Insurance Stinks...

[Ratatosk]

Jennifer,

Do you know any attorneys who might be willing to write a letter to your insurance company indicating that if you do not get home ivs, you will most likely end up in the hospital and that would cost them a heck of a lot more in the long run?

We did this with DS's synagis shots. Insurance wouldn't cover them. A relative who is an attorney wrote a letter indicating costs, plus emotional stress... Within an hour we were approved. Worth a try! L

 

[Ratatosk]

Jennifer,

Do you know any attorneys who might be willing to write a letter to your insurance company indicating that if you do not get home ivs, you will most likely end up in the hospital and that would cost them a heck of a lot more in the long run?

We did this with DS's synagis shots. Insurance wouldn't cover them. A relative who is an attorney wrote a letter indicating costs, plus emotional stress... Within an hour we were approved. Worth a try! L

 

[Jennifer1981]

Hi Liza,

I don't know any attorneys off the top of my head, but I know that if I put my mind to it I could find one.

To be honest, I'm not the type to fight with insurance companies. A few years ago, I did fight with letters, phone calls, and other junk to the insurance companies. I ended up so depressed that I was put on Prozac. I just wanted to end it. It's hard enough living with CF without the BS.

I'd tell other CF'ers in the U.S., not to get married. You get more benefits if you remain unmarried and living with your significant other. It's sad to say, but true. The U.S. rewards you for not marrying.

Jennifer 25 w/CF

 

[Jennifer1981]

Hi Liza,

I don't know any attorneys off the top of my head, but I know that if I put my mind to it I could find one.

To be honest, I'm not the type to fight with insurance companies. A few years ago, I did fight with letters, phone calls, and other junk to the insurance companies. I ended up so depressed that I was put on Prozac. I just wanted to end it. It's hard enough living with CF without the BS.

I'd tell other CF'ers in the U.S., not to get married. You get more benefits if you remain unmarried and living with your significant other. It's sad to say, but true. The U.S. rewards you for not marrying.

Jennifer 25 w/CF

 

[Jennifer1981]

Hi Liza,

I don't know any attorneys off the top of my head, but I know that if I put my mind to it I could find one.

To be honest, I'm not the type to fight with insurance companies. A few years ago, I did fight with letters, phone calls, and other junk to the insurance companies. I ended up so depressed that I was put on Prozac. I just wanted to end it. It's hard enough living with CF without the BS.

I'd tell other CF'ers in the U.S., not to get married. You get more benefits if you remain unmarried and living with your significant other. It's sad to say, but true. The U.S. rewards you for not marrying.

Jennifer 25 w/CF

 

[LouLou]

Jennifer, Are you sure you don't have an out of pocket max? If you do you might consider your plan year start date...say it's Jan. 1 with an out of pocket max of $2500 - well you'd burn through that in your first infusion (in January) and then all year if you needed more care it would be free. Check on this. Also, many plans have two seperate out of pocket maxes... medical and drugs. If you only have one, maybe you could get the bulk of the expense put through the other one. For example, let's say you have no medical OOPM but do have a drug OOPM, you could maybe get your drug coverage to pick up the IV costs and the 'other' costs to go through medical.

Just a thought. I hope you get somewhere with it. Also, your social worker should be able to help you with these negotiations with the insurance co. Although I can't remember if you go to a CF center or not. Take care.

 

[LouLou]

Jennifer, Are you sure you don't have an out of pocket max? If you do you might consider your plan year start date...say it's Jan. 1 with an out of pocket max of $2500 - well you'd burn through that in your first infusion (in January) and then all year if you needed more care it would be free. Check on this. Also, many plans have two seperate out of pocket maxes... medical and drugs. If you only have one, maybe you could get the bulk of the expense put through the other one. For example, let's say you have no medical OOPM but do have a drug OOPM, you could maybe get your drug coverage to pick up the IV costs and the 'other' costs to go through medical.

Just a thought. I hope you get somewhere with it. Also, your social worker should be able to help you with these negotiations with the insurance co. Although I can't remember if you go to a CF center or not. Take care.

 

[LouLou]

Jennifer, Are you sure you don't have an out of pocket max? If you do you might consider your plan year start date...say it's Jan. 1 with an out of pocket max of $2500 - well you'd burn through that in your first infusion (in January) and then all year if you needed more care it would be free. Check on this. Also, many plans have two seperate out of pocket maxes... medical and drugs. If you only have one, maybe you could get the bulk of the expense put through the other one. For example, let's say you have no medical OOPM but do have a drug OOPM, you could maybe get your drug coverage to pick up the IV costs and the 'other' costs to go through medical.

Just a thought. I hope you get somewhere with it. Also, your social worker should be able to help you with these negotiations with the insurance co. Although I can't remember if you go to a CF center or not. Take care.

 

[JennifersHope]

Hi Guys,

Sorry for the delay in responding.. I have been working my butt off.. ( to pay for my presciptions.. HA and UGG all in one)

Liza, I don't have a lawyer to write that type of letter for me, however, my cf clinic is working on some options for me.

The trouble with my insurance that I just found out, my hospital, like a lot of hospitals has their own insurance plan... We are self insured.. what ever that means... So that is why they make us use them.. I have talked to several ppl who have told me that they were able to go out of network when they had to, and that the insurance paid the whole bill..

I don't have a max out of pocket expense for out of network... Just in network... and I always meet that by the end of the first month of January.

this topic makes me so upset.. it just is so wrong that some ppl get help and others don't....I still feel like ppl should not be punished like we all are who have CF and work... I hate injustice.. it is one thing that can turn me into an ugly person.

in the meantime, I continue to see so many ppl day in and day out that are getting free medical care and presciptions.. and Yes I am jealous of that... I could drive a freaken Limo around for the amount of money I pay in medical bills..

Don't get me wrong, I love taking care of all my patients, I never, ever, would want someone not to get medical help, who needs it.. I just wish it was more fair to other ppl who decide not to leech the system.

 

[JennifersHope]

Hi Guys,

Sorry for the delay in responding.. I have been working my butt off.. ( to pay for my presciptions.. HA and UGG all in one)

Liza, I don't have a lawyer to write that type of letter for me, however, my cf clinic is working on some options for me.

The trouble with my insurance that I just found out, my hospital, like a lot of hospitals has their own insurance plan... We are self insured.. what ever that means... So that is why they make us use them.. I have talked to several ppl who have told me that they were able to go out of network when they had to, and that the insurance paid the whole bill..

I don't have a max out of pocket expense for out of network... Just in network... and I always meet that by the end of the first month of January.

this topic makes me so upset.. it just is so wrong that some ppl get help and others don't....I still feel like ppl should not be punished like we all are who have CF and work... I hate injustice.. it is one thing that can turn me into an ugly person.

in the meantime, I continue to see so many ppl day in and day out that are getting free medical care and presciptions.. and Yes I am jealous of that... I could drive a freaken Limo around for the amount of money I pay in medical bills..

Don't get me wrong, I love taking care of all my patients, I never, ever, would want someone not to get medical help, who needs it.. I just wish it was more fair to other ppl who decide not to leech the system.

 

[JennifersHope]

Hi Guys,

Sorry for the delay in responding.. I have been working my butt off.. ( to pay for my presciptions.. HA and UGG all in one)

Liza, I don't have a lawyer to write that type of letter for me, however, my cf clinic is working on some options for me.

The trouble with my insurance that I just found out, my hospital, like a lot of hospitals has their own insurance plan... We are self insured.. what ever that means... So that is why they make us use them.. I have talked to several ppl who have told me that they were able to go out of network when they had to, and that the insurance paid the whole bill..

I don't have a max out of pocket expense for out of network... Just in network... and I always meet that by the end of the first month of January.

this topic makes me so upset.. it just is so wrong that some ppl get help and others don't....I still feel like ppl should not be punished like we all are who have CF and work... I hate injustice.. it is one thing that can turn me into an ugly person.

in the meantime, I continue to see so many ppl day in and day out that are getting free medical care and presciptions.. and Yes I am jealous of that... I could drive a freaken Limo around for the amount of money I pay in medical bills..

Don't get me wrong, I love taking care of all my patients, I never, ever, would want someone not to get medical help, who needs it.. I just wish it was more fair to other ppl who decide not to leech the system.