Insurance and Healthcare

[Jim]

I decided to let everyone know about this just in case it can help anyone.

As everyone knows by now, I have some large medical expenses here and coming soon. I had what I thought was a decent health plan. At first, they seemed to pay for everything. It had a crappy prescription plan but I was told that if something catastrophic came around, a different policy would take effect and it would cost a little more. Basically, I was swindled.

After I received a $6k bill for a blood test, I called the "Patient Advocate Foundation". They then called our insurance company and found out there were very low caps on everything they pay for. And, it was already maxed out for the calender year.

A little known fact about New York state is that as long as you have some sort of health insurance for 11 continuous months, you can not be turned down by any insurance company for any reason. And, the new insurance company has to pay for pre-existing conditions. The problem is...we started our health insurance in March of this year.

As I tell everyone to do, went to my local chamber of commerce. They told me to call their broker and see what could be done. The lady I spoke to was very sympathetic and told me there was one Insurance company that had NO pre-existing condition clause. Who ever heard of such a thing? Why would an insurance company take someone with a serious illness when legally they didn't have to? I didn't believe it and searched online. I found 6 documents pertaining to this company saying that they had NO pre-existing condition clause.

This company actually pushed our application through in one day after the broker told them about expensive meds and surgery coming up Yesterday they called to give me our new insurance numbers to use. They backdated it to 8/1 and said they wanted to get it setup quickly so I didn't have to pay for the expensive meds and gamma knife surgery that my wife has to have.

I watched Sicko and thought all insurance companies were scum. These people bent over backwards to help us. This is a real major medical insurance company. But, they only cover NYS and Vermont.

As for using the chamber of commerce...every county in the US has one. In NYS they are all tied together and act as an employer to over 100,000 people. I assume that most states are the same. With so many people, they have some pull with insurance companies. Everyone knows that if you get insurance on your own, they can raise the rates to anything they want. Being in a group of over 100,000 stops that. Really, if you don't have insurance or if you got it without going through a group, check out your chamber of commerce.

Anyway, these past few weeks have been really tough for my wife and myself. When I found out that I had no insurance, I started selling things and felt like I could no longer cope. My only real fear was that my wife would not get the treatment she needs. And now that fear is gone. Don't get me wrong...I still have huge bills for up to 8/1. But, I can deal with that.

[jetpat]

Jim, I'm a noob here as of today, however I've read a few of your posts regarding your wife. My mother was diagnosed in Feb with esophageal cancer. She began an immediate and aggressive treatment regime and has one more chemo treatment in a few weeks. She's done fine and is actually on a trip to my in-laws with my wife and kids for the weekend. Luckily, the company she works for and the insurance have been top notch. I find it absolutely disgusting AND amazing that some insurance companies can get away with this crap. Thousands and thousands of people paying hundreds of dollars a month, and they're going to cap benefits?!!

I'm glad you found someplace to help you guys out, and I will mirror what others have said: Positive attitude, mindset is a key. Peace.

[sue-fl]

I'm so glad you found some decency in our messed up Health Care system.

When I first started reading your post I was like oh hell no they did not cancel him You know an illness like your wife is going threw can happen to any one of us or family member at any time. Having to deal with insurance crap is the last thing you think we would need to worry about. So sorry you had to go threw all that with everything else you two are dealing with.

Take care of yourself Jim, I know your wife is your main concern but watch yourself also.

Positive thoughts and many prayers are coming your way.

[Jim]

Just a quick fyi on this deal. I believe yesterday we received the last bill before our "real" insurance company started paying. I totaled it up and plan on taking a fist full of cash to pay part of it today. The total to find out that my wife had cancer was $63,480.32. Remember, that was only tests and not one bit of treatment had started.

We actually had a $16k blood test. I admit that the blood did have to be driven to Maryland right after it was drawn but DAMN... I would have happily driven it there myself if I could have saved better than $10k.

Anyway, the new insurance company is bending over backwards to cover everything.

[Ramster]

Jim, I am glad this seems to be working out.

But I'm with you...WTF is up with those costs? A blood test, $16,000? Jesus!!

[Jim]

The previous high for a blood test was just under $6k. I have no idea what they could do with blood for that much but...what do I know? I just can't imagine how much the treatments will end up costing. As long as the insurance covers it, I don't really care very much. I do know that the last prescription we got was for 5 pills and on the bill it said, "Total savings by using this insurance, $13,300".

[Cleo]

I just had to pay two deductibles for a CAT scan. As far as I can tell I only had one CAT scan but somehow the hospital/insurance company says it is two CAT scans. I guess one CAT scan was entering the machine and one CAT scan was existing the machine.

[SirMoby]

I have some friends that are doctors and one of them often prescribes a treatment that costs him over $5,000 to administer a single drug dosage.

The cost of insurance and health care has more then doubled since 2001. That's about the same increase we've seen in gas prices. The companies that have had record profits these past 6 years? You guessed it.

We need some serious change.

[ponygirl]

Originally Posted by SirMoby

I have some friends that are doctors and one of them often prescribes a treatment that costs him over $5,000 to administer a single drug dosage.

my husband takes Remicade every 6 weeks, which costs from $3500-$5000 for a single infusion. We are lucky in that his insurance coverage at work covers it (not without a fight, mind you) with the basic reality being if he didn't get the medication, they would be paying him for disabilty. I guess they figured it's cheaper this way. If we didn't have that coverage, I don't know what we'd be doing. I really don't know how some people do it, it's shameful that people go bankrupt paying for this stuff, or go without.

[Jim]

Originally Posted by SirMoby

I have some friends that are doctors and one of them often prescribes a treatment that costs him over $5,000 to administer a single drug dosage.

The cost of insurance and health care has more then doubled since 2001. That's about the same increase we've seen in gas prices. The companies that have had record profits these past 6 years? You guessed it.

We need some serious change.

See, that's why I keep saying to go through your local chamber of commerce. I have the ratecard from 8 years ago and it is exactly the same as the most recent. The chambers tied together in the insurance company's eyes are the largest employers in the country. And remember back when you filled out the paperwork for insurance from an employer. All you had to fill out was your name and ssn. That's the way it is through the chamber. No health questions included.

But I agree, everything health related is expensive. I thought $5k for a catscan was a good price

And while insurance seems expensive, imagine how long I could have had insurance for the price of $63,480.32. At my current rate for just my wife, I could have paid for insurance for almost 11.5 years for her. And remember, that money was for 1.5 months of tests.

[Yell]

Glad you found some insurance Jim. I know what it will cost you.

I have a one inch binder full of all paper work that my wife had done to her, I have not gone though it in a long time but i know that the cost was close to $500k and that was just from Roswell Park Cancer Institute. Her first surgery was at Mercy Hospital and i don't have that bill plus the home care she had that i did not add in and thats no joke maybe even more i would have to look.

My job we do have some good insurance but i still had a ton of copays that i had to pay and that was a lot.

[Jason]

18 months ago I quit my job and became a full time webmaster. I rode out the cobra coverage for 6 months then was left standing there wondering where the hell to get insurance. The HR lady at my old consulting firm told me the same thing you're saying, get your coverage under a group plan or you're going to get bent over.

Turns out my personal trainer had his insurance through Costco, which has a small business plan. Since Jim was talking about a company that only covers a couple states in the northeast, I thought I'd post a link to Costco's plan as it only covers some states on the west coast.

http://www.costco.com/Service/Featur...uctNo=10166086

Thankfully, we haven't had to test any of the financial limitations but they have been great.

And seeing your post Jim, really puts that $550/month I pay for myself and my wife into perspective. This month it will sting quite a bit less to pay that.

My best wishes to your wife, it's quite a fortunate day & age we live in where people beat cancer all the time. Do keep your chin up.