Discussion in 'Off The Beaten Track' started by BaileyCatts, Mar 4, 2012.
My personal opinion is this: Everyone should be given the opportunity to get some kind of affordable health insurance, whether it's employer group, private, or something that the government will help to provide. Something should be available to everyone regardless of your income or employment status. However, if you turn down that option and you become ill, it is then your problem and you should be forced to work it out the best way you can. It's not fair to make someone else's irresponsibility my problem.
Your benefits department determines what services, procedures, and coverages you will have the same way they choose your provider. These corporations and insurance companies work together to deceive us and keep their costs down. Your boss is required to provide benefits and the insurance company provides the least amount possible. It's unfortunate that many people have group coverage and it doesn't pay for anything.
Does his school offer insurance? While I was working on my undergrad, all registered students were required to have health insurance. You had to provide proof or you had to pay for it thru the school. I was employed at the time, so I had coverage, so I don't know about the specifics, but this might be an option?
I have a cousin in New York and I know that he had a catastrophic hospital coverage only policy when he was between jobs. A quick search shows that New York does in fact offer catastrophic coverage, and there is no minimum one-year coverage period - the policy can be canceled with 30 days advance notice, so it's basically a month to month. Maybe this is relatively new. My cousin had his policy about four or five years ago - don't know when you were looking.
I agree with this.
We get a number of patients referred to our practice from various charities and other doctors calling, saying, will you please please please see this guy for free, he really needs it. One such guy showed up with a pleural effusion that had to be tapped, so our doc went ahead and did the (minor) surgery and drained it free of charge. However, he couldn't waive the fee for pathology tests, since he doesn't own the lab. He agreed to call some buddies at the NIH and see if he could pull some strings.
A few days later he found somebody willing to do it, and tried to contact the patient to tell him the good news. The guy emailed him back in response and said "F*ck that! I'm on vacation in Spain."
God people like that tick me off SO much when there are so many people out there who are trying to play by the rules and can't get healthcare coverage.
^^^Hope your practice bills him for everything, full price.
Same with my 20 year old son. I give thanks to Obama every day that he has medical coverage while he deals with his depression and gets his life in order.
If you can afford insurance, the Federal Health Care Reform Act prevents insurers from denying coverage to anyone who has current coverage. BC, Humana told you the wrong thing. Call them back and ask about your rights under FHCR!!! Whoever told you they "can't" sell you a new policy is just plain wrong.
If you look into other insurance, get a "Certificate of Creditable Coverage" from Humana to prove that you had prior insurance.
I am so fortunate to live in Massachusetts where insurance is required. Those who can afford it have a wide choice, and those who cannot get a subsidy to help pay for it. It's almost unheard of to be unexpectedly dropped!!!
Some additional information about the availability of catastrophic insurance availbility can be found at: http://www.dfs.ny.gov/website2/hny/english/hnyhdhp.htm
Thank you for the info on this and btw I am jealous that you live in Mass. right now.
My sister-in-law is a PhD in optometry specializing in multiply challenged children. She diagnoses and provides help for kids with autism, Down's, deafness and a range of other conditions. She takes no insurance at all since Massachusetts became so difficult to navigate for non-MDs; the law there is good for patients but for providers it can be so much paperwork that a single-person practice can't make it work.
People ask all the time for reduced rates and sometimes she says yes, she's a very socially aware person. Twice so far in 2012 she's discovered that patients' parents begging for reduced or no fees were in fact quite well-off. I don't blame her for being infuriated.
My experience with being unable to get temporary health coverage in NY was five years ago. My recollection is that the temporary health insurance companies would not cover maternity benefits, or something along those lines, and many "liberal" states like NY, NJ, and MA effectively banned them in response. I believe this was before HDHPs.
At my previous job in NJ, I had a prospective employee who would have had an insurance gap if she left her job to come work for our company, which had a mandatory 30-day waiting period for health insurance. Through our group insurance broker and our own independent research, we could not find any suitable solution for one month of coverage. This was in 2008.
The "Healthy NY" program linked has relatively low income restrictions. It won't work for your average job-changer who needs gap coverage. In my 2007 situation, I would've been denied.
BB, I checked out your link, but the New York State Insurance Department's web site is down at the moment. I'm curious about these three catastrophic plans that are recognized, as this is news to me.
Is it true that if you are ever denied coverage, or apply and then are denied during wait time based on application, you cannot ever get health insurance again due to being denied? I was reading an article and closed it by mistake and now can't find it again. Maybe I read it wrong but I was only on about page 2 of a 8 page article.
Can you be denied by an employer plan if you are in employee of that company? I thought if you were an employee of a company, you buy the company plan and can't be denied for any reason?
No. What is true, however, is that just about every individual policy application asks whether you have ever been denied coverage, and if you have been, you need to disclose it.
No. Group plans have to offer coverage to everyone in the group.
Correct. As long as you meet the company's eligibility criteria for the coverage (could be number of hours worked, classification of employee, work location, etc.) you cannot be denied coverage.
BC - one option you should look into is whether your state has a group plan through their small business association. If that's true, you might in the end be better off forming a company (make it skating-related!), paying the incorporation fee, which is usually minimal), and then joining the SBA. The states that offer that have group policies so you could not be denied. And they are not individually-rated, so premiums are averaged over the entire group.
I was not covered for a number of years in my late teens, and 2 asthma hospitalizations made me realize I never wanted to be uncovered again. My mother paid for them but I thought the bills were just huge (about $1,200 and $4,000 - very cheap by today's standards).
When my husband started his own business, my firm did not subsidize family coverage at all so it would have been $650 a month to add him. It was a very comprehensive policy, and we were a small firm with a lot of older people and not many younger people. He had no health issues at all. I went online (this was 2006) and found that I could buy the exact same policy for him with the same company as an individual for $225. I also found a number of catastrophics for around $100. He was 41 at the time. I said "hey, maybe I can do better for myself too" and got a quote for me - I was 46. $650. The asthma was part of it for me. But after putting in a variety of ages for him on the online quote system, I figured out that there was a big jump in price at 44.
The part about the employee sounds strange to me. Everywhere I have worked employer provided health insurance takes 30 days after your start date to take effect, but it also covers you for 30 days after your termination date. Was there a gap of more than 30 days between jobs? If so, couldn't she use COBRA?
Couldn't she have done COBRA for that month?
My individual plan didn't cover maternity care, either. And there were other exclusions. And when I shopped around for a new plan after my first one stopped offering policies in my state, I was told (by my state's Blue Cross plan, the supposed insurer of last resort) that anything involving my leg (that I'd broken over a year earlier) would be excluded. It was several weeks later, after I'd already signed up with another plan, that I got a letter telling me the exclusion could be waived if I provided a Certificate of Creditable Coverage.
In 2007, I quit a job on April 20 and had my insurance end on April 30. Whether it was legal or not, who knows. And maybe it was legal then but not legal now.
The situation I referenced above involved a relocation from overseas, so COBRA was not available. In the end, we had the person work from her home country for five weeks so that she'd have in-force health insurance by the time she came to the U.S.
And I have worked at two jobs, this one included, where insurance starts on day #1 of employment, so it is possible somehow.
At most places I've worked, health ins coverage ended at the end of the month in which you left. When I was laid off in 2006, I received 2 months of severance and my health ins was extended through that time.
That company and my current employer are the only places I've worked that provided coverage from Day 1. Both are large organizations. The smaller orgs where I worked previously had a month, sometimes a bit more, waiting period before health benefits kicked in.
Dental and vision is a whole new ballgame. I have excellent medical coverage (thank goodness, as I have a serious health issue), but dental/vision is totally separate.
However my dental coverage has a $1000 yearly maximum (we didn't know that until DH reached it, on normal stuff- nothing extraordinary like root canals or crowns) and covers like 50% of the insane charges the dentists come up with. My vision is a joke- 80% of an eye exam and $75 towards glasses or contacts. That's IT. Thankfully my corneal ulcer a few years back was covered by medical, not vision...
Don't complain. Ours pays $35 toward an eye exam and $60 toward glasses or contacts.
And my retinal condition requires more complete scans each year but won't qualify for medical coverage until something besides thinning or floaters occurs. Lucky me--if one detaches, tears or hemorrhages, then I'll get it covered under medical. Until then, we have to pay out of pocket.
Wow- I didn't know eye coverage could get worse than what I had. Sorry to hear your condition doesn't qualify for medical. Mine required bacteria trying to eat me blind...
Our system is clearly broken.
Well I never thought I had some large pre-existing condition ( swimmers ear when I was a kid!!!) so I ignored this tidbit from "Money" magazine but now I will check:
"If private insurance is a no-go, you have two government-based options. Anyone can get coverage via his/her state's high-rish insurance pool--you'll pay about 150% of the cost of an individual policy (see healthcare.gov) or a similar backstop.
Thanks to health reform, those who have been uninsured for the prior six months will qualify for their state's Pre-Existing Condition Insurance Plan (pcip.gov). The program, intended to bridge the gap until options are introduced in 2014, will cover you for rates similar to those that healthy people pay in your state (a 50-year-old in Minnesota, for example, would pay $220.00 a month.)
I don't think this applies to me but perhaps does to others posting here. I do need to find out exactly why I was turned down on the reasonably priced plans.
It has been diagnosed by a specialist but the "minor" symptoms of retinal thinning and excessive floaters and extreme nearsightedness and early presbyopia (reading glasses before 40--ack!) that it has caused are not considered symptoms. The problem--hereditary retinal degeneration-- is too unknown here--less than 1% of people who are nearsighted in the U.S (rates are higher in Japan where most research is being done). My mother had an evaluation at the University of Iowa--the premier ophthalmologic center in the U.S--and was told she is the most extreme case they have seen there. Fortunately, my eyes are better than hers were at the same age, but I have an 80% chance of being legally blind by age 60.
When I was looking at switching to an optometrist closer to home (mine is an hour and a half away--as is the best retinal specialist in the area who I see every three years right now), one I talked with told me this condition does not actually exist and I am probably "imagining" my floaters.
(On the upside...it may not be considered a pre-existing condition at this point since insurance doesn't think it is a condition!)
I went to my state's page on the pcip.gov site. Oh great. $663 a month for what I would need. Like I can afford that!
My vision plan is so lame that it would only be worth it if I got new glasses every year. I just changed my glasses last year, but before then, I'd gotten the previous pair BEFORE college. I had the optometrist do the calculations and I would save more money just going without the vision plan.
I do have a very strong prescription, but at least it hasn't changed much since high school. When I hit 35 I'll probably be paying more attention to these things...
I canceled my vision insurance. It didn't work at the place I like, and I didn't like any of the glasses at the places it did work.
Your eyesight might improve. Like mine did.
If I called and talked to a place today, and they are currently I guess "reviewing" my application, can I call them back tomorrow and just say I withdraw my application without any issues happening (officially being "denied" by them?). Then I don't have to say I have been "denied" if it never officially went thru the process?
Ooh, don't get me started on vision & dental coverage. After reading this thread I feel very, very fortunate to be Canadian and to have the public health care that I do. However it still only covers "basic medical." That's nothing to sneeze at, but it does not cover outside-of-hospital prescriptions, dental, or eyecare. Not that long ago it did cover eye exams (once every 2 years), but not glasses; now not even the eye exam is covered. Dental has never been part of basic medical (in BC -- different rules in different provinces), but it should -- how are rotting gums and teeth not a health issue? And how is poor eyesight to the degree that it affects your safety not a health issue?
You can of course get optional extended medical packages that cover various degrees of prescription, eyecare, and dental, but it's never been cost-effective for me. I've done the math, and for me it would cost more to pay for insurance than what I pay for eye exams, glasses, and dental work directly. And, thank goodness, I don't take any prescriptions. But all that may change as I age.
My dental insurance maxes out at $1500 a year. And I basically need crowns/caps on about 10 teeth. I'm looking at more than 10K in bills when I have it done, and am determined to do so before it gets even worse.
How does someone raising children or with other serious health problems afford something like that? They don't.
And reading this thread I'm struck again by how bizarre it is that American's health coverage is pegged to their employment. Especially since some people have to stop being employed because of health issues, which might not qualify them for disability. Talk about Catch-22.
(On vision, I have good news for you all. If you're near-sighted in your twenties-forties and need glasses to drive or go to the movies, your distance vision will improve in your fifties. Then you will need reading glasses.)
I feel your pain. My plan maxes at $1500, also. I have had 2 root canals over the last 3 months and I paid $200 out of pocket for each.....the crowns, which aren't covered by my plan, are going to cost me $1200 each! I had to take out a supplemental dental plan to pay for the crowns and whatever other work I'm going to have to have done. My dentist put in temps until I can get it together to pay for the crowns. I have to wait 6 months, but with the premiums being $35 per month (I can't remember the exact amount, it debits from my bank account), that sure beats the cost of 2 crowns!
I need new glasses, but I have decided that I'll just change the lenses. The thought of trying to find frames makes my head hurt.
It really varies by employer. I've mostly worked places where coverage started the day you did. That's pretty standard in my industry. It used to last until the end of the month you left the company but now it's changing in some places to the day you leave. I hope that doesn't become an industry standard!
I had wonderful vision though. It was through VSP so it covered almost every place I could go and I was able to get 1 pair of regular glasses and 1 pair of computer glasses covered every year!
Of course, I haven't got it now.
Isn't that determined when you get hired? So, if you have a job that terms your insurance on the last day of the month that you left the company, that wouldn't change for you, only for those newly hired, if they change the policy?
My distance vision started improving when I hit 36 or so, leveled out at 40 and has gotten worse the last two years .
I still don't need reading glasses, though.
My son and I just got our eyes examined. He got new glasses; I got contacts for the year. The optician ran our bill through insurance and it turned out the bill was more than it would be with a sale the store was having. Eye exams, contacts for a year, and new glasses (with relatively cheap frames) came to more than $800. My daughter got new glasses a few months ago and it was the same deal--the sale took more off the bill than our insurance would.
We've done fairly well on dental insurance, but only because we've switched coverage several times and so had half of the kids' multiple orthodontic procedures and most if not all of my surgeries covered. If we had been with one company all aong, that would not have been the case.
We paid more than that a month at one time through my husband's job--but we had a family plan, which is probably more than you need.
My husband's insurance coverage has started day one of every job he's had for many years, so it definitely must be possible.
Oh, how I wish. My brother, who did not inherit any of the plethora of genetic eye issues, is having that experience already, before 50. But I got to have reading glasses over contacts before 40.
I'm just lucky it is nothing worse yet, though.
There are a LOT of online places that do glasses for cheap. You just have to give them your prescription and make some measurements and bam! $15 later you have your glasses.
Can't recall who dh used but I'll ask him. He got himself some fab orange frames, lenses and all, for like $6.
I never understood why one's teeth, eyes, and mind (for mental illnesses, as they were generally capped lower than physical issues) were not considered to be part of one's body, and thus covered under medical insurance.
We also dropped our vision and dental insurances because they covered very little. And the dentist we use gives us a significant discount for paying in cash or with a credit card (no insurance). We use the discount eye places because I wear contacts and don't generally need fashionable frames for backup purposes. There are also lots of eyeglass places on the internet if you can stand to order your frames that way and get adjustments from a friendly optician (in my case, that is my brother).
Usually that is only possible for very low prescriptions.
I won't even traumatize you all with what lenses alone cost for me.
I read these stories and am extremely grateful for our universal health coverage in Australia.
That is ridiculous. I am beginning to think that former Congress member from Florida was right: 1. Don't Get Sick
2. If Sickness Occurs: Die.
I know he worded it differently but his meaning was clear. What scares me is the prices are skyrocketing every year. Next year that figure may be $800 a month-who knows? If they will have me I'm going to roll the dice with Starbucks and hope Mom is going to have a good year.
Separate names with a comma.