Health Insurance

[sasha]

This is my first post so be gentle! Ive been on a travel insurance but that is now going to be running out and I cant renew it, I cant get health insurance here on my own so have been advised that it might be better to get a job that offers health insurance. If I can get a job what does it usually cover? will I be able to get all my pump supplies and insulin? Ive been looking on line and see it aint cheap!! In the Uk I was VERY lucky that I got free prescriptions so never paid for any of my medication. (well say free you paid National Insurance!) any advice would be gratefully received:)

[kgm0612]

If I'm correct, you moved from the UK to sunny Florida!

All health insurance plans are different, Sasha. I have United Healthcare through my husband's state job. My plan pays 80% for all my pump supplies and my 300 test strips a month. I have a co-pay of $5.00 for two bottles of Novolog.

Good luck!


Karen

[sasha]

Thanks yep its sunny most of the time! except when some of my family came to visit and I told them to pack there shorts and it rained and was cold well for here anyway! None of the insurance companys will insure me on my own, my partners has his own business but its only small and the cost to insure me tho that is a lot. So looks like im job hunting !

[Siren]

Thanks yep its sunny most of the time! except when some of my family came to visit and I told them to pack there shorts and it rained and was cold well for here anyway! None of the insurance companys will insure me on my own, my partners has his own business but its only small and the cost to insure me tho that is a lot. So looks like im job hunting !

I don't want to sound negative after everyone just noted how positive I usually am, but insurance is one of the biggest rackets in the states. You have what they'll call a pre-existing condition. They will use it to say that you will use services more, and you likely will due to your background; in the UK you have a preventative insurance system. In the US, most people only visit doctors when they're ill (sadly). I have no idea how long you've been here, but I agree that job hunting is likely your best bet right now. Good luck :)

[Aggie06]

I don't want to sound negative after everyone just noted how positive I usually am, but insurance is one of the biggest rackets in the states. You have what they'll call a pre-existing condition. They will use it to say that you will use services more, and you likely will due to your background; in the UK you have a preventative insurance system. In the US, most people only visit doctors when they're ill (sadly). I have no idea how long you've been here, but I agree that job hunting is likely your best bet right now. Good luck :)

Normally, a pre-existing condition clause will only apply if you have a lapse in insurance coverage.

As long as you have insurance, through a job, COBRA, or otherwise, you will be exempt from such clauses.

[Siren]

That's provided you can get care through your employer though and/or don't need supplimental care.

You are right though about group plans.

[thomasb]

im in a similar situation too. Might be moving to the states(LA) in the future with my fiance.
So did I understand correctly that it is harder to get a good, cost effective insurance as i am already diagnosed in my homecountry? Have never had insurance before in the states. Come to think abou it, i am i the precise same situation Sasha!

[Siren]

I didn't mean to imply it's "Hard", just different from what you're likely used to if you're from Europe. I have friends from England that work as nurses, so this is what I'm basing my assessment on; I admit it might be biased. In the US, insurance is basically based on the probability that you will need care; if you're under a group plan, your employer negotiates a price and care model for everyone.

What happens is:

With a group rate, (a PPO, HMO etc), in general, the people you work with mediate the cost. So if you work for say Wachovia, (it's a bank), you can opt for insurance through your work. My mother works for Aetna and has terrible coverage though, so not all businesses are equal coverage-wise, which seems different than England; also, nobody will make you go for your tests. Our system is terrible in preventative, though I've heard many Americans prefer not being told, "You should go for your annual pap" for whatever reason. We work under an accute-care approach.

If you have a pre-existing medical condition, I would generally check out how much you'll be paying for things like co-pays, prescriptions, routine visits, and emergency. You're not obligated to divulge to your perspective employer that you have a condition in the U.S., and I wouldn't.

If you lapse in coverage, need supplimental coverage, or can't find work fast enough, you might be in for some very high bills. This was what I was referring to in my first post.

[It Ain't Over]

One thing to watch out for is if you start a new job, they will usually offer health insurance and will waive any insurabilty exams. If you do not take it up, you may be subject to those insurablity exams later, and that is when you could have the health insurer refuse the prior condition treatments.:eek:
Make sure to ask a lot of questions when you get to that, and be carefull about not taking on the group coverages.

[notme]

You can avoid most of these problems if you can find employment through a large organization or company. Many small companies cannot afford to offer insurance to their employees. Pre existing generally does not apply if you are offered "group" insurance.

Each employer and organization offer different plans to their employees. Sometimes you are given several choices of plans. If that is the case then you need to choose wisely. If you don't understand, then contact human resources and make sure you understand before agree to a plan.

Individuals that offer employment will not offer you any insurance. With diabetes, the only choice you have is group insurance.

Good luck in your search. I hope you are able to find a job with great benefits.

[labob]

A large part of the reason why the health care system in the U.S. is broken (and I say this as a defense lawyer who has represented insurance companies) is because if you have a chronic or pre-existing condition, such as diabetes, your only realistic option for coverage is through a group plan offered through your employer. If you sign up immediately upon hire, you cannot be denied coverage for pre-existing conditions.

Note that this means that you must work for an employer that offers health care coverage and that you must go on your employer's plan as soon as you begin working. There are a couple of problems with this system: first, the social compact that we used to have that basically said "if you work full time, you and your dependents will be covered" is a thing of the past for many as an increasing number of employers do not offer health plans to their employees. Second, self-employed people, even those who used to be able to get health insurance through professional guilds and associations (such as writers, real estate agents, etc.), are finding that the rates they are charged are becoming cost-prohibitive. I have a friend who is a professional writer with a number of books available at any Borders or Barnes & Noble store. His insurance through the Writers' Guild costs him over $2,000 every three months (and that doesn't count co-pays, etc. -- that's just the cost of the plan). Even with that high rate, he can't move out of state because the guild's coverage is available only in a select few states.

And unless you're in your twenties with no pre-existing conditions or any medical history at all, getting individual coverage is close to impossible. Even if you do get coverage, you may be dropped as soon as you become ill. That's theoretically against the law, but it happens. Just ask the Insurance Commissioner in California: a large insurer was recently fined for doing just that.

Sorry to vent, but it really distresses me that we in the U.S. spend more money per capita on health care than just about anywhere else in the world (I think we are number one in that regard) and still can't manage to figure out how to come up with universal coverage, which many other countries take for granted. If you're among the lucky who have insurance, you have nothing to worry about (unless, of course, you move or lose your job). If you're among the 15% of the population without insurance, good luck. (And that 15%, by the way, does not include children and the poorest of the poor, because they have coverage through the state -- we're talking about working adults.)

It's grotesque and irrational. But to return to the original point, if your employer offers health insurance, you cannot be denied coverage if you sign up as soon as it becomes available to you, which is usually immediately upon hire.

[sweetcheeks]

you cannot be denied coverage if you sign up as soon as it becomes available to you, which is usually immediately upon hire.

question..

everytime ive switched jobs, they throw this prexisting condition my way and was just screwed for a complete year.

is their away around this? being that i signed up with them from the get go??

[labob]

Thanks for giving me the opportunity to correct myself -- I should avoid making generalities. It's apparently the case that the law in various states differs regarding denial of coverage for pre-existing conditions; it may even be dependent on the contract that your employer negotiates with an insurer. All of which is further evidence that our health care system is not working -- why on earth would anyone think it's OK to deny coverage for a condition just because someone changed jobs?

That said, in California, where I live, at least for the large employers for whom I've worked, it is the case that coverage is immediate and cannot exclude coverage for pre-existing conditions. The rules for different states and different employers' contracts may vary.

[Cyborg]

In Florida, pre-existing condition rules do apply and if you are without insurance there is a 1 year waiting period without coverage of that condition, even with group insurance plans. If you lose your job, try to pay for the COBRA...

[KritterMom]

Hi, and welcome to the group!:)

[Maddogg]

I've been trying to get health insurance with the Trillium insurance group (some of you canucks have heard of it or have it themselves) for over 6 months and they've denied my application 3 times already. They're representatives are always giving me a hard time and its just been dragging on forever. I always have the feeling they're not doing anything to mitigate the issue and just trying to come out with new excuses or reasons to deny me.

I've been paying full price for my meds for almost a year now... If I have all the receipts and paperwork can I still use those to get some kind of compensation if I do get health insurance in the near future?

Anyway, I won't have to worry about those Trillium douchebags since I'll soon be eligible for the health insurance with my employer so at least I'll start saving a bit more money...

[sasha]

Thanks for all your advice :)