Re: Insurance

[Guest guest]

Bree,

I never thought of that. Of course I am thinking of something for 's

benefit in 12-15 years from now. I suppose there would be a pre-existing

clause that " She " would have to fill out......good food for thought. But

let's just look at today for a bit. We had existing insurance through work

that covered when she was born (diagnosis or NDA). That insurance is

in effect and there was never any type of application or questions to add

her to our policy. I never lied or withheld requested information.....I

just asked the doctor if there were specific diagnosis codes that we should

use, rather than a blanket DS code. Once again, you go back to is she more

" DS " or more " normal " ?....You see, there is no such code as MDS that I know

of. I hope I have not done anything unethical in your eyes.

I surly see your point that when may have to get insurance on her

own....... " She " may have to fill out an application. Now we have an ethical

delima. This could come in to play even sooner if we were to change

employers, etc. The fact of the matter is that by now, we have done most of

the " special " testing that I can think of, and I expect 's medical

bills to be that of any other child NDA, except for the annual blood testing

for thyroid, and that sort of thing. The dollars involved with annual blood

work are insignificant as compared to the VSD, ASD, AOI instability, etc.

Let me type out loud here for a second......If a new employer were to

request pre-existing information, is it fair that could not be covered

just because she has MDS? What if she is more " normal " than DS? What if

she is more DS than " normal " ? Should any of that make any difference? (I

am using the term " normal " very loosely here and only descriptively to get

my thoughts out....please do not take offence!)

I don' know the answers...I do have some food for thought, don't I?

Marie

>Just food for thought here, on this insurance thing......might it be

>considered insurance fraud if, one day, 's insurance company found out

>she has MDS, and it wasn't noted on her original application? I'm thinking

>it would be kind of be like if someone said they weren't a smoker (and they

>were), and then they got very ill, due to smoking complications......would

>the insurance company still cover the treatment or hospitalization or

>whatever, even though the person lied on their application? Am I making

>sense here?

>

>Bree

>Mommy to (MDS), born July 17th, 1999, 2 sons (ages 11 & 9) and a

>step-daughter (9).

>

>

>---------------------------

[Guest guest]

There have been some posts about keeping the MDS diagnosis off school

records, medical records or insurance. As I read these a few things came to

mind. When was three yrs old and transitioning from our county early

intervention program to the school district's early childhood program her

delays (except for gross motor) were not significant enough for her to

qualify for the program. She was pretty much on target in many areas.

However, because her diagnosis put her at risk for developing delays the

district admitted her. I hate to think where we would be today if

hadn't had that essential experience they provided for her.

When she transitioned to Kindergarten she was determined to be " borderline " .

Again, without the diagnosis it might have been more difficult to get the all

services that truly needs. She would fall between the cracks in a

classroom without the extra help. It has at times been difficult to get some

professionals to look past the diagnosis, but as a parent its my job to make

sure that they see my child as an individual, not a syndrome. And so far,

we've successfully enlightened anyone who needed to be.

Whether its school records, insurance or medical records, you want to be

careful not to close any doors that your child might need open to them later.

Sue

(mom to Norah, 11 and , 6yrs MDS & ADHD)

[Guest guest]

Hi Sue, and thanks for your post, much of what your are warning against have

been very high concerns of mine.

These questions are not directed to anyone in particular, but really just

questions I have in my heart. I am actively searching for direction and am

open to any thoughts and suggestions.

Why does the diagnosis make a difference? I was told (by the school), that

children do not receive services because of any particular diagnosis, but

rather on an individual basis, because of current specific needs. It makes

me wonder if WE ('s mom and dad) had never found out the diagnosis,

does that mean that doors would have been shut to us? started her

services long before we knew about her MDS.

I have the exact fears you expressed were possible, such as slipping through

the cracks, etc. I am just curious as to exactly how the school system

determines who should and should not qualify for special services. Is it

possible that the school, because of 's good pshycomistrist (?) scores,

could deny her services, but then if we told of the " Diagnosis " she would

some how magically become eligible again?

I really believe that there are numerous children out there that have no

idea they have MDS. We would not have known, unless I pushed and pushed

myself and my husband to look for answers to 's (not so significant)

delays. Is it possible that these children are not getting the help they

need, simply because they do not know they have a possible " future " risk

factor to learning disabilities?

I know has these possible risks, and I am working very hard to keep

the services needed. I see my job as 's school advocate, and securing

all the services she may need (with or without a diagnosis). We meet with

the school tomorrow to discuss her (good) results from this summer's

testing. I am wondering if they deny us further services (PT, OT and

speech), if we should present the " possible risk at developing (or

re-developing) delays " position. It seems to me that ANY child with an IEP

could be faced with these same possible risks?

Help me sort out the difference. I may need the help as soon as this week!

Warm Regards,

Marie

>There have been some posts about keeping the MDS diagnosis off school

>records, medical records or insurance. As I read these a few things came

to

>mind. When was three yrs old and transitioning from our county early

>intervention program to the school district's early childhood program her

>delays (except for gross motor) were not significant enough for her to

>qualify for the program. She was pretty much on target in many areas.

>However, because her diagnosis put her at risk for developing delays the

>district admitted her. I hate to think where we would be today if

>hadn't had that essential experience they provided for her.

>When she transitioned to Kindergarten she was determined to be

" borderline " .

>Again, without the diagnosis it might have been more difficult to get the

all

>services that truly needs. She would fall between the cracks in a

>classroom without the extra help. It has at times been difficult to get

some

>professionals to look past the diagnosis, but as a parent its my job to

make

>sure that they see my child as an individual, not a syndrome. And so far,

>we've successfully enlightened anyone who needed to be.

>

>Whether its school records, insurance or medical records, you want to be

>careful not to close any doors that your child might need open to them

later.

>

>Sue

>(mom to Norah, 11 and , 6yrs MDS & ADHD)

>

[Guest guest]

<<-----Original Message-----From: SCarMGar@...

Whether its school records, insurance or medical records, you want to be

careful not to close any doors that your child might need open to them

later. >>

Thank you Sue, for this very important gentle reminder! I'm all ears, eyes

and heart!

Bree

Mommy to (MDS), born July 17th, 1999, 2 sons (ages 11 & 9) and a

step-daughter (9).

[Guest guest]

<< -----Original Message-----From: M. L. Murrell

Let me type out loud here for a second......If a new employer were to

request pre-existing information, is it fair that could not be covered

just because she has MDS?

Hiya Marie......

Of course I can't answer your questions here, but since we're brainstorming

with all this food for thought, why would a new employer even request

pre-existing information? In all my years of employment, the only parts

I've ever needed to fill out was the pertinent information (name, DOB, SS#,

etc...) for me and my dependents, to get them covered under my policy.

My family is now covered under my husband's medical insurance only. I got a

call about 3 weeks ago from the insurance company, because they needed to

add to the policy. I was never asked if she had any special medical

needs or anything......just her full name and DOB, and SS# (if I had one

already for her).

The only insurance form, to the best of my knowledge, where a diagnosis

would probably need to be listed, would be for life insurance, should

(or any of our children here) ever apply for it, outside of employment. Am

I correct?

Bree

Mommy to (MDS), born July 17th, 1999, 2 sons (ages 11 & 9) and a

step-daughter (9).

[Guest guest]

Bree, A couple of years back, my husband interviewed and was offered

another job. The company's insurance company had a questionnaire....because

we as a family were ALL new to the insurance. On this application, it

requested pre-existing information on all individuals we were covering.

We did not accept the position (perhaps partly because of fear of no

coverage for a period of time), and so we never filled out the application.

I am sure every employer is different in their initial screening of new

employees, but I do know it is possible.

Marie (Mom to 6 yr. old, and her big sister 9 yr. old)

>

>

>The only insurance form, to the best of my knowledge, where a diagnosis

>would probably need to be listed, would be for life insurance, should

>(or any of our children here) ever apply for it, outside of employment. Am

>I correct?

>

[Guest guest]

,

Blue Cross Blue Shield specifically told me that services associated with a

number of diagnosis may not be covered. Examples they gave me: Speech

Therapy was not covered with a " primary diagnosis " of Autism, Mental

Retardation, Stress, etc. However, if you have an Autistic child with a

primary diagnosis of " apraxia " then speech would be covered.....GO FIGURE!

Anyway, I am not in the insurance field, and I am sure there are a number of

Autistic children getting speech therapy covered......Every company is

different and EVERY individual circumstance is different.

I can for sure tell you this. 's speech as been denied by BCBS since

they took over as our carrier in January. 's " primary diagnosis " was

multiple congenital anomolies....the same diagnosis we have had since she

was born....(we had no idea she was MDS until many years later). However,

when the Doctor changed her primary diagnosis to speech language

disorder.....those services were magically covered. NOTHING has changed,

just what we were calling her " primary diagnosis " !

One other thought. In my instance, having DS has DEFINITELY put our

insurance at risk of increased costs. The annual blood work, hearing tests,

speech therapies,VSD, ASD, AOI (atlanto-occipital instability), etc, etc,

etc. have been very costly. My oldest daughter (NDA) has met $3500 toward

her one million dollar life-time maximum in nine years. had met

$35,000 (notice the extra zero <grin>) in less than six years.

Marie

-

>

>

Technically, DS is a

>developmental disorder (syndrome), something insurance companies are not

>interested in. Having DS will not put your child at risk for any

>increased cost to the insurance company, so why should they care,

>right? If anyone is on the big DS-Listserve, this might be a good

>question for them, or for Dr. Len.

>

[Guest guest]

My four day stay in detox for alcoholism cost $8,600.00 ! can you believe that ?

Thats some expensive librium, and food.

I mean the AA meetings didnt cost anything, and the doctor and nurses arent

making a mint so all I can chalk it up to is

the food (which was really good) and the librium.

Insurance

Insurance rules. Insurance tells the doctor what he can or cannot

use or do. Insurance sets a limit on how long the doctors can see a

patient and how long a patient will stay in the hospital.

Insurance tell them what medication they will pay for and what

they won't cover. Insurance makes patients change doctors

they have been with for many years and don't care if the

patient has established confidence and trust in the one they

are forced to leave. Insurance uses patients to get further

advancement in their business by working through employers to

go with it and then the patient has to accept what their employer

picks or they will lose all their benefits with their company

and not be able to ever have it again. Therefore, the patient

is forced to try to convince the doctors to go with this insurance or

are forced to find one they don't even know anything about.

Insurance decides what they will pay for and what won't be

covered...they might say they pay 100% but in actuality,

they pay what their, decided upon, 100% level is and if the

doctor asks for more than this level, you have to pay the rest.

Insurance and employers do not provide their patients with all

the coverage they have so they can read it, they provide them

with a pamphlet that only gives them the very basic and you have

to call for information if you want more than that...so, if you

get someone who doesn't want to look up your benefits, they tell

you anything they want and you have no proof, for sure, if they

cover it or not cause you are not allowed to have Complete

Evidence of Benefits covered in writing in front of you.

Since insurance is in the business of making as much money as

possible, do you really think they care about the patient...

they try to not even pay for things that are suppose to be covered

under the policy by saying they need more medical records, that the

doctors and hospital didn't have the appropriate code to be paid on

the sheet...even when they have printed out what they did.

Anyway, if the insurance can weasel their way out of paying a

claim...they do it.

I rate insurance companies right up there with tax collectors.

We have no control over tax rate increases, though they say we

do...and we have no control over stopping the insurance from

determining whether we get the best medical care or not, because

they are hunting for the cheapest way possible so they keep the

money in their pockets not the patients.

If you ever compare what the bill was, you have gotten from the

doctor office, and what the insurance actually paid them...it will

shock you. The bill may be for $120 and the insurance will pay

the $30.00 and the rest is wrote off. If doctors, hospitals, etc

would stay in the normal range of things and stop trying to

price things so far out of range...maybe we could eliminate the

need for high insurance premiums.... till that time, we are stuck.

I don't know of any middle to poor class people who can even

afford to pay, out of pocket, for even one hospital stay of 5 to

10 days. You may pay the hospital $1200.00 a day to stay in

one room with a TV and nursing care and the doctors close by.

Or you could go to the best luxury spa type resort, employ a

private nurse for day and night, and be as close to the hospital as

possible and pay half of that price and receive better meals. You

decide. It may even come complete with massage, sauna, and

more than Tv entertainment. It definitely would be more relaxing,

more natural, more uninhibited environment.

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