Re: Insurance...anyone have United Health

[Guest guest]

I believe that is the plan they were telling him it was. Do they insure for transplants?

Thanks,

Mindy

[Guest guest]

We have UHC and it is a good insurance.Our plan has a cap on

transplants(500,000) & a 2 million general cap.Oh, well there is

nothing you can do about that.

('s Mom) 17,PSC & UC

[Guest guest]

I do and I like it so far.

If you can get the type plan where you can go to any doctor or specialist

inthe network without a referral from a PCP.

Carol

Insurance...anyone have United Health

> My husband is looking at changing jobs, I just wondering if any of

> you have United Healthcare Insurance and what do you think?

>

> Thanks,

> MINDY

>

>

>

>

>

>

>

[Guest guest]

Does any one know how BC/BS is with coverage. I know blue cross has a

lot of different plans, but in general., is it good coverage?

Lee

> We have UHC and it is a good insurance.Our plan has a cap on

> transplants(500,000) & a 2 million general cap.Oh, well there is

> nothing you can do about that.

> ('s Mom) 17,PSC & UC

>

>

[Guest guest]

Mindy,

The company that got me the contract I’m

on now offered UHC as one of their benefit choices, and I’m really glad I

took it. They have paid everything like clockwork, and when I had a question

about the original paperwork, it was easy to get to a real live customer

service person who actually followed up to make sure

my question was answered.

Unless there is more than a 62 day gap

between when coverage ends with your husband’s previous employer’s insurance

carrier and the new employer’s insurance carrier, there is no need to pay

a COBRA premium, and there will be no gap in coverage. You will, however have

to pay the annual deductible under their plan, even if you had already met that

threshold in the same calendar year under the old plan. This is because of

HIPAA. Along with some very stringent privacy provisions, this law limits the

period that a new insurance carrier can exclude a pre-existing condition from

coverage to 12 months minus the time that the condition was covered by a

previous plan. Even Medicaid (but not Medicare) coverage qualifies as

exclusion-limiting coverage.

COBRA coverage is limited to 11 months,

unless a person who elects COBRA extension is disabled at the time of the “qualifying

event”, or becomes disabled within 60 days. Now having a

much-too-thorough understanding of the Social Security Disability Determination

“system”, I think it is probably very rare that any is able to

qualify for the additional time.

Steve

Rahn

PSC '80, L Tx 9/6 &

9/8 '85. (Wash. U-STL)

Recurrent PSC

'02, (re) Born on the 4th of July, 2003 (Re-L Tx, U of Iowa)

www.presumedconsent.org

" Solve

the Problem, not the Solution " Dean Kamen

[Guest guest]

Lee in reference to your insurance question.

We had United Healthcare for many years, and at least in the state of Florida it is one of the best for almost everything.

Unfortunately, now we have BCBS, HMO (only option at my company) and it is horrible, especially for the disease my husband has (UC and PSC). We need referrals for everything, the prescription medications co-payments are very high, some of my husband's old doctors do not take that insurance (especially the HMO) and we have to switched to new doctors and start from scratch. In summary, I am very dissapointed with the new insurance. I will give anything for my company to change back to United or maybe other insurance companies, such as Neighborhood or ADMED that are better than BCBS, at least in the State of Florida.

Again, this is in the state of Florida, and I know for a fact that in different states BCBS are better than here, such is in NY. I really don't know in which state do you reside.

I hope this help. Vivian (husband with UC-2000, and PSC-2003)

Re: Re: Insurance...anyone have United Health

Does any one know how BC/BS is with coverage. I know blue cross has a lot of different plans, but in general., is it good coverage?Lee> We have UHC and it is a good insurance.Our plan has a cap on> transplants(500,000) & a 2 million general cap.Oh, well there is> nothing you can do about that.> ('s Mom) 17,PSC & UC>>

[Guest guest]

Hi Vivian,

I think the problems you're having are because your insurance is an HMO, not because it's BCBS. When my son Ken had Pacificare of Texas - an HMO we had the same problems (and many more) then your having now.

My son's Texas High Risk Pool Insurance (for folks who can't get any other insurance) is with BCBS and we couldn't be happier. Yes, it costs a lot and yes it pays only 80%, but I promise trying to get a transplant without insurance is almost as bad as the disease itself.

What everyone has to be concerned with is this - if & when you go on S.S. disability you'll have to have insurance (whatever kind & however much it costs) because you don't become eligible for Medicare until you have been receiving disability for a full 24 months.

Our mistake was not knowing this. When Ken was no longer able to work full time, he changed to part time work and lost his insurance. So he used his Cobra to cover himself, not knowing about the waiting period for Medicare. When Cobra was over - he was left with no insurance except to continue the Cobra in a conversion policy (very $$$). So if you are employed the thing to do is save your Cobra coverage for when you go on disability. That way you'll be covered by the same good insurance you had while working (it may cost a lot more but will be worth it). The Cobra will then last for 18 months almost the full waiting period for Medicare.

If you don't understand what I have just said please go to Medicare.gov web site and/or visit your nearest SS office to learn more - you'll need this info. Don't wait until you have to have it. Or....everyone could write their Congress people and ask for Medicare to start right away when you have an illness like PSC.

-Barb in Texas - Son Ken (30) UC 91 & PSC 99

[Guest guest]

Barb thank you for the information; however, I already knew about the issue with the "S.S. disability" and Medicare. I am also know that the problem I am currently having with BCBC is because is an HMO, however, it is also depends on the package the company gets. I know for a fact that BCBS have better options. Unfortunately, my company has bought propably one of the worst options they can get through BCBS.

In my case my husband insurance is thru me. I am the main subscriber. Anyhow, thanks for the information you sent. Viv

RE: Re: Insurance...anyone have United Health

Hi Vivian,

I think the problems you're having are because your insurance is an HMO, not because it's BCBS. When my son Ken had Pacificare of Texas - an HMO we had the same problems (and many more) then your having now.

My son's Texas High Risk Pool Insurance (for folks who can't get any other insurance) is with BCBS and we couldn't be happier. Yes, it costs a lot and yes it pays only 80%, but I promise trying to get a transplant without insurance is almost as bad as the disease itself.

What everyone has to be concerned with is this - if & when you go on S.S. disability you'll have to have insurance (whatever kind & however much it costs) because you don't become eligible for Medicare until you have been receiving disability for a full 24 months.

Our mistake was not knowing this. When Ken was no longer able to work full time, he changed to part time work and lost his insurance. So he used his Cobra to cover himself, not knowing about the waiting period for Medicare. When Cobra was over - he was left with no insurance except to continue the Cobra in a conversion policy (very $$$). So if you are employed the thing to do is save your Cobra coverage for when you go on disability. That way you'll be covered by the same good insurance you had while working (it may cost a lot more but will be worth it). The Cobra will then last for 18 months almost the full waiting period for Medicare.

If you don't understand what I have just said please go to Medicare.gov web site and/or visit your nearest SS office to learn more - you'll need this info. Don't wait until you have to have it. Or....everyone could write their Congress people and ask for Medicare to start right away when you have an illness like PSC.

-Barb in Texas - Son Ken (30) UC 91 & PSC 99

[Guest guest]

thanks, I guess that I won't be moving to Florida. Our BS/BC is not an

HMO so thus far we have been able to chose our physicians. We have been

paying a lot out of pocket though for office visits.

Lee

On Sunday, July 25, 2004, at 02:14 PM, Osvaldo and Vivian

wrote:

> Lee in reference to your insurance question.

>  

> We had United Healthcare for many years, and at least in the state of

> Florida it is one of the best for almost everything.

>  

[Guest guest]

"Along with some very stringent privacy provisions, this law limits the period that a new insurance carrier can exclude a pre-existing condition from coverage to 12 months minus the time that the condition was covered by a previous plan. Even Medicaid (but not Medicare) coverage qualifies as exclusion-limiting coverage."

Hi Steve- Thanks for your post. Could you explain the above sentences to me like I'm 2 yrs. old haha I'm just not getting what that actually means?

Thanks!Mindy

RE: Insurance...anyone have United Health

Mindy,

The company that got me the contract I’m on now offered UHC as one of their benefit choices, and I’m really glad I took it. They have paid everything like clockwork, and when I had a question about the original paperwork, it was easy to get to a real live customer service person who actually followed up to make sure my question was answered.

Unless there is more than a 62 day gap between when coverage ends with your husband’s previous employer’s insurance carrier and the new employer’s insurance carrier, there is no need to pay a COBRA premium, and there will be no gap in coverage. You will, however have to pay the annual deductible under their plan, even if you had already met that threshold in the same calendar year under the old plan. This is because of HIPAA. Along with some very stringent privacy provisions, this law limits the period that a new insurance carrier can exclude a pre-existing condition from coverage to 12 months minus the time that the condition was covered by a previous plan. Even Medicaid (but not Medicare) coverage qualifies as exclusion-limiting coverage.

COBRA coverage is limited to 11 months, unless a person who elects COBRA extension is disabled at the time of the “qualifying event”, or becomes disabled within 60 days. Now having a much-too-thorough understanding of the Social Security Disability Determination “system”, I think it is probably very rare that any is able to qualify for the additional time.

Steve Rahn

PSC '80, L Tx 9/6 & 9/8 '85. (Wash. U-STL)

Recurrent PSC '02, (re) Born on the 4th of July, 2003 (Re-L Tx, U of Iowa)

www.presumedconsent.org

"Solve the Problem, not the Solution" Dean Kamen