Guest guest Posted February 26, 2002 Report Share Posted February 26, 2002 Hi Gretchen, I had to go through a very similar experience a couple of years ago. However I wasn't a full time student, but I was working temp jobs here and there, and wasn't getting health insurance. SO, I had to apply for it all by myself. No help from no one. I basically got an application, filled it out and waited. Pacificare was the company I filed with. But here is what I learned from this experience. DON'T tell them you have dwarfism. Because then by being a new applicant, they can accept you, BUT, they are not responsible for " pre-existing " conditions. THEREFORE, meaning if you tell them you have dwarfism, they WILL NOT pay for anything relating to your dwarfism, especially if they think any type of pre-existing conditions could have costly surgeries or medication relating to it. This is how I got accepted. They had no problems with me having horrible allergies, which I told them about, nor did they have any problems with my having ear infections consitantly. The only question they had for me was when I said on my form I was four foot two, they asked me " Did your current Doctor tell you anything about you being so short? " . And I truthfully said " Nope, he never said anything about it, I've just always been short " . (which is technically true, I wasn't diagnosed by my current physician, I was diagnosed by Dr. Ramoine and my pediatrician when I was a little girl). I was accepted under the plan I chose....$500 deductible, and $28 a month. Oh and for prescriptions, check with the insurance company about going through a mail service, such as PCS or AdvancedRX.com. Saves you a TON of money (my prescription for my allergy medication for 3 month supply only cost $39). Well that's my experience, hope it helps out a little. GOOD LUCK!!! www.ummmyeah.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2002 Report Share Posted February 26, 2002 I see you have Pacificcare Insurance. I hope you realize they are rated as the worst service companies. Infact here in Texas they are being sued left and right. They have crappy care providers, take forever to pay claims if they pay at all that''s why the premiums are so low. Be careful because the first time a doctor list you as a dwarf this will probably blow your whole coverage-the insurance will say you lied to them therefore they can refuse to cover any expenses above prescriptions and routine office visits. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2002 Report Share Posted February 26, 2002 In a message dated 2/26/2002 1:11:03 PM Eastern Standard Time, egan921@... writes: > <My suggestion would be to find out from your university to see if they have > some kind of group plan for students, or another organization with which > you are affiliated. You'd be better off trying to get coverage as part of a > larger group.> A possible solution would be for LPA to check into group rates and, if feasible, set up a group plan for its members. Apologies if this has already been considered and found not to be cost-effective. luthien Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2002 Report Share Posted February 26, 2002 Hi Gretchen, The problem you are facing is fairly common for anyone, especially a person with dwarfism, in seeking health insurance in the individual as opposed to the group health insurance market. The Health Insurance Portability and Accountability Act of 1996 made sure that genetic conditions such as dwarfism could not be considered pre-existing conditions--but only for a person going from a group insurance plan to another one. Sounds like you are moving from a group insurance plan to individual coverage, correct? People who get individual health care coverage can be much more vulnerable in this respect; although while HIPAA provides some measure of protection in terms of pre-existing conditions, even it does not stop insurers from charging higher rates to individuals they deem to be at high-risk, whether they have group coverage or not. My suggestion would be to find out from your university to see if they have some kind of group plan for students, or another organization with which you are affiliated. You'd be better off trying to get coverage as part of a larger group. The only other suggestion I can make is that, depending on what state you live in, you may be able to get help from a health care ombudsman, i.e., an advocate who helps people in the state with health care issues. Only a few states have them...I don't have the list available right now, but I can get it to you later today. Good luck, Cara Egan LPA Public Relations Insurance Woes > > > Ok people, I never thought this was going to happen to me but it's obviously > inevitable. > I turn 23 this May. Two weeks before my 21st birthday my insurance, Champus > (military), was going to drop me. So we scrambled and got my dr to basically > write a letter to prove to them that I'm still a dwarf and then they > picked me back up 2 days before my 21st bday and said they'd keep me until I > was 23. Well.....that time is coming up and I'm freaking out. I am a full > time college student WITH my congenital condition, yet it doesn't seem to > matter to them. My dad said that is normal for insurance companies, > especially around the ages of 23 and 24. My dad is working with a consultant > to find some insurance for me but so far the only one he can find has a > $2500 deductable and is about $170 a month. I can't remember if it > does/doesn't cover RX's but I'm praying it does b/c I'm the queen of RX's : > allergies, birthcontrol, ear infections, etc. I have a Trust Fund which my > grandfather set up for me for college, surgeries, house, van, etc so I have > the money for this but I hate touching it, you know? I was wondering if > anyone has had this problem and which insurance company you suggest I should > look into? Also, is this a fair price for insurance? My boss said that it > was actually pretty reasnable, but it just sound like a lot to me. My > parents use Tri-Care and MediPlus but I can't remember if that's just for > active duty/retired military or what.....anyways, I'm really stressing out > because of this and I'm having a crappy semester. If anyone can give me just > a snippette of advice, I'd really appreciate it. Thanks! > Gretchen > http://www.geocities.com/elfsnot20 > > " It is never good when you're being pursued by giant icicles! " Bob Costas, > 2002 Olympics > > > _________________________________________________________________ > 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 February 26, 2002 Report Share Posted February 26, 2002 On Tue, 26 Feb 2002, Gretchen Deitze wrote: > Ok people, I never thought this was going to happen to me but it's > obviously inevitable. I turn 23 this May. Two weeks before my 21st > birthday my insurance, Champus (military), was going to drop me. I have no idea if this is workable or not, but you might check and see if you can get on with USAA Insurance, also a military insurance company. If you can, then this is WITHOUT A DOUBT the best way to go! USAA is the co. my parents and my brothers use, and they are easily the best company I have ever dealt with, bar none. Even if they aren't the cheapest, their service more than makes up the difference! In my experience, they have their sh*t together so tight you couldn't pry it apart with the jaws of life. Dave Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2002 Report Share Posted February 26, 2002 Just keep in mind that you'll have to serve two weeks in Afghanistan every winter! DK >On Tue, 26 Feb 2002, Gretchen Deitze wrote: > >> Ok people, I never thought this was going to happen to me but it's >> obviously inevitable. I turn 23 this May. Two weeks before my 21st >> birthday my insurance, Champus (military), was going to drop me. > >I have no idea if this is workable or not, but you might check and see if >you can get on with USAA Insurance, also a military insurance company. If >you can, then this is WITHOUT A DOUBT the best way to go! USAA is the co. >my parents and my brothers use, and they are easily the best company I >have ever dealt with, bar none. Even if they aren't the cheapest, their >service more than makes up the difference! In my experience, they have >their sh*t together so tight you couldn't pry it apart with the jaws of >life. > >Dave Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2002 Report Share Posted February 26, 2002 luthienxxx@... wrote: > > > A possible solution would be for LPA to check into group rates and, if > feasible, set up a group plan for its members. Apologies if this has > already > been considered and found not to be cost-effective. > > luthien Excellent idea! LPA has already set up financial planning services for its members; I see no reason why they can't set up a group health plan. Matt, are you reading this? -Bill Bradford > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 11, 2009 Report Share Posted March 11, 2009 Ask your doctor about adding methotrexate. I was on Enbrel for 3 years and I think it stopped working. The doctor said if I continue to be uncomfortable then we would switch to Humira. Methotrexate helps. I had to get off of Enbrel because my insurance does not cover it. I am applying for prescription assistance through the manufacturer. thanks, Beth Madron Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2011 Report Share Posted January 17, 2011 Thank goodness! Lori From: " tshindle@... " <tshindle@...> Sent: Mon, January 17, 2011 1:58:58 PM Subject: Re: Insurance woes When I had insurance issues, I found out that my insurance company has " complex case managers " . I spoke to one on the phone a couple of times and she made an appeal on my behalf and got everything sorted out for me ($14,000 for a new wheelchair). Insurance woes My daughter got a g-tube in April 08. The insurance company was paying for the Ensure that was prescribed by her doctor for feedings. A few months ago, I got a call from the vendor saying that insurance had been paying sporadically and now informed them that they should not have been paying at all and will attempt to get back the money that they had all ready paid claims on. I am going to try to appeal but am kind of lost in the whole process. I did get a letter of medical necessity from our doctor and I wrote a letter but I feel like I need more than that. Anyone have ideas about who to go to for help? We live in NJ but our insurance goes through NY where my husband works. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2011 Report Share Posted January 17, 2011 From my experience as a hospital case manager, over-the-counter items (which Ensure is) are not covered by *most* insurances. My own insurance (UHC) doesn't cover tube feedings. You can appeal, write letters, get upset, etc. but I doubt it will help (at least for any future or recent claims). Another example I have found for a none-covered item, are my suction catheters. Why, because they are usable and disposable. Can't fight it so I just pay for them. Lori I am Bippy on Twitter. ________________________________ From: Kathy Maloney <kitty72470@...> Sent: Mon, January 17, 2011 1:51:46 PM Subject: Insurance woes My daughter got a g-tube in April 08. The insurance company was paying for the Ensure that was prescribed by her doctor for feedings. A few months ago, I got a call from the vendor saying that insurance had been paying sporadically and now informed them that they should not have been paying at all and will attempt to get back the money that they had all ready paid claims on. I am going to try to appeal but am kind of lost in the whole process. I did get a letter of medical necessity from our doctor and I wrote a letter but I feel like I need more than that. Anyone have ideas about who to go to for help? We live in NJ but our insurance goes through NY where my husband works. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2011 Report Share Posted January 17, 2011 If you have private health insurance I would guess you could get in contact with a case manager to resolve your issue timely. However, if Ensure is not something that they should have paid for, then I would think it would be highly unlikely that they would continue paying for it. But perhaps you can express that paying back the amount already paid for by the insurance company would be a hardship and ask that they forgive that amount. If your husband's company self-insures and administers their own plan they may grant a special exception to pay for this item. But unfortunately, due to legislation that makes it easy to sue company health insurance plans, most companies don't self insure or administer their own plans anymore to avoid the liability. > > My daughter got a g-tube in April 08. The insurance company was paying for the Ensure that was prescribed by her doctor for feedings. A few months ago, I got a call from the vendor saying that insurance had been paying sporadically and now informed them that they should not have been paying at all and will attempt to get back the money that they had all ready paid claims on. I am going to try to appeal but am kind of lost in the whole process. I did get a letter of medical necessity from our doctor and I wrote a letter but I feel like I need more than that. Anyone have ideas about who to go to for help? We live in NJ but our insurance goes through NY where my husband works. > > > > > Quote Link to comment Share on other sites More sharing options...
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