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realisticdreams
member
Grr. Insurance, anyone have individual policy?
realisticdreams
member
We will be switching to Dh's insurance in a few weeks, because I can't go back to work FT. I used more than my 12 weeks, and I no longer have a FT position being held for me. Not that they are willing to work around 2 sick child's dr appointments, anyway.
Peyton is over the income limit for her SSI for the last 3 months because DH worked OT. So, she is probably going to lose her medicaid. I can't find a single damn waiver in Virginia to help us.
His insurance is going to have a $50 copay on all therapies, and 20% on most imaging studies, hospital is $400/day!!
We only made 36,000 last year & probably won't make more than 45,000 this year. How the freak is it fair that someone can keep having babies on purpose and get medicaid, but I just want it as a supplement for my sick child & we have no options. We are trying to crawl out of debt and now this is going to shove us back in forever. They want MRI's yearly to bi yearly to check on her lipoma, the last one was $15,000 with anesthesia at children's.
If you have an individual policy, how did you get them to cover a pre-existing condition?
DD1(4):VSD & PFO (Closed!), Prenatal stroke, Mild CP, Delayed pyloric opening/reflux, Brachycephaly & Plagiocephaly, Sacral lipoma, Tethered spinal cord, Compound heterozygous MTHFR, Neurogenic bladder, Urinary retention & dyssynergia, incomplete emptying, enlarged Bladder with Poor Muscle Tone, EDS-Type 3. Mito-Disorder has been mentioned
DD2(2.5): Late term premie due to PTL, low fluid & IUGR, Reflux, delayed visual maturation, compound heteroygous MTHFR, PFAPA, Bilateral kidney reflux, Transient hypogammaglobulinemia, EDS-Type 3
http://justthetipblogg.blogspot.com, The Neglected Blog.
This discussion has been closed.
Re: Grr. Insurance, anyone have individual policy?
Isn't that one of the things Obama's healthcare reform fixed? I don't think they can deny you based on a pre-existing condition anymore. I was able to get a private policy for my ds with asd, but that was based on autism insurance reform that was passed in my state years ago. No co-pays, $1500 deductible, OT visits limited to 20 per year, same for ST, unlimited visits for ABA (what we primarily used it for), $165 per month. We have Anthem. We had no problems with them the first 18 months, now major issues with processing claims due to them changing from a manual to electronic filing process.
Good luck.
I think you need to call Medicaid and talk to them. I am not sure about VA, but here in TX you can talk to MHMRA (mental health), DADS (dept of disability), HCS (home care services) - among those three you can find a waiver or a low cost solution. Medicaid is not always income-based, and your daughter may qualify based on her disability or the needed care, etc.
Good luck!
As of right now PPACA says no child can be denied insurance based on a pre-ex condition. However, an insurer can have what is called a pre-ex waiver where if the child was not continuously insured or had a gap in coverage over a certain amount of time (depending on the policy terms) the insurer can make you wait several months before the pre-ex is covered. So if your children are currently without coverage and it has been more than 60 days you could have to wait up to 90 days to get coverage on the pre-ex. PPACA didn't change that little nuance in the law.
Additionally, your premiums will be based upon the pre-ex and it's going to be pretty heavy. Based on medical history the underwriter will assign points values to the conditions- the more points the higher the premium. Some will charge a flat rate increase premium for conditions that will not resolve (they do this in life insurance as well). You have to see what your options are and you have to look very VERY closely at the pre-ex waiver on the contract and the limitations and exclusions.
I don't know what we're going to do. I've just sent an email to the woman in charge of most waivers for my area to see what she has to say.
It just doesnt' seem fair, that because dh gets a little bit of OT, we lose the SSDI & medicaid, which honestly all I care about is the medicaid, and now we will have more than 1/3 or 1/2 of our income in her medical bills.
I'm not glad this is happening to you, but i'm glad I have someone I can relate too. We also have to pay back from now until December! I give them our paystubs as soon as we receive them. I didn't even get the letter saying she was going to be non-payable. I called after we didn't get anything for March and had to have them re-mail it out.
It's frustrating. Medicaid should be available to ALL children with a diagnosis! Dh's insurance has a 20% copay & her last MRI was $15,000 at children's. She has to have one yearly to bi-yearly to monitor her lipoma!
As if I don't have enough to stress out about already, i'm worried about this and if medicaid is going to take back there payments on her last MRI in JAN & everything else she's had done.
We used ALL of dh's OT money that he made to pay off old bills. I had a lot of medical bills too. I still have a lot of money from all of my short stay admissions with Peyton & my hospital admissions with her. We are trying to get ourself in a better place so that we can get a nice house and the girls can have nice things, but at this rate we will never have good enough credit to buy a house because of the massive amount of medical bills.
Plus, we won't even be able to pay her copays for her therapies. My other medical bills had to go to collection bc they wouldn't accept ANY less than $100/month! It was that or collections so I said, well I don't have a choice.