Special Needs

Fukking insurance companies

Marley's cardio has recommended that she get synagis shots in light of her recent heart issues.

Insurance will cover the cost of the shot- but only 80% because while we have met our?deductible?for 2009, we also have a $3000 coinsurance.I'm a nurse I don't get that. I mean, I ALREADY pay $300 a month for the insurance because it's COBRA. And it has to be COBRA because Marley is not eligible for private health insurance due to her "pre-exisiting medical condition".

Therefore I have to pay $620 OOP per month/shot!!!

So I called the Public Health Dept as they have a special program for SNC. The pharmacy that dispenses and administers the med may have a program available where I could pay a discounted amount. I looked into Medicaid but we are not eligible because DH and I both make too much money even though we haven't received paychecks yet (not until the end of the month) for our new jobs. So we don't actually HAVE any money yet.

I cried at my desk today. The upside is that I'll be getting new insurance April 1st through my new job. That covers everything 90% but only after I've met a $1500 deductible which will come out of my HSA. Of which I've elected to contribute the maximum amount- $4500 per year. With a SNC, I have no doubt that I'll use every bit of it.

Anyway, I just needed to vent. I'm so frustrated. I really can't understand why insurance companies make it so hard for sick, little babies to receive medical care. They make me sick.?

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Re: Fukking insurance companies

  • Insurance companies suck!  I don't understand why they don't cover some medications that kids/adults need.  If a doctor wants them on a particular medicine, then the insurance company should have no say it in. 
  • I don't understand why medicaid doens't automatically qualify her due to her medical condition.  I have a cousin who is 8 and both parents work but she still gets medicaid since she has a life threatening health issue.  And, insurance through her parents still covers her although her condition was present at birth as well.  How can a effing insurance tell you that your baby's congenital issue is a "preexisting condition"?
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  • My uncle is in PA and his medicaid for Kasey has been really good about things.  She sees someone who specalized in CEP out of Clevland, OH.  Our DI for EI said yesterday that she would call up someone to help us advocate for Chris to get additional insurance.

    Amajane, do you have a program for insurance for kids who are uninsured in your state?  Here in NJ we have Family Care that covers children if they don't have insurance or can't get it.  In PA is't called CHIP.  Would they insure her?

  • i hear ya! ?insurance companies do suck! ?thankfully we got ryan medi-cal through their waiver program so that's not a headache anymore. ?now it's just me. ?i just don't understand how it's $300 a month then i have to pay over $500 for blood work.
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  • That does suck! Those RSV shots are so important - why do they make it so hard?

     Right now we have 2 insurances, one through my job, and one through my husbands.  BOTH denied the RSV shots, but my pediatrician is giving us free samples. 

    We are in the process of applying for a waiver medical card here - it takes a little bit, but we were told with his condition he would likely qualify and that covers everything, irrespective of our incomes, and is just like Medicaid.  I had asked about something like this with our local DHHR office and got nowhere.  Finally a lady in our EI told me how to go about it - otherwise I wouldn't have had any idea!!

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