United Healthcare/MAMSI

[CowTown]

Okay, so my husband's new job is offering United Healthcare/MAMSI, which is a PPO plan. I'm trying to search all this on their web site but feel so much pressure right now because we are supppose to be reviewing this and then he signs.

Any have this insurance?

Is PPO good or do you typically want HMO?

I never can grasp these insurance stuff. It's so confusing. Is there a rule of thumb on PPOs or do I just need to look more deeply? This may take a while to understand.

Thanks.

 

[EnergyGal]

Sounds great to me. My husband had united health and they were awesome to me. they gave me four thousand dollars for my transplant expenses when I traveled to a transplant center for an evaluation and paid for my transplant operation (not all but most of it) I also had medicare.

 

[becca23]

I had United Healthcare several years ago it was wonderful. I would just check into the deductible and copays and see how high they are? I know they payed for all of my medicine. HMO are awesome if you know how to work the system but PPO are preety easy to. Good Luck. It pretty much suck that we have to decide on a job based on insurance. I absoulutly hate it. Do you qualify for any kind of help. Like I would qualif for Medically Handicapped Childrens Program but I ould have a spin down and it is more than my deductible on my ins.

 

[CowTown]

Can you pick your own specialists with United Healthcare?

And your own hospital to tune ups?

 

[lovingBenandCambree]

I am not sure what MAMSI is, but I have had some difficulty with my United healthcare due to the fact that they are IHC and the accredited CF center is not IHC, it is actually giving me a huge headache right now. I would just make sure that the center you will be seen at is accepted by your insurance as In-Network. Good luck, I know it is scary to make such life changes.

 

[LisaV]

I don't know anything about MAMSI.

Is the policy a standard UHC policy or is the policy a special one written by the hiring company and managed by UHC?

We had my company's PPO which was managed by UnitedHealthcare. The PPO was good because we got to go to specialists without needing prior approval as we would have with the company's HMO.

If there are innetwork and outofnetwork physicians, you'll want to see if the docs and hospitals you use now are in network.
Also what your copays are.
What the deductibles are
What the lifetime limit is (maybe).

 

[miesl]

Questions...

Out of pocket maximum per person and per family?
Lifetime Maximum?
Deductable?
Rx coverage? What is covered (and what is formulary), and what are the copays? Can you use a mail order pharmacy?
What is the coverage level for doctor visits, lab work, hospital stays, home health care (IVs)?
Is your doctor in network?

Most importantly - is there a pre-existing condition clause?

Opinions on the company... UHC has been f*cking with me lately on my appendectomy. It's really, really starting to tick me off. They're denying half of my claims (preexisting condition bs - urrr?), and I am extremely unhappy. Customer service has been hit and miss (mostly miss), and again - unhappy.

 

[folione]

My son w/CF is 3 and I had a MAMSI family plan from his birth until this past January. I'd imagine there are many versions; mine was through the Federal government. It was a decent plan overall with no more than an occasional hassle getting things paid for.

We've moved to a different insurance plan because mamsi was only going to pay 50% for the vest and I went to a plan that paid 100% - but like I said, the specifics of copays, etc. probably varies from plan to plan within what mamsi offers

 

[CowTown]

Okay so that was a whirlwind and quite the learning process this past hour.

I have asked just about all these questions listed above...so thank you so much for all these heads ups.

This sounds like a good deal. Anything InNetwork is paid 100% (so this means my hospital stays and home health care). Anything out-of-network is covered 80/20 (and with a secondary GHPP, they should cover the rest). I'm unclear as to whether my doctors are InNetwork, need to find that out. Meds are covered by participating pharmacies on tiers of brands/generic. The most I'd pay for med copays sounds like would be $35 for brand names.

There is NO pre-existing conditions clause since it is a group policy. yipee.

lifetime max = $1 million
out of pocket max = $2,600/year
deductible = $600/person per year


Sounds good right?

I think I've covered everything. Thanks for all your help!

 

[NoExcuses]

good news. I had united for two years.

but since it's through a company, EVERYTHING varies. the company that your hubby works for contracts with United for how much employees will pay. so it will vary comapny to company.

My out of pocket max was $2000/year and there was no deductible. all meds were $10 no matter if they were brand or whatever. But that doesn't have to do with United - my company contracted that with united if that makes sense.

Rao is in network with United so you should be good <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[NoExcuses]

oh ya and make sure you DON'T chose HMO. PPO all the way.

 

[Giggles]

I ALWAYS pick PPO's because you then have an out of network benefit. In case your docs or hospitals drop out of the network you then can still go to them and get coverage but it would be out of network coverage which has higher deductibles etc but at least it pays something. I NEVER pick HMO's they scare me because of all the care you have to coordinate with a primary and if that doc is not good about referring you to your CF doc then you got big problems. Also, I am always scared that my doc and hospital will drop out of network this has happen many times, especially with United Healthcare recently so I ALWAYS pickPPO's so I have options and I can just go see my doc with out coordinating with ill informed primary care docs.

This is just my experience but HMO's are tightly regulated and I just am to scared to deal with it, although they pay typically 100% of everything and cheaper to the employee.

Good Luck!
Jennifer 34 years old with Cf and CFRD

 

[Giggles]

Also, make sure you have certificates of creditable coverage in case you need them for any pre-x waiting periods. I think you mentioned there was none so if that is the case great.

Otherwise you would have to show 12 month of insurance coverage with no breaks to over rule the pre-X clause. I just had to do this myself so it made me think of it!


Jennifer 34 years old with Cf and Cfrd

 

[Momto3]

My concern with your particular coverage is the lifetime maximum.
 $1 million sounds like a lot of coverage but can actually be
used up pretty quickly... especially with medicines that cost in
the hundreds/thousands per month, cost of hospitalizations, etc.
 Not to mention the cost of transplant if you choose that
option when the time comes...  Otherwise, the coverage does
sound much better than average coverage.

 

[CowTown]

Good point momto3. It's confusing but I asked about that and I think what she said was that lifetime max of 1million includes the annual deducitbles, and out pocket expenses, not the actual price tags for each medication and hospital stay year after year. Do you think? Or IS that like the gross amount all my stuff year after year? I'm not sure.

They say the open enrollement to add or change dependants to the policy is February of every year, but I'm thinking he can just add me on when he's hired. He'll start covered after 1 month of working there, and I hope my name can be included at that time too. I'm not sure.

 

[sdelorenzo]

I have united healthcare ppo. We used to have Aetna HMO. I loved the HMO and now the ppo causes some problems. It really has to do with the company you work for and how much money they want to spend on healthcare. My husband did work for a large company with the HMO so almost everything was covered. Now he is with a very small company and we have a lot more expenses when it comes to my kids care. Just check with your company, they should be able to answer some of your questions.
Sharon, mom of Sophia, 4 and Jack, 2 both with cf

 

[sdelorenzo]

I have united healthcare ppo. We used to have Aetna HMO. I loved the HMO and now the ppo causes some problems. It really has to do with the company you work for and how much money they want to spend on healthcare. My husband did work for a large company with the HMO so almost everything was covered. Now he is with a very small company and we have a lot more expenses when it comes to my kids care. Just check with your company, they should be able to answer some of your questions.
Sharon, mom of Sophia, 4 and Jack, 2 both with cf

 

[NoExcuses]

Kell, I have been on Blue Cross my whole life (since before I was diagnosed), which has a lifetime maximum of $1 million. Even with all my doc visits, 2 surgeries, 6 hospitalizations and all my meds, I haven't reached that threshold.

If you ever do, your hubby can always switch jobs and get a different insurance. Not idea, but definitely possible.

 

[CowTown]

It's good to know that what I think this company has lined up and what they have invested in their employee's benefits should work for CF stuff. It's so confusing how every situation is different. I see that you can't really make any blanket statements about one insurance carrier since there are so many variables. What a pain in the butt.