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1 week ago
Aug 31, 2009
Dumbfounded....
I am absolutely sick to my stomach. I am sorry that this post is a vent session... but I also need some advice. We have had the same health insurance coverage for years. 7 1/2 years to be exact. When we started we paid around $350 per month. We are currently just pennies shy of $800 per month. It has gone up significantly since Justin was diagnosed with Down syndrome. Since that diagnosis... they have denied coverage for many things. So not only do we pay $800 per month to be insured, but we owe many hospitals additional money from the non-covered things. We are basically paying a mortgage every month in Medical bills. We decided to call and switch to Catastrophic Health coverage only. I know that's scary, but we are tapped out in medical expenses. Well, NO WAY would anyone even consider us! Are you kidding me?! Because of Justin, they won't make ANY changes to our policy. Nor will any other insurance companies! The only change we can make is to drop coverage all together or drop HIM and leave him un-insured. I know our system is whacked... but give me a break! Tyler works his butt off to put food on our table and a roof over our head, and this is what we get. But there are those who sit on their butts every day and work the system... they are better off than us at this point! It makes me sick! Now that I have gotten that off my chest, does anyone know what we can do for Justin. We can get insured somehow with out him, but what about HIM!? He is the one I worry about the most, even though he is very healthy. Does he qualify for Shriners Hospital if he needs medical attention? How does CHIP work? I know I can look all of this up and make calls, but I am in no mood to talk. I am in tears trying to figure out how to stay afloat through all of this. Thanks for your advice....
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This is a post that hits right at home for me. Please call me if this doesn't answer your questions (801.733.0571). Our kids cannot be on a personal plan of any kind unless they were born while you were on one. They do not qualify because of 'mental retardation'. Because you know how much that costs in medical/health illnesses! What a joke!! They can only get covered on a group health plan. You have to apply to an insurance company, get the denial for Justin and then you can apply for health insurance just for him through HIP of Utah (a insurance plan for individuals that cannot qualify for insurance through work or a personal plan). We have this plan for Morgan. We pay $350+ a month for Morgan and $500+ a month for our family's personal plan. We are close to $1000/mo with dental. It is totally a mortgage payment, but with 6 kids I can't risk not having insurance. It's not worth losing my home over.
HIP's monthly costs are from $300+ for a $500 deductible down to $151 for a $5000 ded. and is based on the age so that is the premium for anyone under 21 years old.
Here is a link to HIP of Utah for youhttp://www.utahinsurance.org/HealthInsurancePoolofUtah.html
Shriners he would be able to get if he had orthopedic problems. They don't deny anyone. Who is your insurance right now? We have Ihc and I know we've been lucky, but if they put down syndrome as the diagnosis it will not be covered. So anytime he has something done, never let them put ds as the initial diagnosis as it will be denied every time. Our insurance hasn't gone up because of Jax, but it has gone up with inflation. I didn't know they could raise it because of a kid with medical stuff.
Our country is ridiculous, it makes me so angry I could scream. What do we have to do to get our kids covered? We are paying taxes, we should be able to get what we need. I do believe you can get chip. Chip is for people who can't afford their company insurance. I would definitely check into it.
How frustrating! It makes me so mad when people choose to do nothing and get everything! We've been very fortunate so far with Mattie's insurance. Sorry I can't be more helpful as I am clueless to all those programs. Praying that it will all work out.
Sorry that I don't really have any advice for you Emily. Just wanted you to know that I will be praying for this situation.
oh man, that stinks!! I know you are very frustrated and its not fair that people out there take advantage of programs that are supposed to help the less fortunate. Just know that not everyone who gets state help takes advantage of it. Malachi gets the state medical card because he is a ward of the state. Once we adopt him he will continue to be on the medical card, I guess its one of the perks when you adopt through the state. We are soooo thankful for this because of we didnt have it we would be in the same situation you are! We are thinking of you and hoping something works out!!!
I think we discussed this a little bit when we got together in Bakersfield.....didn't you say that your husband is basically like a self-employed worker when it comes to ins??? I don't know much either in regards to your issues because my husband works for the county and we are in a VERY big group insurance so haven't had any problems. HOWEVER...I have to wonder if you still aren't better off to stay with the company you are with now because they have to cover him. Any new company would consider him pre-existing...which is absurd!!! I am soooo sorry that you have to deal with this right now....its so unfair. I watch hours of news coverage about this Obama health care program and just wonder if it will help people like you at all. People who work hard and don't qualify for govt help!! Hang in there my friend!!!
I feel your pain. We are self-employed and we pay $1500 a month for health insurance. Since we pay the health insurance before we pay ourselves, we make so little money my kids qualify for free lunch.
Have you tried to get a Medicaid waiver? Some states are better than others.
Emily...I remember talking about all this when we got together at your mom's...Brayden is on my husband's employer insurance with no problems and is able to be qualified for the institutional deeming medical...we just filled out our renewal form done only annually and they do NOT look at income...we haven't used this hardly at all as we have been very fortunate that he has really only needed healthy visits...but for instance if we have to go to ER our insurance co-pay is $100...well, because he has the other medical coverage that will cover that cost...there just HAS to be a way that this is in the state of UTAH too! I have no idea except to contact the disability office and ask your worker about getting a diagnosis written up by your doctor ,and applying for the institutional deeming medicaid or medical??? Call me if you want...I wish I could be of more help to you! I know every state has certain guidelines, etc...I will be praying for you and your family for solutions! I agree, OUR Healthcare system is MESSED UP!
I wish I had some advice for you...I am so sorry that you guys have to go through this!! We are praying for you!
Oh this hits close to home with us too. We are on a plan all by ourselves (husband's company isn't big enough to qualify for group) and we have been told the same thing. We can't do anything to our insurance because no other insurance will accept Carter. Our premiums went up so much this year because of Carter - it is absolutely ridiculous. And then we like you basically spend a mortgage payment a month for co-pays, deductibles, co-insurance stuff. It is ridiculous. We looked into medicaid and we are told we don't qualify. Our neighbor got denied medicaid when her husband was out of work because "they didn't have a car payment" so therefore they must have money to pay insurance - what? They said if they went out and bought a car and had a car payment they would qualify for medicaid with no problem - what is wrong with our country? So because we work hard and pay things off - we are not eligible for state benefits.
I am sorry I don't have any advice for you either. We are just continuing to pay our insurance because at least Carter has insurance. It might be better to at least keep Justin covered. We did call our insurance agent after our premiums went up and he did say that if Alan ever switches jobs and the new company has a group insurance plan then they automatically have to accept Carter and he cannot be denied coverage -which is good in the event Alan does ever find another job. He is looking into the government/state/city jobs because they have got awesome insurance coverage.
Hang in there - you have vented to the right place - a lot of us understand exactly what you are going through. Hope you find some answers to help you through this.
Emily I am so sorry that breaks my heart just reading it. It totally does seem unfair that those that are really trying to do the best they can get the raw end of the deal. I had no idea it was so hard to get insurance coverage for little sweethearts like Justin. Good luck getting some help, I wish I had some answers, but I have no idea. I hope you guys can figure out something, the system is defintely whacked out.
Oh I know those feelings...makes me sick too! Thankfully our business did so poorly last year and we have been scraping ourselves of the 'bottom'ever since, Preslie qualified for Medicaid. Otherwise she wouldn't be insured either. Kurt and I aren't insured. They wont insure me for stupid things. I went to www.utahclicks.org. I believe. Fill out the forms...can't hurt and see if you can at least get him on Medicaid and keep the rest of your family on individ. Insurance. That's the ONLY way we are making it!
Emily, I'm so sorry to hear you are in such a hard situation. I don't have any additional advice from what everyone else has said, but I just wanted to tell you I really hope things work out and you are able to get to a point you feel better about with all of this!!
Insurance sucks, what else can I say?! Currently Adrian and I are without health insurance, because we can't afford it, but we do have CHIP for Alexis. I'm not sure if it would make a difference with Down Syndrome, but I know that it has to do with your income and whether or not you have the option to get insurance through your employer. If you call the Dept. of Workforce Services they could tell you more about CHIP, that's who you have to go through to get it. It wouldn't hurt just to call & ask some questions. That's outrageous how much you guys are/were paying, I'm so sorry! Wish you guys the best, and wish I could help more:)
Oh Emily, I'm so sorry to hear about this. After our first $3000 doctor appt with Max we started joking as to when we would be declaring medical bankruptcy! And I'm sure open heart surgery this week will cost a pretty penny. I'm sure our insurance will be loving us. Because of the adoption, we should qualify for medicaid, but it takes 5-6 months to get qualified, so we're hoping our insurance works with us until then. Sorry I don't have any advice. Although, I did read something on a supplemental insurance website (AFLAC or Colonial) about joining a credit union to qualify for a group insurance policy.
I forgot... there's also a program called UPP that helps families with their employer insurance premiums - check it out here:
http://health.utah.gov/medicaid/
{this is also the CHIP link}
That is so frustrating Emily! I'm sorry that I don't have any experience in this as others that have commented seem to. But here is what I know about insurance options coming from a medical point of view:
Try Medicaid: your family wouldn't qualify, but Justin probably would based on his diagnosis.
Try CHIP: again, your family wouldn't qualify, but Justin should.
If those avenues don't work, try applying for social security disability. This will cover him FOR LIFE!
I hope that things work out. Keep your head up, you are doing the right thing for your family!
Emily, I am so sorry you are having to deal with our lovely Insurance world. I do know, as someone else mentioned, don't put down DS as a diagnosis for anything. When Sam was born they would not pay for his echo or his genetic testing. We had his pediatrician and the hospital recode it as a heart issue etc and the insurance company paid. As far as getting coverage I can ask my husband what we have. He works for his Brothers Printing company and they only have 5 employees and the insurance so far hasn't been to much and hasn't gone up yet. I know that one of his co-workers has a little girl (1 year old) who has Spina Bifida and has some major health issues so it might go up because of that but if you want I can ask. Acutally I believe it's Altius. I don't know if we are okay since Doug was alread on it before Sam was born or what the deal is? The guy who gets them their policy and works with them has a child with a disibility as well so I am sure he knows all the ins and outs of insurance and a child with a disibility. What you are going through really scares me as Justin is like Sam, they are very healthy. I hear with the Obama plan these little kids get left out. A person who doesn't have a disibility will get a heart/surgery/kidney etc before our kids will since they think they are more productive in society and will have a full life. Not sure if that is true or not but I have heard it. So sorry, if I find out anything I will let you know.
How frustrating! We had no problems with W on our insurance and they should not discriminate since you were already on the plan..Also check into medicare or medicade for him. William got on one or the other (don't really know right now) b/c of the disabilities act that was recently passed, your income can be, I think 300 percent higher if your child is labeled "disabled" I hope this helps
I'm really disgusted by the whole health insurance crisis! I guess I've always taken our relatively inexpensive health insurance for granted. But after reading your post and everyone's comments, I realize that anyone of us could be dealing with the same insurance nightmares at anytime. I sure hope someone fixes the system soon. And in the mean time we'll keep you in our prayers. Let us know how it turns out...
This is Joyce. Oh the mess of insurance. We have tried a few times to switch carriers and we are always denied because of the Ds. Our monthly premiums hit $2,600 last year. I went back to work at a job with the same carrier and then left after a year so we could COBRA at $1400 which most people think is outlandish - for us it is like we just found $1200 a month. On the flip side we own a medical billing company so we see it from the billing side too. As others have mentioned, try to not let any claims go in with the Dx of Ds as many services will be denied. It is such a catch 22. Good luck.
I just wanted to add that Medicaid and SSI in Utah are based on income and you do not automatically qualify because of disability. Morgan should qualify for SSI and Medicaid when she is 18 and not considered a dependent. Until then we will keep her on the HIP plan or go to a group plan if I go back to work full time when all the kids are in school again. I think your personal plan is probably your best option but not if they are denying everything-then I would look at the HIP plan for him but he would need to be on it until a group plan became available for your family. Good luck!
I'm so with you on this. As if we parents don't have enough on our plates to think, stress and worry about. I would definitely look into some sort of state or federal help. In california, it's Medi- Cal and Joaquin qualified based solely on his diagnosis- nothing to do with our income. So, all our copays are reimbursed by Medi-Cal. There are so other crazy things going on in California with our Early Intervention services that has my head spinning. So all I can say is, we're all in this together!
Emily - I assume you're in Utah, since other commenters have mentioned that state (I'm embarrassed that I don't know where you live!). We're also in a state that provides state Medicaid coverage for ANY child with medical issues, regardless of income. The program here is called Katie Beckett. We're moving to MN and they have something similar called TEFRA, but even though Micah qualifies, we will be paying a fairly high co-pay based on income. We'll wait for our assessment to determine whether we're going to pay it. But I'm with you... we have enough going on. I spend a number of hours each week dealing with medical issues and I HATE dealing with insurance. But I also don't let anything default to the state just because our insurance company decides to pay late, or whatever. We pay good money for our insurance (major employer group plan), and I feel that the Medicaid for Micah should be a last resort. Good luck. I'm sorry you have to deal with this.
Emily- Do you have an early intervention worker that can help you figure out how or who the TEFRA program is run through in your state? I tried to google it and it looks like in your state (Utah right?) it is referred to as the Katie Beckett Program. It is essentially a form of medicaid that is not income based- it gets you the medicaid insurance card. Every state has a version of this- in SC it is called TEFRA, in Wisconsin I know it is also Katie Beckett. It says essentially that your child is at risk for institutionalization except that you are choosing to care for him at home. It is a federally funded program instituted I believe in teh 1980's. You hear people say different things- that the dx is enough for you to qualify and you also hear that you may be denied but keep appealing it b/c the older the child gets and the more involved they get in services (OT/PT/SLP) then the more likely they are to qualify. I don't know which is actual vs fiction though- we are in the middle of the application process for our daughter right now. This is different then applying for SSI- TXVI Social Security though- that is income based. If you need more info then come post a comment on my blog and I'll see if I can help you clarify- if you already know this then sorry for duplicate info- but I didn't think I saw anyone mentioning this in the comments already.
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