Insurance Issues

[wsieving]

I am so frustrated right now I could scream!!! My husband is a truck driver and makes a pretty good living that way, well enough for me to stay at home (oh bless him). But he had to have shoulder surgery for a work related injury at the very end of July. He has been at home ever since, doing physical therapy, and drawing workman's comp. We can still live on what work comp gives him, but it is tight. We still have to pay his insurance premiums out of that, plus put money back in the savings, put back bill money, then live through the week on the rest.

Well, we pay 75 a week to keep his company insurance active. They raised their premiums this year, and raised copays along with it. Used to be 20 for doc visit, 35 for specialist, 100 for ER, and we paid around 60 a week for family coverage. Now it is 55 to see a specialist. So we were really freaking out, not knowing how many visits DD was going to need, already dipping into savings for several of her pediatrician visits leading up to see the specialist. On top of all of that we know that we are going to have to spend a boat load of money on gas because the specialist is 2 hours away, and our van gets really crappy gas mileage. But we have savings, and were going to make it work.

My Mom suggested that we try to get her on Medicaid. I told her we probably didn't qualify, and that I didn't think that kids who already had insurance would be approved anyway. Well, she insisted that I go apply, that all they could say is no, and if they said yes it would be a huge help. So I went, and to my surprise, they allow it as a secondary insurance meaning they pick up everything my primary doesn't including copays. I was so ecstatic! My caseworker told me her insurance should be effective September 1 which is great because her appt is this coming Friday.

Well, I got a letter in the mail today. I guess I gave to much information at the Medicaid office. I told them what she was needing a specialist for and when her appointment was. Wouldn't you know the letter I got in the mail says her coverage is effective 9/20/08..... her appointment is 9/19/08!!!! I had a nice little pity party for myself, and sucked it up. I just don't understand why these insurance companies have to be so cold hearted.

There was a number on the paper so I called it requesting an earlier date. They said it would take two weeks to move up her date, and that if I wanted to do that then I need to reschedule her appointment... I told her there was no way I could do that, I've already waited 3 weeks to get her in, and she was just weighed a few days ago and lost another couple of ounces. She said that DD should have straight Medicaid until then and that I should have received a card already for that. Which I don't have a card, and don't expect I'll be getting one.

It is just so frustrating because I really had to suck up my pride to even go in there, and then I get treated like I'm begging for handouts in the process. I just hope that I do not have any trouble getting them to cover any additional appointments with the specialist. I guess if that is the case, we'll just have to do what we can, our daughter is what is important here.

Sorry for the long rant, but I really needed to vent.

[mftnchn]

I've just had a summer from H__ dealing with insurance about my own stuff, so I can totally relate. Its to the point that any email about bills or insurance claims triggers anxiety and physical symptoms.

The next thing you know, your appointment and diagnosis on the day before will be used to exclude a prior condition! Maybe you better check on that...

Oh, also I found that the billing office of the various providers are sometimes really helpful and call insurance for you; you might check on that too.

[ravenwoodglass]

Check back with Medicaid. They will at times make coverage retroactive and they should cover the appointment. If you have not yet gotten a card call the office and find out why. There are sometimes different levels of coverage and if your insurance has dropped her that would qualify as an emergency need and may get the card or at least the coverage available sooner.

[debmidge]

I am so frustrated right now I could scream!!! My husband is a truck driver and makes a pretty good living that way, well enough for me to stay at home (oh bless him). But he had to have shoulder surgery for a work related injury at the very end of July. He has been at home ever since, doing physical therapy, and drawing workman's comp. We can still live on what work comp gives him, but it is tight. We still have to pay his insurance premiums out of that, plus put money back in the savings, put back bill money, then live through the week on the rest.

Well, we pay 75 a week to keep his company insurance active. They raised their premiums this year, and raised copays along with it. Used to be 20 for doc visit, 35 for specialist, 100 for ER, and we paid around 60 a week for family coverage. Now it is 55 to see a specialist. So we were really freaking out, not knowing how many visits DD was going to need, already dipping into savings for several of her pediatrician visits leading up to see the specialist. On top of all of that we know that we are going to have to spend a boat load of money on gas because the specialist is 2 hours away, and our van gets really crappy gas mileage. But we have savings, and were going to make it work.

My Mom suggested that we try to get her on Medicaid. I told her we probably didn't qualify, and that I didn't think that kids who already had insurance would be approved anyway. Well, she insisted that I go apply, that all they could say is no, and if they said yes it would be a huge help. So I went, and to my surprise, they allow it as a secondary insurance meaning they pick up everything my primary doesn't including copays. I was so ecstatic! My caseworker told me her insurance should be effective September 1 which is great because her appt is this coming Friday.

Well, I got a letter in the mail today. I guess I gave to much information at the Medicaid office. I told them what she was needing a specialist for and when her appointment was. Wouldn't you know the letter I got in the mail says her coverage is effective 9/20/08..... her appointment is 9/19/08!!!! I had a nice little pity party for myself, and sucked it up. I just don't understand why these insurance companies have to be so cold hearted.

There was a number on the paper so I called it requesting an earlier date. They said it would take two weeks to move up her date, and that if I wanted to do that then I need to reschedule her appointment... I told her there was no way I could do that, I've already waited 3 weeks to get her in, and she was just weighed a few days ago and lost another couple of ounces. She said that DD should have straight Medicaid until then and that I should have received a card already for that. Which I don't have a card, and don't expect I'll be getting one.

It is just so frustrating because I really had to suck up my pride to even go in there, and then I get treated like I'm begging for handouts in the process. I just hope that I do not have any trouble getting them to cover any additional appointments with the specialist. I guess if that is the case, we'll just have to do what we can, our daughter is what is important here.

Sorry for the long rant, but I really needed to vent.

Note to all: I don't know what state in US you are in, keep in mind that not all doctors take Medicaid patients. Just to be safe, call the doctor to see if he/she accepts Medicaid.

More and more doctors are turning away Medicaid (here in NJ).

Here in NJ, all the doctors which take Medicaid are in the inner cities and perhaps only a handful of them are probably competent.

I am sure everything will work out in the meanwhile and hubby will be back at work and doing fine. I have had shoulder surgery and know how long and painful the physical therapy portion is. Best wishes. D.

[wsieving]

Ok, well I guess I was getting excited over nothing. It is so hard to really freak when there is a glitch and you are already stressed out over a sick child. I called Children's Mercy today and spoke with someone who assured me that even without a card if her Medicaid was approved that she would be covered. So thank God we should be ok. We would have made it work even if we only had our primary insurance, but it is going to be so much easier without having to worry about the horrid copays.

I really hate the new way that Missouri handles medicaid. I suppose that if I were used to it, the new system wouldn't bother me, but it is so confusing now with the different branches of care. Thanks for listening to me rant!

[debmidge]

Ok, well I guess I was getting excited over nothing. It is so hard to really freak when there is a glitch and you are already stressed out over a sick child. I called Children's Mercy today and spoke with someone who assured me that even without a card if her Medicaid was approved that she would be covered. So thank God we should be ok. We would have made it work even if we only had our primary insurance, but it is going to be so much easier without having to worry about the horrid copays.

I really hate the new way that Missouri handles medicaid. I suppose that if I were used to it, the new system wouldn't bother me, but it is so confusing now with the different branches of care. Thanks for listening to me rant!

As long as you have Medicaid approval but I thought you had a coverage "start date" issue?

Here in NJ (my 87 yr old mother in law is on full Medicaid) most doctors who still take full Medicaid are in

the areas of the inner cities where there are drug dealers, shoot outs, robberies, etc.

My SIL who cares for her mother refuses to drive into those areas and I don't blame her.

My MIL's primary care doctor refuses to take Medicaid and HMO's too. His practice is

in a wealthier area of NJ (he used to be a few blocks from my MIL for many years and he

moved up into the hills).

I had a shoulder injury: torn totator cuff...Is that what your husband ended up with too?

Hopefully your husband will be back to work soon - most workers' compensation insurance

companies require the employer to put the person back to work asap (on a job that would

be compatible with their injury/illness until they have a full recovery). These are

mandatory "return to work programs" . Your husband may want to look into that with his

employer as he'll get a partial workers' compensation payment and pay from his

company and it'll be like he's back to work. Then you will not have to worry so much

and deal with govt. programs.

I must have missed your info, but how often does baby need to see pediatrician?

[wsieving]

As long as you have Medicaid approval but I thought you had a coverage "start date" issue?

See, this is what is so confusing and complicated about the new way Missouri Medicaid is. There is straight Medicaid, which mostly nobody has, then once you are approved you have to choose one of 3 or 4 difference insurance carriers (Health Care USA, Mercy Care, Missouri Care, and I think maybe another), and then they give you another effective date. It is a huge mess, and I really think they are heading in a good direction, but need to improve it before it is truly better than the old system.

Here in NJ (my 87 yr old mother in law is on full Medicaid) most doctors who still take full Medicaid are in

the areas of the inner cities where there are drug dealers, shoot outs, robberies, etc.

My SIL who cares for her mother refuses to drive into those areas and I don't blame her.

My MIL's primary care doctor refuses to take Medicaid and HMO's too. His practice is

in a wealthier area of NJ (he used to be a few blocks from my MIL for many years and he

moved up into the hills).

This is a real shame. We have to be really careful which company we choose here because now that there are 3 or 4 branches of our version of Medicaid most docs only take one, while another doc you need to see may take another. I will be so glad when our government finally makes a way for people that truly need help to be able to get it and use it when they need to.

I had a shoulder injury: torn totator cuff...Is that what your husband ended up with too?

Hopefully your husband will be back to work soon - most workers' compensation insurance

companies require the employer to put the person back to work asap (on a job that would

be compatible with their injury/illness until they have a full recovery). These are

mandatory "return to work programs" . Your husband may want to look into that with his

employer as he'll get a partial workers' compensation payment and pay from his

company and it'll be like he's back to work. Then you will not have to worry so much

and deal with govt. programs.

DH had a distal clavicle resection with decompression, otherwise known as the Mumford procedure. Basically his clavicle bone was digging into his rotator cuff, doc said another couple of months and it would have been torn b/c it was really swollen and hemoraging. So they sawed off the tip of his clavicle bone and removed burrs. He was really lucky because they sent him to a surgeon who was skilled enough to do this the arthroscopic way instead of going in with a scalpel. This cuts down on his recovery time, but we still have at least another month of physical therapy. He is a truck driver, but the dedicated route he was on required him to unload his trailer at every stop. Since he has physical therapy 3 times a week, there isn't even an option for light duty anyway (his home office is 2 hours away, so couldn't even do office work), and if he were only driving or doing office type work, he would be making less than he does on work comp. Our biggest struggle here is that we are living on his income alone. He has always made really great money over the road, so I have been so blessed to be able to stay home. It is very important to us that our kids do not have to go to daycare. I know this isn't everybody's ideal lifestyle, but it is what we are comfortable with, and until he was hurt at work, we never required anyone's help or government assistance to make ends meet. I have tried to get temporary work while he is at home, but nobody around here wants to hire someone as temporary as I need the job to be. So we're kind of stuck, but hopefully at his next doc appt he will be released to full duty.

I must have missed your info, but how often does baby need to see pediatrician?

She only sees him once per month, but we went through a stretch before getting her specialist referral that she was going weekly. We won't know until Friday how often our trips to KC are going to be. I've never been through anything like this before and really do not know what to expect.

[sarabmore]

I feel your pain on this! My employer does not offer health insurance. I have been on COBRA for the past 18 months. My coverage expires in October. I have been shopping around for insurance for quite some time. If I went to the state, I would pay $500 a month! I have a pre-existing condition (hypothyroid) and that makes it IMPOSSIBLE to get insurance on your own. I was paying $280 a month on COBRA, but it was good coverage. Now, I applied to Aetna. In order to have them, I have to choose a high deductible and I will not be covered for thyroid visits for 6 months. Other company's denied me without even giving me a chance to apply. I am 23 years old and I can't find insurance that is afforable. I am a college student and I live on my own and pay for my own school. I think it is crazy that I can not find someone to cover me. I sent my money and application into Aetna on September 1st and I have not heard anything from them. I am counting on being denied. A young girl with thyroid conditions and celiac disease. Too much of a risk. Heartless.

I am so frustrated right now I could scream!!! My husband is a truck driver and makes a pretty good living that way, well enough for me to stay at home (oh bless him). But he had to have shoulder surgery for a work related injury at the very end of July. He has been at home ever since, doing physical therapy, and drawing workman's comp. We can still live on what work comp gives him, but it is tight. We still have to pay his insurance premiums out of that, plus put money back in the savings, put back bill money, then live through the week on the rest.

Well, we pay 75 a week to keep his company insurance active. They raised their premiums this year, and raised copays along with it. Used to be 20 for doc visit, 35 for specialist, 100 for ER, and we paid around 60 a week for family coverage. Now it is 55 to see a specialist. So we were really freaking out, not knowing how many visits DD was going to need, already dipping into savings for several of her pediatrician visits leading up to see the specialist. On top of all of that we know that we are going to have to spend a boat load of money on gas because the specialist is 2 hours away, and our van gets really crappy gas mileage. But we have savings, and were going to make it work.

My Mom suggested that we try to get her on Medicaid. I told her we probably didn't qualify, and that I didn't think that kids who already had insurance would be approved anyway. Well, she insisted that I go apply, that all they could say is no, and if they said yes it would be a huge help. So I went, and to my surprise, they allow it as a secondary insurance meaning they pick up everything my primary doesn't including copays. I was so ecstatic! My caseworker told me her insurance should be effective September 1 which is great because her appt is this coming Friday.

Well, I got a letter in the mail today. I guess I gave to much information at the Medicaid office. I told them what she was needing a specialist for and when her appointment was. Wouldn't you know the letter I got in the mail says her coverage is effective 9/20/08..... her appointment is 9/19/08!!!! I had a nice little pity party for myself, and sucked it up. I just don't understand why these insurance companies have to be so cold hearted.

There was a number on the paper so I called it requesting an earlier date. They said it would take two weeks to move up her date, and that if I wanted to do that then I need to reschedule her appointment... I told her there was no way I could do that, I've already waited 3 weeks to get her in, and she was just weighed a few days ago and lost another couple of ounces. She said that DD should have straight Medicaid until then and that I should have received a card already for that. Which I don't have a card, and don't expect I'll be getting one.

It is just so frustrating because I really had to suck up my pride to even go in there, and then I get treated like I'm begging for handouts in the process. I just hope that I do not have any trouble getting them to cover any additional appointments with the specialist. I guess if that is the case, we'll just have to do what we can, our daughter is what is important here.

Sorry for the long rant, but I really needed to vent.

[debmidge]

This is a real shame. We have to be really careful which company we choose here because now that there are 3 or 4 branches of our version of Medicaid most docs only take one, while another doc you need to see may take another. I will be so glad when our government finally makes a way for people that truly need help to be able to get it and use it when they need to.

You're right, that's confusing......

I had a shoulder injury: torn totator cuff...Is that what your husband ended up with too?

Hopefully your husband will be back to work soon - most workers' compensation insurance

companies require the employer to put the person back to work asap (on a job that would

be compatible with their injury/illness until they have a full recovery). These are

mandatory "return to work programs" . Your husband may want to look into that with his

employer as he'll get a partial workers' compensation payment and pay from his

company and it'll be like he's back to work. Then you will not have to worry so much

and deal with govt. programs.

DH had a distal clavicle resection with decompression, otherwise known as the Mumford procedure. Basically his clavicle bone was digging into his rotator cuff, doc said another couple of months and it would have been torn b/c it was really swollen and hemoraging. So they sawed off the tip of his clavicle bone and removed burrs. He was really lucky because they sent him to a surgeon who was skilled enough to do this the arthroscopic way instead of going in with a scalpel. This cuts down on his recovery time, but we still have at least another month of physical therapy. He is a truck driver, but the dedicated route he was on required him to unload his trailer at every stop. Since he has physical therapy 3 times a week, there isn't even an option for light duty anyway (his home office is 2 hours away, so couldn't even do office work), and if he were only driving or doing office type work, he would be making less than he does on work comp. Our biggest struggle here is that we are living on his income alone. He has always made really great money over the road, so I have been so blessed to be able to stay home. It is very important to us that our kids do not have to go to daycare. I know this isn't everybody's ideal lifestyle, but it is what we are comfortable with, and until he was hurt at work, we never required anyone's help or government assistance to make ends meet. I have tried to get temporary work while he is at home, but nobody around here wants to hire someone as temporary as I need the job to be. So we're kind of stuck, but hopefully at his next doc appt he will be released to full duty.

I must have missed your info, but how often does baby need to see pediatrician?

She only sees him once per month, but we went through a stretch before getting her specialist referral that she was going weekly. We won't know until Friday how often our trips to KC are going to be. I've never been through anything like this before and really do not know what to expect.

I had burr removal during my rotator cuff surgery too. The surgery and after surgery wasn't painful but the physicla therapy was. I went back to work after two weeks but I do office work, but I was able to drive my car back and forth, but it was a 30 minute drive. The length of the drive is important too. I hope your husband can go back to his work even when he's healed. That lifting could be too much on his shoulder - when I carry too much or have to yank at file folders in file cabinet at work my shoulder hurts.....

It would have been a great idea if the employer could put him on "office" duty during the Physical therapy time. The employer is not supposed to pay an injured employer less money while they are on "lite duty" - that's the point of the employer having a "back to work" program. It's supposed to be partial WC payment and the employer is to make up the difference. Now don't quote me, but that's a NJ WC law; I don't know about your state. The Missouri State Dept. of Insurance could tell you what the law is. My Physical Therapy took 6 months - which was longer than normal. We are a one-income household too, but no children. My husband's celiac & other health problems keep him from working.

Thought for the future: if you need a temp job, never tell employer just how long you need the job. PM me if you wish to talk about this strategy. Another consideration if your huband cannot ever go back to truck driving again: start a business from home --one that you and your husband can do as a team (if that's what you want). This way you can work from home and he can do the "foot" work that will need to be done (visiting customers, etc.).

[wsieving]

A home business would be AWESOME! I am thinking of getting into photography when we get income tax. I really have an eye for it, and it is the only thing I can see myself being happy doing from home. I know there are a lot of people who do this, but I am hoping I can come up with a unique kind of service that other photographers do not offer. I doubt it would bring in enough revenue for him to stay home too though. Who knows, but I am still eager to try.

[buffettbride]

I am a college student and I live on my own and pay for my own school. I think it is crazy that I can not find someone to cover me. I sent my money and application into Aetna on September 1st and I have not heard anything from them. I am counting on being denied. A young girl with thyroid conditions and celiac disease. Too much of a risk. Heartless.

If you are a student, shouldn't your college have a student health plan?

[Jestgar]

It is just so frustrating because I really had to suck up my pride to even go in there...

I just want to point out, that as a taxpayer who ends up paying for the under-insured, YOU ARE DOING ME A FAVOR BY GETTING MEDICARE. The only pride involved here is you being proud enough to take the extra steps here to keep your family healthy, and out of the emergency room.

[debmidge]

A home business would be AWESOME! I am thinking of getting into photography when we get income tax. I really have an eye for it, and it is the only thing I can see myself being happy doing from home. I know there are a lot of people who do this, but I am hoping I can come up with a unique kind of service that other photographers do not offer. I doubt it would bring in enough revenue for him to stay home too though. Who knows, but I am still eager to try.

...my favorite are the specialty photography studios which let you "dress up" in costumes for photos. I like "period costumes." But you could include rock star costumes (with display-type musical instruments) - that would appeal to young and the "young at heart."

You'd have to compete with the "baby photo studios" by taking photos of children on their birthdays from the youngest age new born. It could be a novelty in that the parents would have a whole album of that child of their child of what they looked like every year - on their birthday (except perhaps original date of birth). You'd send them a postcard about 8 weeks before their birthday -- Or every Autumn for Halloween costmes (or traditional Christmas photo). Some quirky angle is needed.

A friend of mine is divorced and supported her 4 children by selling window treatments from home. This would be blinds/shades and curtains/drapes. Her mom would babysit while she was out selling in people's homes and she'd send an installer to put the stuff up. Of course she had to have full insurance. Eventually she wound up doing businesses as well as residential work. It worked for her. If her husband & her stayed married, he'd be doing the installation or at least be home to watch the children while she was out selling. That's how they handled it when they were married.