Guest guest Posted July 28, 2001 Report Share Posted July 28, 2001 Hi! Because of a law passed by Congress in (I think) 1996, Insurance companies can no longer refuse to cover you due to pre-existing conditions as long as you can show proof of continuing coverage with no lapse - so, you can find a new insurance company, show them a certificate of insurance and as long as your daughter has had continuous coverage since birth with no lapses greater than 60 days, no insurance company can deny her coverage according to law. President Clinton pushed this law through so parents would not feel trapped in a job just to keep the insurance but believe me, insurance companies will be real sticklers about it, so you need to make sure you do not have any gaps and that you get the certificates from the current insurer. Now there is no regulation concerning price, so insurance companies are free to charge a big price but they cannot refuse to cover as long as you have had continuous coverage. This came in handy since between my husband and I switching roles as primary caregiver and switching jobs, we have changed jobs and insurance companies 4 times. Let me kinow if you have any questions. Jodi Health Insurance >Our family is in a dilemma. My husband wants to quit his job with ExxonMobil >to start his own consulting company. I support him except that I am very >concerned about health insurance for our family, or at least health insurance >my daughter . I was shocked to discover that insurance companies can >simply refuse to cover simply because she has Down syndrome. We know >that we can use COBRA coverage for 18 months and then pay full price for >coverage with the same insurer for another 18 months, but then what? Does >anyone have any suggestions for us to investigate? We found a >hospitalization plan with ARC - but it is a bare minimum. The other >alternative is that I go back to work full time - YUCK. >Caio, >Joan > > >Click reply to all for messages to go to the list. Just hit reply for messages to go to the sender of the message. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2001 Report Share Posted July 28, 2001 Hi! Because of a law passed by Congress in (I think) 1996, Insurance companies can no longer refuse to cover you due to pre-existing conditions as long as you can show proof of continuing coverage with no lapse - so, you can find a new insurance company, show them a certificate of insurance and as long as your daughter has had continuous coverage since birth with no lapses greater than 60 days, no insurance company can deny her coverage according to law. President Clinton pushed this law through so parents would not feel trapped in a job just to keep the insurance but believe me, insurance companies will be real sticklers about it, so you need to make sure you do not have any gaps and that you get the certificates from the current insurer. Now there is no regulation concerning price, so insurance companies are free to charge a big price but they cannot refuse to cover as long as you have had continuous coverage. This came in handy since between my husband and I switching roles as primary caregiver and switching jobs, we have changed jobs and insurance companies 4 times. Let me kinow if you have any questions. Jodi Health Insurance >Our family is in a dilemma. My husband wants to quit his job with ExxonMobil >to start his own consulting company. I support him except that I am very >concerned about health insurance for our family, or at least health insurance >my daughter . I was shocked to discover that insurance companies can >simply refuse to cover simply because she has Down syndrome. We know >that we can use COBRA coverage for 18 months and then pay full price for >coverage with the same insurer for another 18 months, but then what? Does >anyone have any suggestions for us to investigate? We found a >hospitalization plan with ARC - but it is a bare minimum. The other >alternative is that I go back to work full time - YUCK. >Caio, >Joan > > >Click reply to all for messages to go to the list. Just hit reply for messages to go to the sender of the message. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2001 Report Share Posted July 28, 2001 Joan; It is my understanding that they cannot deny her coverage based on any pre-existing condition- I would confront this agent and tell her that she has had continuous coverage since birth and see what her response is. The only thing different I can see is if these rules apply only for going from group to group coverage whereas you would be going from group to individual .. That might be why you are getting those responses. Jodi From: Joanson@... <Joanson@...> < > Date: Thursday, August 02, 2001 11:44 AM Subject: Health insurance >As I understand it (and my understanding is minimal), SSI/Medicaid has income >requirements. I believe that we would not qualify. >As far as the law regarding pre-existing conditions go, I think that someone >failed to inform the insurance companies. I spoke with an agent who gave me >no hope of her being insured. I spoke with Trigon (Blue Cross), the largest >private insurer in the state, and they will give catastrophic coverage >only after she has been on the plan for a year. has no gaps since >birth in her coverage. I have looked into a couple of association plans and >their costs are astronomical, let alone including a child with Down syndrome >on the plan. Will the insurance companies flat out lie to you about their >obligation to honor the law! Can you tell that I am ranting and smoke is >billowing out of my ears? > >Joan > > >Click reply to all for messages to go to the list. Just hit reply for messages to go to the sender of the message. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2001 Report Share Posted July 28, 2001 Joan; It is my understanding that they cannot deny her coverage based on any pre-existing condition- I would confront this agent and tell her that she has had continuous coverage since birth and see what her response is. The only thing different I can see is if these rules apply only for going from group to group coverage whereas you would be going from group to individual .. That might be why you are getting those responses. Jodi From: Joanson@... <Joanson@...> < > Date: Thursday, August 02, 2001 11:44 AM Subject: Health insurance >As I understand it (and my understanding is minimal), SSI/Medicaid has income >requirements. I believe that we would not qualify. >As far as the law regarding pre-existing conditions go, I think that someone >failed to inform the insurance companies. I spoke with an agent who gave me >no hope of her being insured. I spoke with Trigon (Blue Cross), the largest >private insurer in the state, and they will give catastrophic coverage >only after she has been on the plan for a year. has no gaps since >birth in her coverage. I have looked into a couple of association plans and >their costs are astronomical, let alone including a child with Down syndrome >on the plan. Will the insurance companies flat out lie to you about their >obligation to honor the law! Can you tell that I am ranting and smoke is >billowing out of my ears? > >Joan > > >Click reply to all for messages to go to the list. Just hit reply for messages to go to the sender of the message. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2001 Report Share Posted July 28, 2001 Joan, Yeah, those rules only apply if you are changing from group coverage through your employer to different group coverage. I thought the one lady who is an agent had a great idea in that if your husband can incorporate then obtain a small business group plan or get on the plan through the chamber, that might solve the problem. Good luck with everything. I too have been lucky enough to always have primary health coverage for that pays their portion of his expenses, then medicaid picks up the remainder. also qualifies for the CHildren with Special Health Care Needs program here in Indiana that would pick up as a third layer. I will always try to retain s private insurance because I personally believe that in Indiana, it makes a difference in the quality of care you receive. If we just had medicaid coverage we would be limited in our choice of providers, since so many providers here are now refusing to accept medicaid patients because of the low reimbursement rate. Is it that way everywhere? Just curious. is also on the waiting list for medicaid waivered services which provides services regardless of income. But here again, it is almost impossible to find quality service providers. I wish you the best Joan, I know you are in a hard spot , but as an ex-insurance agent I would definately pursue getting incorporated and finding a group with the chamber of commerce, or getting a small business plan. Good luck Jodi Re: Health insurance >In a message dated 8/2/2001 12:00:12 PM Central Daylight Time, >rjprather@... writes: > > >> It is my understanding that they cannot deny her coverage based on any >> pre-existing condition- I would confront this agent and tell her that she >> has had continuous coverage since birth and see what her response is. The >> only thing different I can see is if these rules apply only for going from >> group to group coverage whereas you would be going from group to individual >> . That might be why you are getting those responses. >> >> > >AH hem... as one who has always had private insurance, if you change >providers the child with a disablity can indeed be denied coverage under pre >exsisting condition. And indeed according to what my sister said when she >was expecting her 2nd child 14 yrs ago, some insurance companies do indeed >deny coverage for 24 hrs after birth, (again private ins.)tho that may have >changed. The world of private insurance is different then the employer >provided kind. Course we also have more choice and can change providers if >the current one is crappy and someone else offeres a better deal. But once >you have a child with a pre exsisting condition (be it DS or diabetes or >whatever) you don't change providers, tho you can roll over to different >types (we went from Major medical to PPO) within the company without having >the child (or even an adult with some condition) dropped. > >I would say check to see what the states plan for uninsured children is if >you make to much money to get medicaid free or for a small fee. (all states >are supposed to have implemented such programs by now) usually TEfra/kaite >beckett does have a process where you can protest the fee if it's high. So >just check into all aspects of the program before deciding you won't be able >to make the payments it never hurts to send in your information to see if you >would qualify. :-) > >Joy > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2001 Report Share Posted July 28, 2001 Joan, Yeah, those rules only apply if you are changing from group coverage through your employer to different group coverage. I thought the one lady who is an agent had a great idea in that if your husband can incorporate then obtain a small business group plan or get on the plan through the chamber, that might solve the problem. Good luck with everything. I too have been lucky enough to always have primary health coverage for that pays their portion of his expenses, then medicaid picks up the remainder. also qualifies for the CHildren with Special Health Care Needs program here in Indiana that would pick up as a third layer. I will always try to retain s private insurance because I personally believe that in Indiana, it makes a difference in the quality of care you receive. If we just had medicaid coverage we would be limited in our choice of providers, since so many providers here are now refusing to accept medicaid patients because of the low reimbursement rate. Is it that way everywhere? Just curious. is also on the waiting list for medicaid waivered services which provides services regardless of income. But here again, it is almost impossible to find quality service providers. I wish you the best Joan, I know you are in a hard spot , but as an ex-insurance agent I would definately pursue getting incorporated and finding a group with the chamber of commerce, or getting a small business plan. Good luck Jodi Re: Health insurance >In a message dated 8/2/2001 12:00:12 PM Central Daylight Time, >rjprather@... writes: > > >> It is my understanding that they cannot deny her coverage based on any >> pre-existing condition- I would confront this agent and tell her that she >> has had continuous coverage since birth and see what her response is. The >> only thing different I can see is if these rules apply only for going from >> group to group coverage whereas you would be going from group to individual >> . That might be why you are getting those responses. >> >> > >AH hem... as one who has always had private insurance, if you change >providers the child with a disablity can indeed be denied coverage under pre >exsisting condition. And indeed according to what my sister said when she >was expecting her 2nd child 14 yrs ago, some insurance companies do indeed >deny coverage for 24 hrs after birth, (again private ins.)tho that may have >changed. The world of private insurance is different then the employer >provided kind. Course we also have more choice and can change providers if >the current one is crappy and someone else offeres a better deal. But once >you have a child with a pre exsisting condition (be it DS or diabetes or >whatever) you don't change providers, tho you can roll over to different >types (we went from Major medical to PPO) within the company without having >the child (or even an adult with some condition) dropped. > >I would say check to see what the states plan for uninsured children is if >you make to much money to get medicaid free or for a small fee. (all states >are supposed to have implemented such programs by now) usually TEfra/kaite >beckett does have a process where you can protest the fee if it's high. So >just check into all aspects of the program before deciding you won't be able >to make the payments it never hurts to send in your information to see if you >would qualify. :-) > >Joy > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 Hi Joan, Does she receive SSI? If so, she is eligable for Medicaid. Log on to- http://www.igive.com/lindseyrae. Each time you purchase from this site, a percentage is donated to the Lindsey Rae Foundation(a non-profit organization for children with Down Syndrome). Plus, your purchase maybe tax deductible. ----Original Message Follows---- From: Joanson@... Subject: Health Insurance Date: Thu, 2 Aug 2001 08:40:39 EDT Our family is in a dilemma. My husband wants to quit his job with ExxonMobil to start his own consulting company. I support him except that I am very concerned about health insurance for our family, or at least health insurance my daughter . I was shocked to discover that insurance companies can simply refuse to cover simply because she has Down syndrome. We know that we can use COBRA coverage for 18 months and then pay full price for coverage with the same insurer for another 18 months, but then what? Does anyone have any suggestions for us to investigate? We found a hospitalization plan with ARC - but it is a bare minimum. The other alternative is that I go back to work full time - YUCK. Caio, Joan _________________________________________________________________ Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 Hi Joan, Does she receive SSI? If so, she is eligable for Medicaid. Log on to- http://www.igive.com/lindseyrae. Each time you purchase from this site, a percentage is donated to the Lindsey Rae Foundation(a non-profit organization for children with Down Syndrome). Plus, your purchase maybe tax deductible. ----Original Message Follows---- From: Joanson@... Subject: Health Insurance Date: Thu, 2 Aug 2001 08:40:39 EDT Our family is in a dilemma. My husband wants to quit his job with ExxonMobil to start his own consulting company. I support him except that I am very concerned about health insurance for our family, or at least health insurance my daughter . I was shocked to discover that insurance companies can simply refuse to cover simply because she has Down syndrome. We know that we can use COBRA coverage for 18 months and then pay full price for coverage with the same insurer for another 18 months, but then what? Does anyone have any suggestions for us to investigate? We found a hospitalization plan with ARC - but it is a bare minimum. The other alternative is that I go back to work full time - YUCK. Caio, Joan _________________________________________________________________ Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 Your husband may be able to keep the insurance he already has, but it will cost a lot. Also, he may be able to join an association that offers group insurance. SSI/Medicaid will not help the rest of your family! This is a crying shame. The US is the ONLY industrialized nation without National Health. We should be ashamed of ourselves! granny --- " Setting a good example for your children takes all the fun out of middle age. " -- Feather http://www.bspyle.com/granny.html Health Insurance > Our family is in a dilemma. My husband wants to quit his job with ExxonMobil > to start his own consulting company. I support him except that I am very > concerned about health insurance for our family, or at least health insurance > my daughter . I was shocked to discover that insurance companies can > simply refuse to cover simply because she has Down syndrome. We know > that we can use COBRA coverage for 18 months and then pay full price for > coverage with the same insurer for another 18 months, but then what? Does > anyone have any suggestions for us to investigate? We found a > hospitalization plan with ARC - but it is a bare minimum. The other > alternative is that I go back to work full time - YUCK. > Caio, > Joan > > Click reply to all for messages to go to the list. Just hit reply for messages to go to the sender of the message. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 Your husband may be able to keep the insurance he already has, but it will cost a lot. Also, he may be able to join an association that offers group insurance. SSI/Medicaid will not help the rest of your family! This is a crying shame. The US is the ONLY industrialized nation without National Health. We should be ashamed of ourselves! granny --- " Setting a good example for your children takes all the fun out of middle age. " -- Feather http://www.bspyle.com/granny.html Health Insurance > Our family is in a dilemma. My husband wants to quit his job with ExxonMobil > to start his own consulting company. I support him except that I am very > concerned about health insurance for our family, or at least health insurance > my daughter . I was shocked to discover that insurance companies can > simply refuse to cover simply because she has Down syndrome. We know > that we can use COBRA coverage for 18 months and then pay full price for > coverage with the same insurer for another 18 months, but then what? Does > anyone have any suggestions for us to investigate? We found a > hospitalization plan with ARC - but it is a bare minimum. The other > alternative is that I go back to work full time - YUCK. > Caio, > Joan > > Click reply to all for messages to go to the list. Just hit reply for messages to go to the sender of the message. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 In a message dated 8/2/01 9:13:10 AM, writes: << As I understand it (and my understanding is minimal), SSI/Medicaid has income requirements. I believe that we would not qualify. >> You may want to check into the the Cap waiver program in your state. (called Beckett in some) I believe they base the income on the CHILDS income, not the parents to qualify for Medicaid. (For children with DD only) There is often a waiting list, and other hoops to jump through, but it is well worth it! Another option may be the CHIP program (Children's health insurance program) I believe every state has this now. It does have income limits, but at least in our state they are pretty liberal. (Well above the limits for medicaid) It is available to all children not just DD. The upper income limits pay a premium (very resonable) and the lower ones are free. Hope this helps, M. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 In a message dated 8/2/01 9:13:10 AM, writes: << As I understand it (and my understanding is minimal), SSI/Medicaid has income requirements. I believe that we would not qualify. >> You may want to check into the the Cap waiver program in your state. (called Beckett in some) I believe they base the income on the CHILDS income, not the parents to qualify for Medicaid. (For children with DD only) There is often a waiting list, and other hoops to jump through, but it is well worth it! Another option may be the CHIP program (Children's health insurance program) I believe every state has this now. It does have income limits, but at least in our state they are pretty liberal. (Well above the limits for medicaid) It is available to all children not just DD. The upper income limits pay a premium (very resonable) and the lower ones are free. Hope this helps, M. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 Joan, Can you apply for Medicaid for your daughter? maybe now that your husband wont have any insurance it will be easy to get then. We have GHI as our primary and I have a medicaid waiver for . Find out what you have to do in your state to apply for the waiver. Good luck! ~Mom to almost 11DS and 7 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 Joan, Can you apply for Medicaid for your daughter? maybe now that your husband wont have any insurance it will be easy to get then. We have GHI as our primary and I have a medicaid waiver for . Find out what you have to do in your state to apply for the waiver. Good luck! ~Mom to almost 11DS and 7 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 In PA. Nic qualifies for MA (Medical Assistance) just because he has DS. He doesn't get SSI, just medical coverage. Di, mom to Jake(18,nda) and 4 (DS) Pennsylvania Re: Health Insurance Hi Joan, Does she receive SSI? If so, she is eligable for Medicaid. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 In PA. Nic qualifies for MA (Medical Assistance) just because he has DS. He doesn't get SSI, just medical coverage. Di, mom to Jake(18,nda) and 4 (DS) Pennsylvania Re: Health Insurance Hi Joan, Does she receive SSI? If so, she is eligable for Medicaid. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 There is an organization, can't remember the name and there may be more than one, for self employed people, and they offer insurance. However, any time you make a change you can run into them not accepting . Used to be on a family policy they had to accept the whole family but I understand it is not that way any more. So even if you went to work full time they might not cover her. You need to be sure of this before you make any changes. Jessie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 There is an organization, can't remember the name and there may be more than one, for self employed people, and they offer insurance. However, any time you make a change you can run into them not accepting . Used to be on a family policy they had to accept the whole family but I understand it is not that way any more. So even if you went to work full time they might not cover her. You need to be sure of this before you make any changes. Jessie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 Here in PA you don't have to qualify for SSI to be given medical assistance. I just applied and got approved for to receive medical assistance, so I know this to be true. Jackie, Mom to 13ds, 10, and Bradley 7 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 Here in PA you don't have to qualify for SSI to be given medical assistance. I just applied and got approved for to receive medical assistance, so I know this to be true. Jackie, Mom to 13ds, 10, and Bradley 7 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 In a message dated 8/2/01 11:50:39 AM Central Daylight Time, Joanson@... writes: > Can you tell that I am ranting and smoke is > billowing out of my ears? > > Yes, I see it going over. I don't blame you. I haven't had to deal > with this for a long time, thank goodness. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 In a message dated 8/2/01 11:50:39 AM Central Daylight Time, Joanson@... writes: > Can you tell that I am ranting and smoke is > billowing out of my ears? > > Yes, I see it going over. I don't blame you. I haven't had to deal > with this for a long time, thank goodness. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 In a message dated 8/2/2001 11:50:30 AM Central Daylight Time, Joanson@... writes: > I spoke with Trigon (Blue Cross), the largest > private insurer in the state, and they will give catastrophic > coverage > only after she has been on the plan for a year. has no gaps since > So what type of plan has your state implemented to insure children. Here it's MN Care. covers 100%. I would imagine it covers disabled children if they can't get private insurance.....oh in fact I know that they do, since everytime we've been called in the last few yrs by insurance agents (trying to give us a better deal, lol) they've always said they could put her on MN Care, that makes it sound like the state plan for children does cover the disabled kids to. are there still states that cant get it right? :-) Joy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 In a message dated 8/2/2001 11:50:30 AM Central Daylight Time, Joanson@... writes: > I spoke with Trigon (Blue Cross), the largest > private insurer in the state, and they will give catastrophic > coverage > only after she has been on the plan for a year. has no gaps since > So what type of plan has your state implemented to insure children. Here it's MN Care. covers 100%. I would imagine it covers disabled children if they can't get private insurance.....oh in fact I know that they do, since everytime we've been called in the last few yrs by insurance agents (trying to give us a better deal, lol) they've always said they could put her on MN Care, that makes it sound like the state plan for children does cover the disabled kids to. are there still states that cant get it right? :-) Joy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 Hello: >From what I understand about the law Clinton pushed through it only works with group health insurance - that is, moving from one group to another group - which basically means moving from one fairly large company to another. If you're switching to insurance that is not a group plan it all is still totally up to the insurance company. This also has been a dilemma for us also so I'm really interested in this thread. How does the SSI work, is it based on the family's income at all? Thanks and plmk. Mommy to - 3 and Noah - 21 mos. Sign up for FREE and receive CASH for filling out surveys and referring friends up to 3 levels http://www.surveysavvy.com/?ref_email_id=numom93097inwave Want to win Free Cash every day? Try the newest Freebie site on the Internet today, FreebieClub.com. The more people you tell, the more chances YOU get for cash. http://www.freebieclub.com//FC_myfreebies.asp?m=265416 & a=25847 Sign up and Receive $10 FREE http://www.resource-a-day.com/members2/numom1/ Quote Link to comment Share on other sites More sharing options...
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