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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by ClearSkies on November 30, 2007, at 12:58:00
You know, this is the second time this year I've used "debacle" in a thread title.
The good news: my husband, after being really unhappy at his job for the longest time, found a new one and recently started it.
The bad news: it's with an internationally based company that doesn't offer group health insurance to their employees, but a monetary amount to be used for this expense. What this has meant is that we've had to shop around for our own health insurance, and like so many other people have experienced, I was denied coverage for prescription medication AND psychiatric care AND headaches based on my prior history.
Never mind that I rue the day that we ever truthfully disclosed any of my history to the insurance agents, who, at the time, swore up and down that our coverage "wouldn't be a problem". Well, sure - it's no problem, except I can't get coverage for the conditions that I need daily treatment for.
I did an extensive search on Babble and read many posts about other people's experiences. I have one question, though: what if I had lied? What if I had said, "nope, no psychiatric problems, no headaches, no medications, nothing going on here." and then procured coverage. Do people ever get to actually procure the healthcare coverage they need by doing this, and would it work? Or do they do a history of your healthcare based on your personal data (birthdate, social security number) in that Big Brother way and then turn around and deny you coverage anyway?
If I sound desperate and panic stricken, it's because I am. I feel that I've paid a horrible penalty for being honest and fully disclosing my medical history.
I DO understand that if the situation doesn't change, that there are options out there from the drug companies for me to be able to get my medications. The bit about not having my neurological (migraine) and psychiatric care covered is more problematic.
ClearSkies
p.s. Husband likes the new job very much.
Posted by Phillipa on November 30, 2007, at 21:56:41
In reply to Health Insurance Debacle, posted by ClearSkies on November 30, 2007, at 12:58:00
Clear Skies if there is no gap and you use Cobra yes it costs a lot but then you can't be denied insurance. Do you have it now the old job? Phillipa ps one of the reasons stay me on Disability as Greg can't get coverage for me.
Posted by confuzyq on December 1, 2007, at 0:33:43
In reply to Health Insurance Debacle, posted by ClearSkies on November 30, 2007, at 12:58:00
> I have one question, though: what if I had lied? What if I had said, "nope, no psychiatric problems, no headaches, no medications, nothing going on here." and then procured coverage. Do people ever get to actually procure the healthcare coverage they need by doing this, and would it work? Or do they do a history of your healthcare based on your personal data (birthdate, social security number) in that Big Brother way and then turn around and deny you coverage anyway?
>
> If I sound desperate and panic stricken, it's because I am. I feel that I've paid a horrible penalty for being honest and fully disclosing my medical history.
>
> ClearSkies
Hi Clearskies,Boy can I relate. I have some burning questions along the same lines as yours, that I sure wish I knew the answers to. As far as yours in particular, I think the answer is that yes, it's fairly common to omit, and not uncommon for that to succeed. I think it's partly about whether the underwriter sees any factors in one's basic and provided data that triggers their suspicion; but also a little luck of the draw, as far as whether further investigation will take place.
(And these days they can tap into some mega network of combined historical pharmacy records for any given person if they desire, but from what I've heard they do not in fact do that as a matter of routine. But if they do, it will obviously lead to doc names and therefore more records too. Can't remember the name of that network. Very few pharmacies' records are not included in it anymore, they'd have to be very obscure.)
But what concerns me much more than whether omission would succeed towards obtaining coverage or not, is that coverage can be canceled/nullified at *any* point in time (even decades down the road) if it is discovered. And, I'm not even sure it would have to be a related issue. If it was, they could definitely cancel you. But I *think* they could also cancel you if it was completely unrelated to the omitted one. Meaning that if you file a claim and the insurance adjuster does a little digging within the typical course of... not being eager to pay it, and they discover that you withheld something, anything, 20 years ago... your coverage could technically be made null and void immediately. Right before that triple bypass. Read the fine print.
*Sigh.* Hoping someone with the "inside track" happens by, as I've needed to switch independent policies myself for years. Would like to know not only the chances that underwriters will dig if you don't list anything "interesting" on your app; but also, about the chances of later investigation/cancellation, even for conditions unrelated to the originally omitted one(s).
Here's one tip though -- after you apply with given companies, make sure your broker will arrange a surreptitious "voluntary" withdrawal of your application if he/she finds out you're going to be denied, rather than letting the insurer formally deny you. Because apparently denials can get in one's records too, and look bad to the next prospective insurer. Dang this stuff is fun, ain't it?
Posted by confuzyq on December 1, 2007, at 1:19:01
In reply to Health Insurance Debacle, posted by ClearSkies on November 30, 2007, at 12:58:00
...I have no info about this, but acceptance and denial policies may also vary by state. A fairly well-informed friend told me that in his state, insurers can't deny you; they'll just quote an astronomical rate if they don't want you. That is not the way it is in my state, here they can deny anyone they want.
There are some good state web sites that rate/grade insurers on various aspects. (Including, from what I recall, number and type of complaints; pay outs compared to others; and maybe even comparison of rate increases and involuntary cancellations.) Don't think I have the links anymore but your broker or state dept. of insurance could probably give them to you.
I'm probably hopelessly off track from your original question by now!
Posted by yxibow on December 1, 2007, at 3:00:51
In reply to Re: P.S.: Health Insurance Debacle, posted by confuzyq on December 1, 2007, at 1:19:01
I don't know about adults, COBRA is available for children of parents with insurance up until age 26 provided they have been attending college. (At least at the time I made use of it).
I'm lucky to have HIPAA coverage since Clinton signed it in.
But, its only a last resort for dire inpatient service as there are breaks in privacy laws and if insurance X which contracts to one of these piss-poor Mental Health Insurance Contractors is forced to be "overturned" with Mental Health parity laws, there's a chance that they could erase the insurance entirely leaving a court case for years.
Prescription drugs with insurance X is not a problem with the bean counters other than 2 times the going cost or more for new agents, but any provider that's a psychiatrist or a psychologist and not a certified neurologist or such would not be something that is a good idea to use insurance X for. So I don't. Lucky that I can do so.
Posted by ClearSkies on December 1, 2007, at 8:08:31
In reply to Re: Familiar w/ U.S. insurance particulars? Help!, posted by confuzyq on December 1, 2007, at 0:33:43
I am completely paranoid about being caught out for any reason. I do believe that my best course of action is to find employment and secure health benefits of my own. Last night I did some research about companies that offer part time employees health benefits.
I know that some large retailers now offer health benefits to part time employees. Namely, Target, Starbucks, Circuit City, Barnes and Noble, and JC Penny. I don't think that my emotional constitution would hold up to full time employment, but if I could secure a part time job in the first place, I think I could excel at one. (This being based on my experience with extensive volunteering this year.)
The period for applying for COBRA has already expired: my husband signed up for this insurance - and was given the verbal "sure, you'll be covered" assurance and so we didn't get the actual policy until yesterday, with the riders stated showing the bits they wouldn't cover for me. And the policy itself is pitiful: the lifetime benefit for a member for psychiatric care is $3,000. Lifetime!!
Of course, the entire issue of whether I am even employable, after three years of not working, is questionable. I don't even know what resumes are supposed to look like any more.
Thanks to everyone for your thoughtful, as always, responses. I do plan to speak with my individual doctors regarding getting samples if necessary, and to the drug companies for their assistance, until I can arrange my own health plan coverage.
ClearSkies
Posted by confuzyq on December 1, 2007, at 10:45:04
In reply to Re: Familiar w/ U.S. insurance particulars? Help!, posted by ClearSkies on December 1, 2007, at 8:08:31
> I do believe that my best course of action is to find employment and secure health benefits of my own. Last night I did some research about companies that offer part time employees health benefits.
>That creates such a catch-22, I can't decide which way to go myself. I should change both my job, *and* my insurer. I've been working as an independent contractor for many years, and paying for an individual policy with rates that shoot up ridiculously every year no matter what (I rarely file claims or use the coverage for anything).
But with personal policies, from what I hear that same cycle of the rates getting too high will probably take place with any new insurer I sign on with. So if I remain an independent contractor -- OR request that a new employer make a contribution towards my own policy rather than enroll me in their own program -- I'll always be reapplying for new insurance every few years... But the older one gets, the less excited carriers will be to see them coming, even without any health issues to speak of yet.
But on the other hand, if I go the way you describe and get insurance through an employer... Well, I know we shouldn't go into things expecting them not to work out, but realistically it's not unlikely that I wouldn't end up sticking with a given employer for long (unless my lifelong inability to find a good fit in a job is magically about to end now). Then, I'd be out there reapplying for insurance again, whereas if I maintained my own policy all along instead, at least I could be sure I never lost it, as long as I did keep paying the sorry rates.
I want to be a responsible citizen but all this is so messed up and aggravating that sometimes I feel like just giving up and going without insurance after the next time I get my annual rate hike announcement, and again handle it by raising my deductible and lowering whatever coverages I can, etc. :-(
Btw, I largely share your feelings of insecurity about looking for employment after several years' absence, maybe for somewhat different reasons. To me, the environment of the job is 90% of what will make or break it for me, and working from home for years has made me unlearn the little I'd managed to about coping in various environments.
Well, fingers crossed for us all!
Posted by Racer on December 1, 2007, at 11:26:48
In reply to Re: Familiar w/ U.S. insurance particulars? Help!, posted by ClearSkies on December 1, 2007, at 8:08:31
Sometimes the pre-existing coverage exclusion is temporary -- "this stuff won't be covered for [x] months" -- rather than permanent. On the other hand, the $3000 lifetime cap is just ugly.
I'm very sorry you're running into this. Like this sort of thing helps psychiatric problems! ARGH!
Some states have parity laws, I'm guessing yours doesn't? It's worth looking into that piece -- if there are parity laws, certain diagnoses will be covered, even if the insurance company thinks they're not.
And I do recommend talking to a really good insurance agent. I didn't end up getting individual insurance through the one I saw, because of a number of problems including cost, but at least it was someone who knew the system, knew what steps to take, and could walk me through the process without stresses on me. It's possible that there are options out there that could fix this for you, which you might not find on your own -- and it's possible that you could avoid trouble by working with someone who already knows where the pitfalls are dug.
Good luck, it's horrible that a good thing -- your husband's new and improved job -- comes with such a very bad thing attached to it.
Posted by ClearSkies on December 1, 2007, at 12:21:18
In reply to Does the policy state non-coverage, or delay? » ClearSkies, posted by Racer on December 1, 2007, at 11:26:48
> Sometimes the pre-existing coverage exclusion is temporary -- "this stuff won't be covered for [x] months" -- rather than permanent. On the other hand, the $3000 lifetime cap is just ugly.
>It would seem that they've excluded the psychiatric and headache coverage entirely. The prescription drug coverage they have worded so that I'm not able to use the card with the co-pays, but instead would have to fulfill a $1500 annual deductible and then they'd pay 80%. Better than nothing, yes.
> I'm very sorry you're running into this. Like this sort of thing helps psychiatric problems! ARGH!
I find that it's triggering my memories of being deported from England and then having to deal with the IRS and state tax authorities - all that bureaucratic nonsense. Today is all about breathing in and breathing out, and nothing beyond that. Neither of us slept well last night.
>
> Some states have parity laws, I'm guessing yours doesn't? It's worth looking into that piece -- if there are parity laws, certain diagnoses will be covered, even if the insurance company thinks they're not.I'll have to look into that, thanks!
>
> And I do recommend talking to a really good insurance agent.Sorry, I thought this was an oxymoron!!
> I didn't end up getting individual insurance through the one I saw, because of a number of problems including cost, but at least it was someone who knew the system, knew what steps to take, and could walk me through the process without stresses on me. It's possible that there are options out there that could fix this for you, which you might not find on your own -- and it's possible that you could avoid trouble by working with someone who already knows where the pitfalls are dug.
>
> Good luck, it's horrible that a good thing -- your husband's new and improved job -- comes with such a very bad thing attached to it.Yes, the worst of this has been listening to his reassurances of "it's all going to be OK," when all along I've been saying, "no, it's already NOT OK!" and feeling that my warnings were not only unheeded, but that my opinions were being discounted because of my depression - that I was prone to doom and gloom. Well, no - it was actually fact I was predicting. It's not at all what you want from a shiny new job.
OTOH, if I get a job at Barnes and Noble, then that means lots of books in my future.
CS
Posted by yxibow on December 1, 2007, at 13:58:46
In reply to Re: Does the policy state non-coverage, or delay? » Racer, posted by ClearSkies on December 1, 2007, at 12:21:18
> > Sometimes the pre-existing coverage exclusion is temporary -- "this stuff won't be covered for [x] months" -- rather than permanent. On the other hand, the $3000 lifetime cap is just ugly.
> >
>
> It would seem that they've excluded the psychiatric and headache coverage entirely. The prescription drug coverage they have worded so that I'm not able to use the card with the co-pays, but instead would have to fulfill a $1500 annual deductible and then they'd pay 80%. Better than nothing, yes.
>
> > I'm very sorry you're running into this. Like this sort of thing helps psychiatric problems! ARGH!
>
> I find that it's triggering my memories of being deported from England and then having to deal with the IRS and state tax authorities - all that bureaucratic nonsense. Today is all about breathing in and breathing out, and nothing beyond that. Neither of us slept well last night.
>
> >
> > Some states have parity laws, I'm guessing yours doesn't? It's worth looking into that piece -- if there are parity laws, certain diagnoses will be covered, even if the insurance company thinks they're not.
>
> I'll have to look into that, thanks!
Yes, California has stronger laws, among others.What you have is a PPO which I won't allude to notable X PPO that I deal with -- you have a $1500 deductible before you get to start paying copays but with the copays so high you'll hit your annual deductible.
Posted by stargazer2 on December 1, 2007, at 14:01:42
In reply to Re: Does the policy state non-coverage, or delay? » Racer, posted by ClearSkies on December 1, 2007, at 12:21:18
ClearSkies, are you eligible for disability or would you think of applying since you have been unable to work for 3 years?
I am currently insured under COBRA from my last job which runs out in a few months and like you I am looking for a part time job so I can get coverage myself, since both my husband and I have to buy our own insurance. I was told by an insurance broker that with my history of depression, I would not be able to get affordable insurance until my depression become controlled, with perhaps every other month visits but not weekly or biweekly as my visits have been for 18 mos.
Luckily I did elect COBRA when I "quit" my last job,since i was unable to work, and paid $600 in the beginning and $400 now, but I think my job search will come to fruition in the next month or so.
I too have been out of work for a year and a half and interviewing and answering the questions about that time gap has been difficult, but if you can minimize why you were not working, it will not be seen as you are unemployable but as an elective decision. You just have to be creative with your answer and believe it.
I have never been out of work this long before although I had 2 previous leaves, both considered short term.
Unfortunately, even with my doubts about working or working in an environment that is suitable to my situation, I don't feel that I have any choice but to get a job. I do think too since i have been better on Nardil the time is now to try and reenter the work force. Even when I quit jobs because of depression, I feel I could still do a damn good job. Basically it was my loss of self esteem that caused me to give up.
Why is it that all the morons who do nothing on the job would never think of quitting or taking a leave of absense? They have the most self esteem of all despite their work ethics and laziness.
Stargazer
Posted by ClearSkies on December 1, 2007, at 19:04:56
In reply to Re: Does the policy state non-coverage, or delay?, posted by stargazer2 on December 1, 2007, at 14:01:42
> ClearSkies, are you eligible for disability or would you think of applying since you have been unable to work for 3 years?
>That's a good question; when I stopped working, it was voluntary on my part (that is, I quit before I was asked to leave) after having taken a leave of absence. My pdoc at the time did not agree with my decision, but we did not agree about much of my treatment plan either, which is why she's no longer my pdoc. I have an appointment scheduled in the new year with my current pdoc which whom I can discuss this, though I noted during my intake appointment that his office does NOT get involved in disability cases. Sounds like a dead end to me.
At the moment we're considering trying another insurer for a different type of plan, and withdrawing the coverage that my husband had selected, since it's so poor on so many levels. Funny how you don't get to read any of the fine print on the policies until AFTER you pay the premiums!! So you really have no idea what you're signing up for.
>
> I too have been out of work for a year and a half and interviewing and answering the questions about that time gap has been difficult, but if you can minimize why you were not working, it will not be seen as you are unemployable but as an elective decision. You just have to be creative with your answer and believe it.
>I've been thinking hard about this: I just don't know if I can handle working for a "big box" store like the few that offer benefits to part time employees. I can barely handle volunteer work, some weeks. Especially since social anxiety has compounded my depression in the past. I just don't know.
CS
Posted by Phillipa on December 1, 2007, at 19:18:37
In reply to Re: Does the policy state non-coverage, or delay? » stargazer2, posted by ClearSkies on December 1, 2007, at 19:04:56
Well I was put on Disability first try. Didn't know my anxiety was from thyroid was new then and my pdoc asked if I wanted to go on Disability. Said yes and bingo was. So if you have a good relationship and could use the old dx check in for a few days and get the ball rolling. Worth a try. Phillipa Oh had to go into the hospital.
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