Insurance problems

4

4kidsmom

New member
We are having insurance problems right now. My husband started a new job on 1/10/2005 and we now find out that the primary insurance will not cover anything CF related until 1 year after the 90 day probationary period which is 1/07/2006 so we are his talking insurance would then pick up on 1/07/2007. We are pretty scared, seeing that his medications alone this year so far are $18,500. He does have medicaid, but I just had a meeting today and she suggested me quiting my job in order to keep it. Is anyone else in this situation? My job is really good with me needing time off for sick kids, etc., I feel like I really don't have an option. It is either my sons health or a little extra money by working. It is so aggravating because you can't seem to get ahead with this disease!

Angie
Step-mom to Brittany 13 no cf
Mom to Tyler 12 cf carrier
Brady 4 with cf
Taylor 3 no cf, but has chromosome 9q deletion q21.2 q22.1
 
C

cfgirl2008

New member
My mom had to quit her job to keep the medicade and SSI checks. They say you can't make over then 2,000 a month. But my mom is thinking about just working someone on weekends for a little bit spending money. My stepdad makes like 1,000 a month so that will be ok. The SSI check for is $521.10 and the same with my brother.



Tiffany 15 w/cf
 
W

WinAce

New member
Wait, wait.

Is this the result of a "pre-existing condition" exclusion, or some other crappy policy?

If it's the former, and your CF kid has had continuous insurance without a 63-day gap in coverage (whether it be Medicaid or private) they cannot, by federal law, avoid paying because he has an illness already.

But if not, I'm sorry for YACICBB (yet another case of insurance companies being b*tches).
 
W

WinAce

New member
Wait, you say your <i>husband's</i> meds cost an exasperating amount... does he have an unrelated condition, CF or... did I misread you?
 
A

anonymous

New member
Here's what a lot of people suggest you do when switching jobs:
If you go straight from one job to another and your new job has a 90 day waiting period before you're eligible for insurance coverage, then get at least one month of COBRA coverage if you can in any way afford it, then you've had insurance for 30 of the 90 days, thus you didn't go w/o insurance for more than 63 days in a row and they have to cover any pre-existing conditions.
Clear as mud? Someone can correct me if I misunderstand how this works.
Was this by chance your situation? If so, then you should be covered. I'm not sure about continuous coverage with Medicaid, but it seems reasonable that it would count as coverage during the 90 day period too.
 
J

julie

New member
I do believe the child has been continuously covered (either via a private insurance or medicaid) but maybe a clairification on that one from Angie would clear up that question. If the child had continuous coverage, even a state program, they can't impose what she is doing, it violates HIPPA.

Angie, you/your husband need to present the information that we gave you about HIPPA on the adult forum, and if the still resist, you need to report them for a violation of HIPPA.
 
A

anonymous

New member
One other question to throw into the mix.
If the employer that offers the insurance has just a handful of employees, does that change anything or make different rules apply since it really may not be considered "group" insurance?
 
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