After calling the insurance company every few days, finally I got an "answer" from someone. She said "I see the form in your file and it has not been rejected." I asked what that meant, and she said that it meant Shawn was covered. "Not rejected" didn't sound quite good enough to me, so I asked if I would be getting a letter to that effect. She said to expect a letter in the next 5-7 days. Sure enough, 5 days later a letter appeared. Unfortunately, it did not say what I was told; in fact it said exactly the opposite - that the Shawn does not qualify for continuation of coverage. It is their determination that he is capable of self support and therefore not eligible for coverage unless he is a full time student.
This can be appealed, and we're working on that. Meanwhile, it turns out that prior to this decision, he was being covered by them in January and February, so he is now eligible for COBRA from my new insurance company. And because the event is a loss of dependent eligibility, he is entitled to 36 months of COBRA, rather than the 18 months from IBM. (The event for IBM was not loss of status, it was loss of coverage, which has different time limits).
So for now, we're switching COBRA from one policy to another, and if nothing else we'll at least have that for the next three years, until he turns 24. Hopefully between now and then something will change for the better - his health or our country's insurance situation - is it too much to hope for BOTH of these?
Thursday, February 25, 2010
Tuesday, February 2, 2010
National Donor Day - February 14
I have a friend who recently had a liver transplant. Through him and his family I've seen just how horrific it is to be waiting for an organ. I hope no one reading this ever has to go through such an experience. But whether or not it is someone we know, it's certain that this same horrible wait is being experienced by countless other families.
So I'd like to use this space to tell everyone about National Donor Day:
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As National Donor Day approaches, visit OrganDonor.gov to learn about donating organs, tissue, marrow, blood, and other life-saving matter.
If you would like to become a donor, fill out an organ and tissue donation card, register with your State Donor Registry, and convey your wishes to your family. To donate blood, visit the Red Cross and find a donation site near you.
Monday, February 1, 2010
insurance worries once again
Once again, I'm not sure exactly what will happen with insurance for Shawn. The one big hesitation about taking this new job was whether I'd be able to insure Shawn who is over 19 and not a full time student.
In Illinois, this is not a problem - but the Illinois law (which lets a parent insure any dependent up to the age of 26) doesn't apply to policies that are not written in Illinois. And my company is based in California, not Illinois.
In December, I was told that we'd most likely get insurance by considering him a disabled dependent. We promptly filled out their form and were told that were this submitted by a member it would be accepted, but will have to be resubmitted once you sign up. That, plus the knowledge that at the very least we have COBRA for 18 months, plus the outside hope that SOMETHING would change with regard to health care in the US in those 18 months, made me decide to go for it.
>But now here we are, last year's insurance carrier has been replaced by a new group of carriers, I've signed up for one and submitted new paperwork, and I'm waiting to hear their decision as to whether they will cover him. I call every few days - first to make sure the paperwork was received (which they couldn't verify until two days after it was faxed, as it has to first "get into the system"). Then to verify that it's been filled out correctly and there is nothing else they need from either me or Shawn's doctor. Then to find out the status which for the last few weeks has been "they are processing it." On Thursday I was told that they should have an answer in the next week or so and that if they deny the dependent they will refund the premiums. But of course it's not the premiums I'm worried about, it's the INSURANCE.
I hear lots of pros and cons about the health care bill: "it's not perfect", "it doesn't contain X", "it contains Y which I disagree with".... but I suspect none of those that are against it are sitting around worrying if they or their family will be insured. And now it seems to be more about whether the Republicans or Democrats will "win" and seems to have nothing to do with the people who are denied insurance because they are in the position of needing it.
From where I sit right now, I care less about finding the perfect solution and more about finding ANY solution that will allow me to have the peace of mind to concentrate on finding a diagnosis for my son rather than worry about how to keep him insured.
In Illinois, this is not a problem - but the Illinois law (which lets a parent insure any dependent up to the age of 26) doesn't apply to policies that are not written in Illinois. And my company is based in California, not Illinois.
In December, I was told that we'd most likely get insurance by considering him a disabled dependent. We promptly filled out their form and were told that were this submitted by a member it would be accepted, but will have to be resubmitted once you sign up. That, plus the knowledge that at the very least we have COBRA for 18 months, plus the outside hope that SOMETHING would change with regard to health care in the US in those 18 months, made me decide to go for it.
>But now here we are, last year's insurance carrier has been replaced by a new group of carriers, I've signed up for one and submitted new paperwork, and I'm waiting to hear their decision as to whether they will cover him. I call every few days - first to make sure the paperwork was received (which they couldn't verify until two days after it was faxed, as it has to first "get into the system"). Then to verify that it's been filled out correctly and there is nothing else they need from either me or Shawn's doctor. Then to find out the status which for the last few weeks has been "they are processing it." On Thursday I was told that they should have an answer in the next week or so and that if they deny the dependent they will refund the premiums. But of course it's not the premiums I'm worried about, it's the INSURANCE.
I hear lots of pros and cons about the health care bill: "it's not perfect", "it doesn't contain X", "it contains Y which I disagree with".... but I suspect none of those that are against it are sitting around worrying if they or their family will be insured. And now it seems to be more about whether the Republicans or Democrats will "win" and seems to have nothing to do with the people who are denied insurance because they are in the position of needing it.
From where I sit right now, I care less about finding the perfect solution and more about finding ANY solution that will allow me to have the peace of mind to concentrate on finding a diagnosis for my son rather than worry about how to keep him insured.
Not Myasthenia?
Based on the EMG, Dr. P, who is a neuromuscular specialist, doesn't believe that the muscular weakness is originating from either Myasthenia or any other neuromuscular disease. Which is both good and bad. The bad, of course, is it leaves us once again with trying to figure out what IS causing the weakness, breathing problems, unstable blood pressure...
Dr. P's recommendation was to bring in another doctor - Dr. N, an internist who has a reputation for managing difficult cases. So he's next on our journey, we see him this Thursday.
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