Job in jeopardy - confused on insurance

pamallen · January 2011

I am hoping someone can help me with this. I am really concerned because the company I work for is in financial trouble and probably closing soon. I was just diagnosed with DCIS 12/20/10 and am almost as scared about my insurance as the bc. When my job is gone, how do I go about getting insurance at my next job (will i be denied becauase of preexisting), what about the in between. I am only 41 and still have a lot of good working years left. I can't be without insurance. Any help on this would really be appreciated. It's a shame that on top of everything we have to worry about insurance.

EnglishMajor · January 2011

I can't answer your question, but I am pretty sure others can and will do so shortly. These sites also may help:

http://www.cancerandcareers.org/women/paperwork/

https://www.disabilityrightslegalcenter.org/about/about.cfm

http://www.ovariancancer.org/2010/09/27/frequently-asked-questions-about-health-reform/

Health Reform FAQ:

Will everyone have insurance?

By and large, everyone will be required to have health insurance. Those who choose not to purchase insurance will face tax penalties. The law specifically states that people cannot be imprisoned for not having health insurance.

Until 2014, when some provisions take effect, people with pre-existing conditions will most likely purchase insurance through high risk pools, also known as Preexisting Condition Insurance Plans (PCIP).

The law creates Health Insurance Exchanges - a place to buy and sell health insurance, like a shopping mall for health insurance plans, that meets certain standards, does not discriminate against those with preexisting conditions and is an option to the individual market or employer based plans. Unauthorized immigrants will be prohibited from purchasing insurance on the exchanges, even with their own money.

Will the government be able to make decisions about when people can have life saving care?

There is no such thing as death panels. This is a myth based on a proposed amendment to the health reform bill that was not included in the final bill. The proposed amendment would have allowed Medicare to reimburse doctors for having end-of-life planning conversations with patients, but did not in any way require stopping care.

A provision of the law provides funding for comparative effectiveness - the process by which two or more treatments for the same condition are evaluated for patient outcomes. Within that provision, the law states that all reasonable and necessary treatments shall still be covered by Medicare and that based on the results of clinical comparative effectiveness research shall not be used to deny care.

Did all provisions of the bill go into effect March 23, 2010

Not all provisions of the law will be applicable to everyone immediately. Certain provisions of the law take effect at different times, until 2014 when the entire law is implemented.

Some plans, called grandfathered plans, are exempt from some provisions. Grandfathered plans are those that were in existence on or before March 23, 2010, the date of PPACA's (Patient Protection and Affordable Care Act) enactment. A plan can lose its grandfathered status if it substantially decreases benefits including employer contributions, decreases coverage of a certain condition, or increases the co-payment structure.

On September 23, six months after enactment, some provisions take effect, including

- Young adults up to age 26 may stay on their parents' health plan. This is applicable to all young adults, even married ones, and all health plans, including grandfathered ones.

- Children with preexisting conditions must be covered under all plans, except grandfathered plans purchased in the individual market

- Recission (cancellation of health insurance), except in the case of fraud, will be prohibited.

- Lifetime caps will be prohibited under all plans, including grandfathered plans (annual benefit caps will be phased out by 2014).

- Preexisting Condition Insurance Plans will be open in all states.

- Medicare beneficiaries who reach the "Donut Hole" will receive a $250 rebate.

- New plans will be required to cover preventive services and will not be able to charge a co-pay

Will drugs be approved if they aren't proven to be cost-effective?

The Food and Drug Administration's process of approving drugs is not affected by the enactment of the Patient Protection and Affordable Care Act. Drugs are approved based on recommendations from Advisory Committees presented with scientific data.

Can insurers stop covering certain groups of people or certain diseases?

Generally,no. If insurers change benefits by no longer covering a disease, the plan will no longer be grandfathered and will have to comply with all provisions of PPACA immediately. However, estimates suggest that only 50% of employer sponsored plans will remain grandfathered next year. We expect continued changes in th

AmyIsStrong · January 2011

I can't say for sure, but this is what I think. You may be able to get COBRA (which continues your existing coverage after your job is done) but I'm not sure because there are restrictions due to the size of the company, and also I'm not sure what happens if the company itself is gone.

I also thought that when you get a new job and go into a group, they have to accept you regardless of preexisting conditions.

I know that in my state, MD, the state govt runs an insurance program (admin by Blue Cross) that is specifically and only for those of us who cannot get ins through work and have conditions that would not allow us to buy insurance on the open market. I went on this plan when my COBRA expired and it works fine. So perhaps your state has a program like that as well.

I do know how stressful this can be. But this is your time to focus on yourself and your health. TRY to keep from panicking. I do not say that lightly. I know how upsetting this can be. But the stress is not good for you. Perhaps there is a social worker at your cancer center who can help you sort through your options.

Also, when you apply for new jobs, I would not mention your health condition. You are under no obligation to do so.

EnglishMajor · January 2011

http://www.health.state.mn.us/hmo/hipaa.htm

This is from a Minnesota site, but would likely hold true for all states:

Q. What is "certification of creditable coverage"?

A. Certification of Creditable Coverage is a statement showing your dates of coverage. This statement acts as a "receipt" and is automatically given to any covered person by an insurer, health maintenance organization, or plan administrator when the person loses coverage for any of several reasons:

* employment is terminated
* hours are reduced
* divorce
* death of the covered employee
* other reasons

With certification, when a person is enrolled in a new plan of coverage, he or she can apply creditable coverage against any limitation for a pre-existing condition.

Q. What is "receiving creditable coverage"?

A. Receiving Creditable Coverage means that a new employer or issuer may either: (1) accept the person's previous qualifying coverage without regard to the benefits covered, or (2) evaluate the benefits on a category-of-benefit basis.

Minnesota law does not permit an insured plan to use a "category-of-benefit" evaluation of previous coverage, although self-insured plans may do so.

lago · January 2011

If your company goes out of business there will be no cobra. I would apply for a state/federal high risk plan now till you get employed again. If there is a lapse in insurance it might be a year before a precondition is cover if at all. There have been new laws so I'm not sure what the deal is with preconditions are anymore. In the past it was as long as your health insurance was continuous you would be covered.

State High Risk: http://www.cobrahealth.com/statehighriskpools.html

What Happens When COBRA Ends?
http://www.hcvadvocate.org/hepatitis/hepC/cobra-2.html

FAQs For Employees About COBRA Continuation Health Coverage:
http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.HTML

You might also find this thread helpful:
Pre-Existing Condition Insurance Plan (PCIP)
http://community.breastcancer.org/forum/113/topic/754874

pamallen · January 2011

Thanks for the responses everyone. This is really confusing and the worst timing ever. If we close before all my surgery & radiation is done, I do not know what I am gonna do!!!!!

If my husband has insurance, and I lose my job are they required to take me because of a life changing event. I have heard that but was not sure if it is true or not. Sorry for all the questions, but I am really confused and as someone mentioned, I can't let my insurance lapse, but there will be no COBRA option.

lago · January 2011

Yes I do believe if you lose your insurance you can go on your husband's even if it isn't open enrollment time… Your husband can ask his admininstrator or you can call up the plan yourself. Going on his insurance would be the best and most cost effective for you till you get another job.

pamallen · January 2011

largo, thanks so much. That really eases my mind. One more question if you don't mind. When I do get a new job and apply for their insurance, would I be considered preexisting and not able to get it?

annettek · January 2011

pamellen- if you are still covered by a insurance plan when you go onto another there should be no problem.I think the big problem is when there is a gap in insurance coverage. BUt then again, I don't think there is any clause for perexisting with a major insurance plan when you are hired once you make it through the 90 day trial period. Depends on the company size and their policy of course. I agree with Lago, that you should get on his insurance now. Good luck

Bren-2007 · January 2011

You may also be considered as having a preexisting condition on your DH's plan. He needs to check with his company. I know that if I went on my DH's plan, I would not be covered for 12 months because of preexisting condition. He has BC/BS.

Sending you best wishes that all will work out for you,

Bren

lago · January 2011

Again you would have to check but I am pretty sure that pre-existing condition is only an issue if you haven't had continuous coverage or you are applying for independent insurance. Get your husbands info and call tomorrow.

BTW cancer is considered an uninsurable condition so as long as you have continous coverage it shouldn't be a problem but I don't know is DCIS is considered uninsurable. I'm not sure if it's considered cancer or pre-cancer.

Come 2014 if the law passes we won't have to worry about this crap anymore!

pamallen · January 2011

Bren, that's just great. My husband has BC/BS. I feel like I'm in a nightmare that I will never wake up from Yell I'll have him check with the administrator but they know my situation, can his company say no way since it will make their premiums go up. They are a small company as well.

Bren-2007 · January 2011

Pam .. I don't know the answer to that. I do know that his company can waive those requirements if they choose to. Your DH should contact his HR rep for all the info.

Keep us posted on how you're doing ...

Bren

lago · January 2011

I would call BC/BS directly with your husband's info to find out. I don't think they can selective decide who's spouse/family they will cover. If the company allows for family coverage then they can't just deny you because they don't like your disease. That sounds totally illegal to me.

EnglishMajor · January 2011

Not to put the cart before the horse.... but if you run into problems after you call the insurance company, here are some resources (cross posting):

Some additional resources:

Legal Help for Lower-Income Workers-- A number of regional legal networks operate to help patients dealing with job-related or insurance-related issues along with their cancer. Among them:

*
Legal Information Network for Cancer (LINC, www.cancerlinc.org, 877-644-5462). Services include explanation of insurance benefits and help with appeal for coverage denial; the getting of public benefits such as Medicaid or Social Security Disability, management of debt, including negotiation to ward off collections, arrangements for care and custody of children.
*
LegalHealth at the New York Legal Assistance Group has legal clinics for low-income patients in the New York area dealing with job and other issues, and other services (www.nylag.org, 212-613-5095).
*
Cancer Legal Resource Center (www.disabilityrightslegalcenter.org, 866-843-2572) in Los Angeles offers nationwide assistance with job and health insurance related issues.
*
The Patient Advocate Foundation (www.patientadvocate.org, 800-532-5274) offers counseling as well as referrals for cancer patients dealing with job discrimination, insurance issues and other problems.

Payment for Treatments-- A number of nonprofit organizations can help with financial assistance when treatment expenses for cancer are overwhelming. A sampling:

*
CancerCare (www.cancercare.org, 800-813-4673), offers financial assistance in the form of limited grants for certain treatment expenses. Services also include practical help and support via the free phone line or the website.
*
National Marrow Donor Program (www.marrow.org, 888-999-6743) has a patient assistance program that helps with costs for searching the donor program registry and some post-transplant costs.
*
The Leukemia and Lymphoma Society (www.leukemia-lymphoma.org, 800-955-4572) offers some financial aid to patients with leukemia, non-Hodgkin lymphoma, Hodgkin's lymphoma or multiple myeloma who qualify as needing the assistance.
*
The Patient Advocate Foundation (www.patientadvocate.org, 800-532-5274) also sponsors a Co-Pay Relief program for qualified patients.
*
The Federal Health Resources and Services Administration (HRSA) Bureau of Primary Health Care has health centers nationwide that provide health care based on ability to pay. To locate a health center, visit the web page at http://ask.hrsa.gov/pc.

Payment for Medications-- Relief from the high costs of medications is often needed. Among the organizations that help:

*
NeedyMeds, at www.needymeds.com, is a nonprofit that helps patients by referring them to patient assistance programs to help with medication costs.
*
Patient assistance programs are offered by some pharmaceutical companies. To find them, ask your doctor or social worker or find the drug's manufacturer and visit the company site. Look for a section titled "patience assistance programs" or similar wording.

Payment for Transportation and Lodging

*
Hope Lodge is a housing program supported by the American Cancer Society, providing free housing on a temporary basis for cancer patients undergoing treatment. For information and a listing of lodges, visit the web site at http://www.cancer.org/docroot/subsite/hopelodge/index.asp or call 800-227-2345.
*
Road to Recovery, another ACS program, offers transportation to and from treatments for cancer patients. More information is available by calling your local ACS office or the toll-free national number, 800-227-2345.

pamallen · January 2011

Thanks for the information everyone. It's so nice to have help in sorting all this out.

I have done some research and it appears that if I lose my insurance, my husbands insurance has to take me because of a life changing event, without pre-existing stipulations because I have always had consecutive insurance with no gaps.

If anyone knows any different for a fact, I would apperciate that info. But this appears to be the law according to HIPPA.

Thanks again.

Bren-2007 · January 2011

Pam .. I think you're probably right. Especially about the part of having continuous coverage.

Best of luck to you,

Bren

Fearless_One · January 2011

Whatever you do, don't let there be a lapse between insurances. Carry Cobra, go on your husbands, look for another job in the meantime, but don't let there be a lag between insurances. If there is, you can be denied as pre-existing.

lauri · January 2011

I *think* the magic number is less than 63 days gap between insurance coverages -- but zero days without coverage is better.

happytobhere · March 2011

I have lost my job with a union company. Are should I say laid off. They are still working we some not not much. I have cobra but is high. I have to pay 273.00 per week. That is about as much as my unemployment. I have tried to get more insurance but they would not pay for anything for a year.

Job in jeopardy - confused on insurance

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