Financial mess...advice needed, please.

Hi Colleen, I sent you a detailed PM.

If it was me I would try to get your second surgery sooner if possible before your job starts. And i would not tell your employer yet, I think it is almost more important to  get your finances in order and then think about the cancer. If Medicaid is considered creditable coverage, then you should be able to get insurance through your work, without any waiting period. My husband was out of work when I got diagnosed and I got assistance through the Health Well Foundation (healthwellfoundation.org) They paid all my chemo co-pays at $400.00 every 3 weeks.

Are you sure the new employer's insurance will not cover a pre-existing condition?  Usually if you sign up for the insurance as soon as you start work it will cover you even for pre-existing conditions. 

I also agree that you should ask (plead) for a surgery date before you have to start work. 

maybe you can try to reschedule the re excision on a Friday so you can have 2 days off after.

Good Luck to you.

Sheila

While your health does come first...it seems like passing on the job is not an option unfortunately. I would talk to your doctors again about your surgery schedule and explain to them in depth your situation. Even if you need to use another BS in your dotors office or hospital you need to do what you can do to reschedule that procedure. Then you could start new job with a LOT less worry. You need to really push the docs to work with you. Sounds like you're ok with the Medicaid coverage; I wouldn't give my medical bills a worry at this point. Give yourself time to heal and get through all the treatments then try to negotiate payments and reductions of bills AFTER you're through treatments.I don't know how NYC is but here most hospitals are willing to work with you especially if you are underinsured. I am fortunate that the facilities I went to didn't even send me a bill until a month after my final chemo. I still have tons of bills but I put them in a folder and will pay them as I can.

I wish you the best in getting through treatment and your new job!

Diane

Badger - I could be wrong, because I'm not an expert.  But, I do believe that FMLA and Short Term Disability do require that you be employed for "x" amount of time before you can make a claim.  I think?

Yes, FMLA has a minimum 1-year or 1250 hours employment requirement.

Not to be devil's advocate or anything, but I can see the logic. If people were eligible immediately or within say even 3 or 4 months of employment, I'm sure there'd be those who'd look to game the system by deliberately taking a job that they already know (due to upcoming medical treatment issues) they won't be able to work at for an extended period of time afterwards, but would be guaranteed that job back upon their return. 

FML is unpaid, so it wouldn't help with the expenses of anyone's treatment as they're going through it, though it'd guarantee an income source after the person returns.

Thanks for the info on FMLA!  Agreed the most important thing is to take the job. The rest will work itself out.  Best wishes and please know there are people who care about you!  {{hugs}}

Checking on Colleen to see how things went today.

Sending hugs,

Bren

In New York, AFAIK the 12-month wait for pre-existing-condition coverage (if you haven't been covered by another company within the specified 'lookback period')  applies regardless of whether you get an individual policy or join a group plan.

 If pre-existing didn't apply to group plan enrollees, then the only people who would be denied (or made to wait for) coverage for pre-existing conditions would be those who have individual policies, and unfortunately we know that's not the case.

Of course every state is different, and I'm only familiar with what the situation is in New York. For instance, in NY no insurance company is allowed to deny or cancel a policy because of, or permanently exclude covererage for, a pre-existing condition but they are allowed to impose a waiting period of up to 12 months if you haven't been covered by another insurer (or Medicaid) within a specified timeframe.... so of course that's what they all do. Even the state-run programs, HealthyNY and FamilyHealthPlus.  It doesn't matter (in NY) what type of policy (individual or group) the new coverage is; the carrier can still use the waiting period if it applies under the law.

When you enroll in or apply for medical insurance in NY, you aren't even asked for a medical history, unlike some states where people do have to provide that info. The way the insurance company picks up on a pre-existing condition is when the person puts in their first claim for it. If it's anything that could possibly have been pre-existing during the "lookback period", the insurance company will ferret that out, and use it to make the waiting period kick in if they can.

With people who move from one job (with insurance) to another (with insurance) within the "lookback period", the lookback period for pre-existing isn't a problem because they've had continuous coverage. The problem comes in when people haven't had any health insurance at all for a certain period of time, and then either buy an individual policy or get a job that does offer health insurance, and then during the first year of coverage put in a claim for anything that's related to something that was first diagnosed, treated for, gotten an opinion on, etc etc, during the pre-existing-condition lookback period. Whammo! That condition is flagged as pre-existing and subject to the waiting period, which depending on the particular company can start either on the first day of their coverage OR the day the person first applied for the insurance. I think the companies have a little leeway regarding which point the waiting period can start from (application or the in-force date). But those dates usually don't vary by more than a month or two.

Many people confuse the situation of someone being "denied coverage" for pre-existing condition claims, with the kind of thing NY does, which is a "waiting period for coverage". That's why the new Health Care Bill doesn't change anything for adults in NY as regards pre-existing conditions. It only really affects people who live in states where insurers had been allowed (up till now) to deny or cancel a policy or permanently exclude pre-existing conditions from their policies. "Waiting period" doesn't = denial or exclusion, according to the legal eagles, because the waiting period is temporary (time-limited) whereas a denial or exclusion is permanent. 

Nope, you're not dense     ... it's a somewhat convoluted, murky situation!

If someone has had coverage, say through another insurance company or Medicaid, and gets a job that includes its own group plan which she enrolls in, the waiting period for covering a pre-existing condition can be decreased ("credited") by the number of months she had the other insurance. So let's say Jane Doe has had her own insurance policy for 6 months prior to taking a job with ABC Corporation, but before that, she had no medical insurance at all for two years. She can get credited with 6 months off the normal 12-month waiting period for coverage of a pre-existing condition; and so the ABC Corporation's group plan will start paying for those expenses six months sooner than they would have done if she had not had her own policy.

Even if she cancelled her own policy, say, 45 days before taking that job, she would still get credit for the six months she had insurance... because she did not have a "lapse of coverage" of more than 63 days in between. If, however, she cancelled her insurance 65 days before taking the job, the insurance company can by law make her wait the full 12 months before covering her pre-existing condition.

You can substitute "worked for another company which provided health insurance" for "had her own policy", and "left that other company" for "cancelled her own policy", and the result would be the same. The source of the prior coverage (job, individual policy, Medicaid) doesn't matter; it's the timing that counts.

In Colleen's case, it sounds like she has only been on Medicaid for a couple of months, and has had no insurance for several years before that. So if she takes the job and goes on the new employer's policy, they only have to credit her for the number of months she has actually been on Medicaid. Let's say it turns out to be 3 months; she would still have a waiting period of 9 months for covering anything to do with her cancer. Unless the insurance company is inclined to be more generous than the law says they have to be, and waives the entire 12 months (what are the odds??). But by law those 3 months of Medicaid are "creditable coverage" (as long as she doesn't go without Medicaid for more than 63 days before being on put on a new employer's policy) -- they must give her those 3 months off the standard 12 months' wait. 

So.. as in so many thing in life (*sigh*), timing is everything... 

 (again, the above just applies to NY; don't know how any other state handles it. YMMV for sure.)

patoo, I don't know what the insurance laws are in NJ .... I only know NY's. So I don't know if ins companies in NJ are allowed to base their premiums on your medical history; in NY they cannot do that.

In NY, health insurance companies CANNOT:

* Require you to give them your medical history when you apply for a policy. They can require it, or part of it, though, if you submit a claim (see below).

* Base your premium rate on your medical history or current state of health

* Refuse to give you a policy because of a pre-existing condition

* Cancel your policy because of a pre-existing condition

* Permanently refuse to cover a pre-existing condition

* Refuse to reduce a waiting period for covering a pre-existing condition IF the person proves they had "creditable coverage" beforehand, by the number of months that the creditable coverage was in force.

* Cancel your existing policy for any reason other than non-payment of premiums when due, or for for failing to fulfil your obligations as the insured (as stated in your policy).

In NY, health insurance companies CAN:

 * Impose a waiting period of no more than 12 months before covering a pre-existing condition if the person has had a lapse in coverage of more than 63 days between the termination of their prior coverage and either the (a) application for the new insurance, or (b) the date the new insurance coverage actually starts. It's up to the insurance company whether to have either (a) or (b) apply, but it must be one of those two dates. I've seen it done either way, depending on the company.

* Require you to give permission for them to obtain copies of any medical records that pertain to a claim you make, or the medical condition that relates to that claim (this is included in the Obligations of the Insured section of the policy). If you refuse to give them permission to access that information, they have grounds for denying the claim (and quite possibly also grounds for cancelling your policy, depending on exactly how it's worded).

Again, I have no clue as to what New Jersey's insurance dept regulations are for health insurance companies that do business in that state. They could be entirely different from NY's, or only some regulations the same, or all exactly the same (unlikely, but of course anything's possible).

Ah, I see.  I saw the NJ and just assumed you were asking about that state. Duh!

Some of the NY regs are mandated by HIPAA (the Health Insurance Portability and Accessibility Act) which is a Federal law and thus applies to all states. The 63-day thing is part of the HIPAA regs and thus that would apply to Florida too (unless they amend HIPAA in the future and happen to change that; who the heck knows what those bozos in Congress may one day do??)

Where the states will vary is in how they treat pre-existing conditions. The new Health Care Bill says that (eventually) no state will be able to outright deny or cancel someone a policy based on that factor, but it doesn't say a peep about premium costs depending on that, and it doesn't prohibit waiting periods. Those two things are left up to each state (at least the way the healthcare bill is now written).

My personal opinion is that many states (and I wouldn't be surprised if all states who up till now have let companies refuse or cancel based on pre-existing eventually do this)  will opt for the same scenario that NY has, which is to allow companies to impose a waiting period of up to 12 or perhaps 18 months for pre-existing conditions if a person doesn't meet the prior-coverage requirements.

 The big question will be what each state does about premium pricing and pre-existing. My guess? States that were previously refusing/cancelling, will end up allowing health insurance premium "tiers" based on risk, just like life insurance companies are allowed to do. For example, a perfectly healthy 20 year old who had one parent die of a heart attack (regardless of the parent's age) will pay a higher premium for life insurance than if his/her parent(s) had no cardiac history. The ins co is allowed to consider that risk factor and put them in a different premium-price tier. Likewise, auto ins companies are allowed to consider items on your credit report (including just the length of your credit history) when rating you for a car insurance premium. They're required to tell you that you're paying more for the policy, but they still are allowed to charge you more.

Frankly I'm surprised that NY doesn't allow that for health policies (they do allow tiering for life, auto, and homeowners policies) -- we sure as heck pay through the nose for everything else we get! 

NJ isn't far behind in that respect either, especially in property taxes (don't get me started, off topic!   )

I am SO with you there. Unfortunately there's nothing I hate more than heat and humidity. (snow shoveling is a close second, which is why Up North isn't a retirement option for me either)

Though I bet NJ doesn't have the infamous  but little-known 9.3% surcharge tacked into all hospital bills if you're uninsured. At least I hope not!