Insurance change - what is covered?

fitzdc

I have been covered under a very expensive COBRA policy for 5 months. and before that a work/group policy for more than one year.  Now, my DH's employer is having open enrollment and we are considering enrolling me on his insurance (did not do in the past as we both had good insurance through employers; that changed once my work ended and I went from a 100 dollar a month payment to over 600 per month).  We have worked out the math part and even though I have reached my deductible and my out of pocket max on my insurance, the cost savings with switching is worth it.

Will all my upcoming treatments (revision surgery, oncology appointments, nipple placement, etc,) be covered if  switch insurance? 

lago

Yes as long as there isn't  a gap of more than 30 (or maybe 60) days. This is one of the new laws passed and in effect for healthcare. If you have no gap pre-existing conditions are covered. Just be sure there isn't a 1-2 month wait period at your husband's insurance. If there is you want to continue coverage with the old insurance during the wait period.

fitzdc

Thanks!  That is what I thought - DH is going to speak to his HR and get it in writing, too.  The good thing is his insurance coverage  in network is the same as my in-network so switching wont be so troubling.  Now, if I could just find a job!

cycle-path

Yes, do talk to HR and get it in writing!

fitzdc

Thanks --- HR is calling the insurance company to get it all in writing.  This comes at a good time.  My insurance company is beginning to question everything now- they just denied tests ordered by the MO.

fitzdc

To follow up - my insurance will change on April 1 with no waiting period.  Treatment moving forward will be covered.  And my current doctors are in network with new insurance company.   A huge relief!

fitzdc

Folllow up -- bill in amount of $22,191 (plus other bills for lab and follow up) for Stage 2 recon. was denied.  This after checking with insurance company to verifly that once I switched over everything would be covered.  I had creditable covereage for 2 years, no gap in coverage----It seems strange (and mean) for them to deny at this point.

Char2010

Your doctor needs to appeal. Also, your husband's HR person should be able to intervine.

lago

fitzdc I had issues with my insurance not covering the PS but covering everything else for the bmx. Ended up that there is a general code for reconstruction but then a bunch of specific ones like one for the TE placement, different one for the implants, etc. I would call and find out exactly if it's a coding issue. By law they have to cover reconstruction. I know my PS's office was yelling at them about this. I finally found out it was a code issue.

fitzdc

Thanks ladies.  it seems like for every step forward, there is some hoop that needs to be jumped, too. 

Anonymous

I live in Ohio. My husband changed jobs on August 1, 2012. Insurance stopped on July 31, and new insurance goes into effect on Oct. 1, will there be a pre-existing?

lago

Soteria I would check with your husband's soon to be new carrier. You might be OK if it's only a 60 day lapse but I'm not sure if that goes by state. Some states it might be less. If you go lapse beyond what ever the time period is the precondition will not be covered for a certain time period (could be a year+ or-). You will still be covered for anything new.

BTW call the ACS. They have a free 24 hour hotline. They will have the answer: 1.800.227.2345

itsjustme10

Check with his HR department - the group administrator should either know or be able to find out what your local laws are regarding gaps in coverage.  Is it too late to pay for COBRA from his prior job?  You're still in August, you might be able to do that for the 2 months, and that way you won't have a gap in coverage...

Megadotz

The federal law stipulates that 63 days is a significant break in service and that state laws may be more generous. 

Here's a link to the Ohio Insurance commision healt insurance page:

http://www.insurance.ohio.gov/Consumer/Pages/HealthCareReform.aspx

mdg

We were on my insurance when I got dx in Dec 2010.  I did surgeries and chemo and then we moved and I quit my job in August 2011.  I went on my DH's insurance at that time and finished reconstruction.  I had no issues with anything being covered.