Health Insurance HELP

• By Prinzy
• Reply 3259132
• August 2, 2012 at 10:00 am
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Interesting. I know about short and long term disability insurance.....also COBRA. With the new HC taking effect, an insurance company can not turn you down for a preexisting condition -- it would be interesting to find out what you are told in calling around to a few insurance companies and asking about premiums etc. I am not sure when the preexisting part of the NHC goes into effect, but it is worth checking out.

• By Antigone
• Reply 3259254
• August 2, 2012 at 10:40 am
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Yes, the ACA now has PCIP, pre-existing insurance plans, in place, and, yes, they do require you be without insurance for 6 months to qualify.

• By Antigone
• Reply 3259258
• August 2, 2012 at 10:41 am
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Forgot to add, you probably have a community clinic in your area where you can get low- or no-cost medical services for the six months you're without insurance. You can find one in your area here: http://findahealthcenter.hrsa.gov/Search_HCC.aspx

• By Barb1958
• Reply 3259569
• August 2, 2012 at 12:30 pm
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Is your long term disability going to be SSDI or through an insurance company? Have you applied for SSDI? Social Security Disability recipients can receive Medicare coverage 2.5 years after the first month they are eligible for their monthly disability benefits. This doesn't mean that you will necessarily have to wait 2.5 for Medicare coverage. The two-year waiting period is calculated from the date of SSDI entitlement, which is the date your disability began, plus five months (due to the five-month waiting period for SSDI). If your disability onset date is back far enough, you may have already done the 2-year waiting period by the time you actually get SSDI approval. For example: you apply for SSDI on August 1, 2012 but state your disability date as August 1, 2010. If Social Security approves you for SSDI and agrees that the day you became disabled was indeed August 1, 2010, then you have already completed 2 years of the waiting period. If Social Security lists your disability date as August 1, 2012, then the 2 year waiting period starts from there. That is why that disability date is so important whenever someone applies for SSDI.

I hope this wasn't too confusing. I feel for you as I went through very similar circumstances. I ended up wiping out my retirement savings just to pay for medical insurance during my waiting period - which ended up being almost 4 years (long story). And a major reason why I am such an outspoken proponent of universal medical coverage now. No one should have to lose their savings and have to live at poverty level due to medical problems. Please - feel free to ask me if you have any questions about SSDI and Medicare.

• By ginga418
• Reply 3259885
• August 2, 2012 at 2:36 pm
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Thank you all for responding to me. Long term disability is through my company and I appied for SSDI. SSDI is taking forever and a day to get back to me its been almost 3 months. I'm having trouble paying my mortgage and adding COBRA would just make it worse. I called Medicaid again and they will cover my daughter but not me which is a little bit of help so now i just have to insure myself. Through COBRA its $550 which is much better than the $1K. I wish Obamacare started now and not in 2014 but its progress. I might have to go back to work sooner than the doctors would like just so I can have coverage and pay bills. If SS didn't take so darn long to review my case and send me a check I wouldn't be stressed out. I think that's their whole game plan delay as long as possible and force the person back to work.

• By S122851
• Reply 3259901 · In reply to 3259569 by Barb1958
• August 2, 2012 at 2:40 pm
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2014 is when the preexisting law kicks in. I ran out my Cobra after 36 months (in Calif you can extend the federal 18 months to an additional Cal Cobra 18 months). When Cal Cobra expired, I then contacted a Health Advocacy Group and they found a state funded High Risk Health Insurance program for me that runs about $850 a month. About $500 more than I am used to on Cobra, that was almost $100% coverage. The High Risk is not bad: After the deductable of $500, my copays kick in and it is pretty good coverage with most things $20 or 20%. $2500 out of pocket annual maximum...There were two levels, one that required 6 months without insurance to qualify, and one that was immediate.

The Advocacy group does not charge me anything, and if you would like to call them they may refer you if they are not national....American Health Advocates Corp. http://americashelathadvocates.com or (510) 749 0417. These groups are popping up everywhere, so you might have a local one, though there is no advantage if they do by phone. These groups not only find insurance, but help you navigate the complexity of deductable plans, high bills, bad care... they fight for you. Some are better than others. I think you still have to be proactive and advocate your needs and keep good records...

So sorry, there is nothing worse than fear of losing health care when you have health issues... feels like the floor is dropping out from under you.

Take care.

sz

• By S122851
• Reply 3259907
• August 2, 2012 at 2:43 pm
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Ginga... sorry did not see your last entry. I would call the advocacy group just in case they have some suggestions for someone like yourself who cannot afford the high fees..... sz

• By ginga418
• Reply 3259920
• August 2, 2012 at 2:48 pm
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I appreciate all the help I can get. Its been wearing down on me, but this too shall pass.

• By Gift-Heart
• Reply 3259966
• August 2, 2012 at 3:05 pm
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You can also call your state SHIP (State Health Insurance Program) I work with the State of Washington version, SHIBA, which can be reached at 1-800-562-6900. We are part of the Consumer Protection Division of the Office of the Insurance Commissioner, and the mission it to provide free, unbiased, confidential information about healthcare coverage. Here is a link to the page that will find the SHIP in your state:
https://shiptalk.org/About/SHIProfileSearchForm.aspx?mf=Display
(you'll have to copy/paste it into your browser). In my area there is another option for expanded primary care that is not insurance, but for a range from about $60 - 90 per month you can see the doc as many times as you need to. They do some diagnostics, and lots of maintenance of chronic conditions. There are other options for finding help with prescription drugs.

When you are ready to go onto Medicare, PLEASE contact the SHIP for help in selecting the right supplemental and prescription coverage. Last year I save a woman over $7000 a year by switching her to a better Part D plan.

Hang in there!

V

• By TyTy
• Reply 3260034
• August 2, 2012 at 3:30 pm
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My sister got a very good plan through herbstate's high risk insurance pool. About 1/4 of what COBRA would have cost,

• By Jifizap
• Reply 3260268
• August 2, 2012 at 5:06 pm
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You said " SSDI is taking forever and a day to get back to me its been almost 3 months." Mine took 2-1/2 years, and I think that's more usual that getting it quick. After that long I was finally approved based on my medical records - I didn't even have a hearing - like they didn't have my medical records in the first few months??

• By ginga418
• Reply 3260450
• August 2, 2012 at 6:18 pm
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Jifizap I just know you are laughing at me LOL. I'm impatient to me 3 months is a lifetime. They want all this paperwork RIGHT now but they move like snails to get back to you. I will just give up on SSDI because I will probably be back to work before its approved. That's the one thing that is going to force me back to work. The doctors don't seem to know the reality of being on disability because they way it was explained to me that I would be financially ok just buckle down a little bit. I should have known better that it wasn't going to be easy.

Pchyk - I will let you know, I'm going to check on the state programs like the other ladies suggested. I might end up with the cobra because they will cover me for a ridiculous cost.

• By Barb1958
• Reply 3261120
• August 3, 2012 at 12:29 am
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Please be very careful about going back to work while waiting for SSDI as you could very well ruin your case with them. SSDI will and can deny coverage based on you going back to work. Especially now since the number of applicants has gone through the roof. In my state, they are just denying everyone during the first round in order to delay having to put out more money. Both are my adult children are severely mentally ill and my son was approved after 4 months for SSI but my daughter was denied SSDI. We have now had to retain an attorney and it has been over a year since she originally applied and 7 months since we filed an appeal. And we still do not have a hearing scheduled. I'm not trying to scare you, just want you to be very informed about dealing with SSDI and not do anything to jeopordize your case. My son's psychiatrist - who is head of the County's mental health clinic - told me that SSDI denials are as bad as they have ever been. The only patients getting approved are the ones diagnosed with schizophrenia (like my son) and patients who already had prior approval for disability from the state's SSI program.

And remember -- even if you get the letter of approval tomorrow, the all important date is the date that SSDI decides you became disabled. Medicare starts after two years and 5 months from the "date of disability." There is a website that has really good information about the whole SSDI process: http://www.thedisabilitydigest.com/. It is free to sign up but they do try to sell you their books and things but you don't have to buy anything. They will send you a lot of emails so if you decide to sign up, I would suggest an email address that you use only for things on the internet. If you can ignore the hard sell, their information is good and up to date.

Have you done a google search on "medical care without insurance in [insert state]" And have you checked your county's resources? Both of my children used the county's mental health clinic and their visits were charged on a sliding scale which was very reasonable. My son also used the county medical clinic which was not so great but okay on a temporary basis. Most county clinics are overwhelmed these days so you have to be the squeaky wheel in order to be heard. We were told the waiting list for an appointment for my son was over a year - even after I told the scheduler that he had been on the psych ward of the county hospital. After waiting 3 months, my son had a second psychotic break and I put my research cap on and found the phone number of one of the administrators on the net and he got my son in to a county psychiatrist in a couple of days. Whew! -- that whole thing was such a nightmare and I haven't thought about it in awhile.

My heart just aches for you because I know what you are going through. It's so scary and it feels like no one gives a damn sometimes. And it is so hard to ask for help when you have done for yourself all your life. We were 3 weeks from being homeless and stealing food to eat when the first check came through. 3 weeks. All my jewelry was sold or pawned, my retirement money was gone, my savings was gone, my credit cards were maxed out and I had been using a personal loan through my checking account to pay the mortgage and electricity. I went from a $45,000 a year job to no income for over a year. Today we still struggle a little but we are doing fine. There is very little money for extras but after all that, the basics are okay. The road to permanent disability can be a long and frightful journey. My best piece of advice would be to research, research, research all the programs that are available and learn the rules inside and out. And if you have to get an attorney, do not ever, ever, ever get one of those flakes that advertises on television. Okay, off my soapbox and onward to bed. Let me know if you have any other questions or just need to vent or just need an ear. You are not alone.

• By kkmamawof3
• Reply 3264139
• August 4, 2012 at 10:09 am
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Hi ginga! I am sorry that you are going thru this. When my husband lost his job we stayed on cobra as long as was allowed and it was very expensive. I have been without health insurance for 7 years now. I have tried every where to get coverage and always denied. I had ovarian cancer in 2000 but doing great with that now but the insurance comps still hold that against me. I had to have an Arteriogram with stent placement in my left leg for PAD a year ago and it was very costly, ended up being $50,000. Ouch! I struggle to pay each one monthly with continued threatening phone calls. I still have lots of pain in myu leg and my toes turn black again from time to time. I am supposed to be on Plavix along with the Pletal that I take but just can't afford the Plavix. I explained to my doc that I can't afford it and all he say's it you can't afford not to be on it. Easy for him to say. I have chest pain from time to time that radiates to my left arm and jaw, been to the ER only to be told they can't do test with out insurance unless I am in the middle of a heart attack. My Nurse Practioner wants me to have a heart cath and tried to send me to the Cardio associates and they won't see me with out insurance. She is very upset over this and said she took an oath as they do to help people and she is appaled at the medical field. I am telling you all of this to let you know that you are not alone, I am sure there are tons of people going thru the same situation. I even took out a policy that cost a lot to have them never pay a dime on any thing, I could have been paying doctor and hospital bill's with what that cost. Best of luck to you, hang in there, it's all we can do.


Sincerly,
KK

• By S122851
• Reply 3264256 · In reply to 3259132 by Prinzy
• August 4, 2012 at 10:57 am
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Prinzy ... 2014 it takes effect...If you are without insurance for longer that 60 days, they may still be able to deny treatment of certain conditions for first year, while providing other care...also I am sure premiums will be higher somewhere to compensate for having to take preexisting conditions.... None the less, everyone needs access to HC.....my Cobra expired, everyone denied me any kind of coverage
Listing failure to comply with Doctor's recommendation cause I went off statins, refused another costly test, weight, cholesterol, sleep apnea (even tho treated and compliant)....was able to get high risk medical for well over $800 month...once deductible of 400 is met, it is good coverage.

It is a slippery slope.

• By ginga418
• Reply 3265756
• August 4, 2012 at 11:49 pm
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Thank you ladies for sharing your stories with me. I feel stronger to know that I am not alone. Its a constant fight every day against insurance companies. I pray that one day we wont have to go through this just to stay alive. You are all inspirations to me.

• By BeeBush
• Reply 3267067
• August 5, 2012 at 2:47 pm
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Don't know about other states, but in Texas you can call 211 and they will give you options and numbers for lost cost/free clinics in your area. Depending upon where you live, there might be options you don't know about. Good luck to you.

• By Jeanz
• Reply 3267725
• August 5, 2012 at 8:05 pm
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If you need open heart surgery or stents the Larry King Cardiac Foundation will paid for surgery at certain hospitals.

http://www.larrykingcardiacfoundation.org/

I have come so close in not having health insurance. I now pick up every penny I find and read it " IN GOD WE TRUST".

• By BeeBush
• Reply 3269105
• August 6, 2012 at 11:13 am
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Actually, you don't necessarily get second rate care at the free clinics. I have gone to some of these clinics at one time or another in my life, and mostly the care I got was pretty good. The one exception was Planned Parenthood where I went for an IUD. That was the worst , and what happened to me was very wrong indeed.

While a patient at one of these clinics, I broke my hand and wrist. The clinic sent me to the best orthopedic surgeon in town and paid for everything. I was treated no different than his paying patients in his office.

• By S122851
• Reply 3269281 · In reply to 3268049 by Pchyk
• August 6, 2012 at 12:17 pm
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Dear Pchyk...... I can feel your panic across the air waves. This is the worst feeling, having what I think is one of our basic rights (to good health care) pulled out from underneath us. When you work hard, are a good citizen, it seems you should be able to get better than this.

I was rejected by every Plan after COBRA, until I found the Advocacy group to help me. Now I pay thru the nose and watch my hard earned money go for my care. I am already making decisions about drugs, tests, etc based on whether I can afford it.

I had mentioned earlier this Advocacy Group that really does all the leg work for you. It might help to feel someone is listening just to you, and I urge you to call them. LIke I said, they may be able to help you directly, or refer you. I live in California(these groups are all over) where their office is, but they may have resources all across the country... they are pretty proactive. Many of the people in the office are folks with pre existing conditions, and you would get a very sympathetic ear. I have not idea what they might have for you, luckily I was able to pay for the Plan I ended up with, and hopefully I can get a job with insurance or earn enough to pay for care, and then go on Medicare when I can.

I am sorry that anyone has to be in your position.

Suzie