

Though we're not engaged yet, the backup plan is to get a quick marriage if they deny my coverage and have the reception later (or perhaps another wedding and just not tell people we already got married.)

Sorry I don't have advice...
27 years old, Female, NYC
Diagnosed with severe UC on May 13, 2008 (though I'd apparently had it for years.)
500 MG Sulfasalazine x4 a day
Daily Multi-V


TraciZ
Regular Member


Date Joined Aug 2007
Total Posts : 255
   Posted 6/4/2008 2:49 PM (GMT -7)   
Hi,
I'm not sure, but it's worth checking into...
it may be that if you've been covered by insurance in the previous 6 mos or something, then you can change insurance with certain life changes, such as a job change. Sorry, I don't even know where to look for this info. Maybe every plan/employer is different?
Tressa 34 (F)
Not sure of my dx- currently UC, maybe Crohn's.
Colazal 3X3/day
Lialda upped to 4/day,
Phosphatidylcholine 4 (420 mg capsules) once/day
Colazal 3X3/day (not generic)
Rowasa at night X 14 days
Canasa BID


ediekristen
Veteran Member


Date Joined Apr 2007
Total Posts : 1366
   Posted 6/4/2008 3:07 PM (GMT -7)   
Kasey, that sucks, I'm sorry. It definitely seems like they're trying to get out of paying UC costs... That seems to be a common thing with a lot of insurance companies. What proof would there need to be?? I mean, what constitutes as being an official domestic partner... isn't it just if you're dating and living together?
Female, 22, Ulcerative colitis (pancolitis) since 1999; GERD; gastritis; osteopenia in hip & lumbar region of the spine from long term prednisone use.

Current Meds:
10mg Lexapro (for depression/social anxiety)
Digestive Advantage: Crohn's and Colitis formula (2 pills per day, started 5/14/08)
125mg Azathioprine
4800mg Asacol (Four 400mg tablets, three times a day)
 
 
 


yuckygut
Regular Member


Date Joined Feb 2008
Total Posts : 214
   Posted 6/4/2008 3:47 PM (GMT -7)   
Unfortuantely insurance companies really dont care about anything but the "almighty dollar", I wish I had a better answer than keep what you already have, but I always wondered if there are any free government programs, or programs linked with local hospitals, other than those that help the indigent.

---------------------------------

yuckygut
diagnosed 1998
now off prednisone and colazal
drink 1 Haldi daily

madabs
Regular Member


Date Joined May 2008
Total Posts : 387
   Posted 6/4/2008 4:42 PM (GMT -7)   

My advice would be to hold onto the insurance you have now, because however poor it is  your uc as pre-existing condition wouldn't be an issue.  I suppose they could just drop you, but if they agreed to cover you without any riders then they would have to pay under the terms of the policy. 

My family switched once when we weren't on a group plan and our new carrier put riders on just about every condition we had been treated for the year before.  Really picky stuff,  such as migraines and ear infections.  They are brutally unfair to the self employed/insured.  You might want to look into supplemental insurance.  My sister just signed up for a supplemental health policy for accident, cancer and vision.  It pays over and above what her regular plan doesn't.  It might be worth talking to an insurance agent to check it out and they might have something for people with chronic conditions. 


UC since 10/05, first symptoms felt as early 1983
canasa and lialda daily
 


KaseyF
Regular Member


Date Joined May 2008
Total Posts : 65
   Posted 6/4/2008 5:05 PM (GMT -7)   
"What proof would there need to be?? I mean, what constitutes as being an official domestic partner... isn't it just if you're dating and living together?"

They want us to send copies of our lease and get a Notary to vouch for us. To be a domestic partner, you have to be living together for at least six months. The thing is, we did all this four years ago. We haven't moved. There's absolutely no reason to go through the entire process again.

I think, technically, the domestic partner stuff came about to cover same-sex life partners. We did look into it four years ago and discovered his company couldn't discriminate against sexual preference, which left the domestic partner coverage open for us. But I do worry they'll come up with some loophole that gets them out of covering me.

I do have the marriage backup plan so at least there's another option, but we're saving up for a ring and all that and it would be really nice to do this the traditional way. You know, engagement first instead of an insurance coverage-shotgun wedding.
27 years old, Female, NYC
Diagnosed with severe UC on May 13, 2008 (though I'd apparently had it for years.)
500 MG Sulfasalazine x4 a day
Daily Multi-V


momhatesuc
Regular Member


Date Joined Sep 2006
Total Posts : 78
   Posted 6/4/2008 5:45 PM (GMT -7)   
My husband is self employed and we have had a terrible time trying to find someone to cover me.  He is actually in the process of enlisting in the army reserves mainly for the health benefits.  In VA, where we are, there are two companies that offer insurance without underwriting.  I found out about this on one of the state websites.  It is very expensive though so we decided it was not our best option.  You'll definitely have to do research on your specific state, as you will probably be denied from most private insurance companies.  It is awful.  Good luck in your search.
Leslie, 30~ left-sided UC diagnosed in 1999
9 asacol x day
nightly rowasa (as needed)
multi-vitamin, calcium


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 6/4/2008 6:44 PM (GMT -7)   
I just HATE the insurance aspect of our country. I work for a very small law firm where it would be just too expensive for them to offer group insurance. Instead they pay a large portion of your premiums on whatever plan you buy. Well, that doesn't work for IBD does it! Luckily my husband has great group insurance but I HATE that everytime he thinks about finding a new job I have to remind him that it has to have good group insurance. My crohns is totally holding him back. I realize that once I graduate I might have to find a different job. I really don't want to work for a big firm but that might be the only way I have my own insurance. What a messed up system. (I am not trying to start a socialized health care argument either. No one can say our system is working. How about just having private insurance where NO ONE can be denied coverage!)

Kasey - I totally agree and predicted that the new trend would be marrying for insurance instead of marrying for citizenship. In my state, part of the domestic partner provision is that you have to be in an exclusive relationship with "forever" plans. Not those words exactly but to the effect that it has to be a romantic partnership... not just roommates. I wouldn't be surprised if they have PI's doing surveillance to make sure that you two are really a couple and exclusive.

Bennie
Veteran Member


Date Joined Nov 2006
Total Posts : 552
   Posted 6/4/2008 7:08 PM (GMT -7)   

Kasey, my cousins did that back in 1982.  If I remember correctly, my cousin's wife needed major dental work. So they got married secretly (just their immediate families) on New Years Day. Their "real" wedding was Memorial Day.  Most people never knew and even those that did find out, thought it was great.

I know this has been discussed before but now is when I am thinking about it for my son.  Right now he is under our insurance until he is 23 if he stays a full-time student.  If he gets a job that has group health insurance, can they turn him down?  Or limit him?  It would be very similar to what we have now (my husband works for a school district, my son is trying to get a job in a different school district).  I know the best thing is for him to get group health insurance.  Unfortunately that means giving up working as an auto mechanic (which is what he has gone to school for and what he likes) because most small garages (including the one he works at now) don't have insurance. And because he has Crohns (at least the doctor thinks so) he would have a pre-existing condition.

Also, right now he is working as a substitute for the district. No benefits (yet). He does have to get a physical form filled out by his regular doctor. One of the many questions asks about gastrointestinal issues (they ask about every system of the body).  It asks "Have you ever had any of the following diseases, complaints, or injury or disease of the following organs?  Stomach or duodenal ulcer, recurring indigestion, vomiting of blood, bloody stools, colitis, or any other disease of the stomach or intestines?"  Does he have to acknowledge he may have an IBD?  What would happen if he answers no (assuming his pediatrician doesn't mark it off)?

Sorry if I highjacked the thread. I know the thread was about self-coverage but my son finally has a chance to be covered by group insurance (and not have to stay a full-time student for the next 3 years tongue ).


--Mom of bratcat (17 years old)--
Daughter bratcat was diagnosed with pancolitis October 2006
Current meds:
Asacol - 4 pills/3Xday, 2 tabs 6-mp/1.5 tabs 6-mp every other day, 25 mg prednisone, Remicade
 
11/14/06 - started prednisone; 1/28/07 - finished prednisone!
3/3/07 - began to taper off hydrocortisone sloowwly! Summer 2007 - slowly began tapering Rowasa. 9/07 -- flaring? Nightly Rowasa. 9/21/07 -- added hydrocortisone enemas. 9/30/07--added prednisone. 10/31--started 6-mp, stopped the enemas. Started lowering prednisone. 3/08-another flare!


slimcook
Regular Member


Date Joined Sep 2007
Total Posts : 43
   Posted 6/5/2008 5:41 AM (GMT -7)   
Spent some time with the insurance agent yesterday. BC/BS will consider me five years after surgery to remove the colon. With my low lifetime coverage this will be yet another factor into the surgery decision. It's enough to deal with this disease, concern about the outrageous cost of insurance shouldn't need to be an additional stress, but sadly it is for a lot of us.
Slimcook
dx:2003 Pancolitis
current meds:
Colazol 1500 TID, Imuran 100mg, Healthy Trinity Probiotic, Grape Seed Ext. Biotin, Vit. E., Selenium, Flax Oil, Calcium, Zinc and Emergen-C


julee70
Regular Member


Date Joined Oct 2007
Total Posts : 486
   Posted 6/5/2008 5:53 AM (GMT -7)   
Slimcook,
I have had the same problem as you getting coverage. I was denied by every individual policy carrier in my state. Have you looked into whether your state has a group plan for small business owners? If you are self-employed, you should qualify as your own small business. If you can get on a state's group plan that is far better since it will cover pre-existing conditions.

If your insurance agent didn't consider that option, I would bring it up. Sometimes they don't think about all the possibilities and need a push to find a better option like group insurance through your state.

Most (maybe all) states have high-risk insurance for people who just can't get other insurance. These plans aren't great, but it's better than nothing. They usually have a low-income rate for people who can't afford the full price.

Kasey,
Domestic Partnership requirements vary by insurance company and employer. Usually you just have to be living together for 1 year, show that you are finanically interdependent, and sign an affidavit agreeing that you are in a committed relationship.
If you are being audited by the employer (which is likely since audits of their plans is pretty routine) then they would have no knowledge of your diagnosis since that would be against the law. Privacy of health information laws (HIPAA) require that insurers never divulge your medical info to anyone other than you and people you have authorized. Employers never get that info. If the audit is being conducted by the insurer, I would be surprised.

*** I feel that there's been some hijacking of this thread with the domestic partner discussion. If anyone wants to discuss it further, we should start another thread. ****
-------
UC for the last ten years
Current Meds: 6MP since 2006, Cortifoam
Past Meds: You name it; I've tried it. (Asacol, Colazol, Pentasa, DiPentum, Rowasa, Canasa, Cortenema, sulfasalazine)
5ASA drugs don't work for me. Canasa seems to make me worse.
Alternative treatments I have had success with: Acupuncture, Hypnotherapy


suebear
Forum Moderator


Date Joined Feb 2006
Total Posts : 5698
   Posted 6/5/2008 6:09 AM (GMT -7)   
You cannot be denied insurance for pre-existing conditions in group insurance policies. In fact many employers who offer group insurance policies have a variety of plans to choose from and you can change providers every year with no problem and no denial in care. Over the past 15 years I have flip flopped between HMOs, PPOs, and POS plans. I have never been denied healthcare for UC.

I have always worked for employers who offer group plans, not that I have selected employers for that reason but when you work for the public sector those are the benefit plans offered.

Sue
dx proctitis in 1987
dx UC in 1991, was stable until 1998

1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics

2000 lost all my B-12 stores and became anemic

2001 opted for j-pouch surgery- now living life med-free


Beth75
Veteran Member


Date Joined Jul 2007
Total Posts : 2148
   Posted 6/5/2008 6:35 AM (GMT -7)   
Slim, I don't understand what your saying or maybe I do???? Is it that BCBS will cover you only if you have your colon removed after 5 years?
Beth, 32 ~ small flare - hoping caused by aspirin - hydrocortisone e's
Major Flare Sept/Oct 07
UC dx'd 03/00 (Proctosigmoiditis); Pancolitis since 09/07
Azathioprine 200mg 1xday nightly; Calcium and Vit D 500mg 3xday, Multi Vit, Folic Acid 400mg 2xday, Prilosec, Probiotics.
Minimal Change Disease (Kidney Disorder) dx'd 09/07 - partial remission since 03/08
Prednisone 5mg 1xday (tapered from 60 = ), Simvastatin 20mg 1xday, Diovan 160mg 2xday. Enalapril 20mg 1xday, Fosomax 70mg 1xweek. MCD may be from hypersensitivty to 5ASA drugs.  Do you have edema? If so, check your blood protien level!
 


seconder
Veteran Member


Date Joined Jun 2008
Total Posts : 610
   Posted 6/5/2008 7:31 AM (GMT -7)   
The trick with insurance is to go into a plan in good health and have it when you get sick.  That's kind of tricky sometimes. . . .
 
Caveat:  My experince is in Michigan, so your mileage may vary depending on your state.
 
If you have a policy that you got before UC was diagnosed, you may be best served by keeping it, even if it stinks.  Trying to change the policy may well cause another company to reject your application.
 
In Michigan, BC/BS is the insurer of last resort, meaning that it cannot deny coverage.  You can charge someone an arm and a leg, but it cannot deny coverage.
 
If you (or a dependant child) is a member of a group policy, it would behoove you to get coverage before the policy expires (or within. . . 90 days).  The rules governing coverage change after that grace period and you can be denied coverage.  If you have been in a group policy, I believe you must be allowed coverage.
 
Don't lie on the application.  Your coverage can be denied, and you can be fired.  That said, in Michigan anyway, there is a time period in which insurance companies must discover that lie.  After that, your coverage should be fine.  (But who wants that hassle???)
 
Frankly, though, when I add up what I would have spent on UC and compare it to what I've paid in insurance premiums, I'd have been cheaper off without the insurance.  With that in mind, someone with UC might be well served with a major medical policy and a high deductible.
 
 

Bigphule
Regular Member


Date Joined Dec 2007
Total Posts : 137
   Posted 6/5/2008 9:53 AM (GMT -7)   
Okay I used to sell insurance. I can't vouch for the entire country but this is how it works in New Mexico (though I'm pretty sure that it is similar thorughout)


Most companies will insure for pre-existing conditions after they have been treated for a certain period of time. Treated meaning that they are no longer causing the insured (thats you) problems. Thus the BC/BS beign willing to insure you after you've had your colon removed for 5 years doesn't supprise me at all.

Having an ongoing pre-existing condition will not always disqualify you from getting insured, but outside of group insurance 99.9% of the time will not be covered and any condition that could stem from the pre-existing condition will also probably not be covered. Even if you do get insured you will pay a lot more than someone with out the pre-existing condition for the same ammount of coverage.

Group insurance IE the insurance you get through your employer is magjor medical insurance. Odds are you pay a 30/70 split with your employer, you might even be lucky enough to see a 20/80 split. If you want the exact same coverage except on a private/ self employed ticket, you'd need to find yourself a MMI writer. To find one, the quickest way would probably be to ask one of your friends who has insurance through their employer who their insurance is and then speak to that company directly.

Odds are with MMI you will pay anywhere from $700-$800 USD a month.


There is one other option for you.


It is called private pay.

When you go to the Dr. be it a GI or anything you tell them you are private pay (DO NOT SAY YOU ARE UNINSURED). With private pay you pay everything out of pocket (dependign on the Dr. you may be able to start a "tab").

Okay sorry for the caps above but it is important to never ever ever ever say that you are uninsured. The cost difference between someone who is private pay and someone who is uninsured (at least in New Mexico) is between 10 and 20%. The person who says they are uninsured pays MORE for the same health care as someone who says that they are private pay. On the quick glance it seems very unfair if not a very questionable business practice, but if you look deeper you might see some sence in it. (it still seems unfair though) The people who are uninsured are seen as a payment risk and are charged more because the Dr. wants to get as much money as they can before the person stops paying. Similar to someone with good credit and someone with bad credit who are trying to buy the same exact car from the same exact dealer.

If you can afford it, go for either the private pay or the MMI.
Diagnosed UC 12/2007
Updated 6/2/08 
 
Prednisone 40mg x 1/day 
Mercaptopurine 50mg x1/day 


wrxBRAH
Regular Member


Date Joined Mar 2008
Total Posts : 312
   Posted 6/5/2008 11:21 AM (GMT -7)   
I live in California and I just got done with looking for insurance too. Pretty much every company turned me down because of my preexisting uc. Since I work at the family business (small auto repair shop), even trying to start getting small business insurance was costing an arm and a leg not to mention the 10 page history they want before they even consider you for insurance.

What I ended up doing was sending in an application to MRMIP (major medical risk insurance program) and was accepted but the program is all full up so I have to wait 6 months for a guaranteed spot. I pay more per month than a normal healthy person would but they cant turn me down for insurance. They have 4-5 different plans/companies and if i stay with the program for 3 years i believe, then that company has to allow me to keep the coverage even when I graduate the system.

Not sure if something like that is available where you stay but look into the government offered programs. I pay $250 a month but its a lot better than having to pay out of pocket incase something happens and I need surgery.


Here's a link to what you need to do to qualify: http://www.mrmib.ca.gov/mrmib/MRMIPBRO.pdf

Post Edited (Doz79) : 6/5/2008 12:26:32 PM (GMT-6)


julee70
Regular Member


Date Joined Oct 2007
Total Posts : 486
   Posted 6/5/2008 12:40 PM (GMT -7)   
Doz, the MRMIP program is what I was talking about. I believe that many states have this. If someone googles "high risk medical insurance" and their state name, they should find the program in their state. They all have different names, costs, rules, etc. I have a feeling that the California plan is one of the better ones.

Sometimes its worth getting a job just for the group health insurance. Once you quit, you can stay on their policy through COBRA if the employer has more than 50 employees and is required to offer you COBRA coverage. Seems like an awful lot of trouble, though, just to get health insurance. But maybe you'd wind up liking the job. :)
-------
UC for the last ten years
Current Meds: 6MP since 2006, Cortifoam
Past Meds: You name it; I've tried it. (Asacol, Colazol, Pentasa, DiPentum, Rowasa, Canasa, Cortenema, sulfasalazine)
5ASA drugs don't work for me. Canasa seems to make me worse.
Alternative treatments I have had success with: Acupuncture, Hypnotherapy

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