DD reached limit on medical insurance, ideas??

[pantherlj]

I agree with the PP. The limits and 26 rule are in effect but I am not sure of the exact date.

Per: http://www.healthreform.gov/reports/keyprovisions.html

EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 26TH BIRTHDAY THROUGH PARENTS’ INSURANCE—Requires new health plans and certain grandfathered plans to allow young people up to their 26th birthday to remain on their parents’ insurance policy, at the parents’ choice. Effective 6 months after enactment.

BANS LIFETIME LIMITS ON COVERAGE—Prohibits health insurance companies from placing lifetime caps on coverage. Effective 6 months after enactment.

The new law is very confusing and not clear. From what I understand, it takes effect 6 months after signed which would be September. However, it won't start until your policy renews. So, if your policy renews every January, that's when you would see the changes.

OP- sorry for both your medical and financial troubles

 

[disney1990]

The new law is very confusing and not clear. From what I understand, it takes effect 6 months after signed which would be September. However, it won't start until your policy renews. So, if your policy renews every January, that's when you would see the changes.

OP- sorry for both your medical and financial troubles

Some insurance companies are sticking with the January start date and some are going ahead and enrolling these kids now.

 

[Leajess99]

I am so sorry you are having to deal with this. Have you tried applying for medicaid for her?? With her being 18 and no job and the illnesses she should very well qualify. Please go tomorrow and apply for it at your local social services office. If they deny her application than please file an appeal. I am so sick of these women that keep having babies (one in particular that I am speaking of is pregnant with her 5th baby and her first 4 are in the custody of others. Her attitude is that as long as she can have babies she will) and not supporting or taking care of them but having medicaid pay for them.

Your child should qualify. Also contactthe hospital to see if they have any options to waive the bills due to extreme economic hardship. I know some hospitals have the ability and before anyone else has a fit, situations like the above are why there needs to be more help.

 

[debbiemomto4]

The way Medicaid works is that they usually deny you the first time then you have to appeal and then they give it to you. Not sure why but that is usually the case.

 

[GoofyGolferGirl]

First of all to you and your family!! I agree with PP that once they are 18 they are considered on their own and their income would be the basis for aid. Which I think you SHOULD qualify for! I think that our system is so messed up I don't know if it will ever get fixed. Ha I have a friend whose nephew hasn't worked in about 2 years, he's a drug addict and alcholic has 4 kids that he hasn't supported in at least 10 years. He took some pills and called her and told her of course she took him to the hospital, he was in the hospital for a week and then transferred to another mental hospital for 2-3 weeks. They ran all kinds of test on him heart lungs liver etc etc He has no insurance so we the tax payers get to pay but here you have a young girl who had no choice in getting sick and we are not going to help her!! This guy has applied for SS or SSI and he knew this would make his case good, gets out of the hospital and goes to work for a tree trimming service for cash! This is just wrong!! Sorry I vented!!

 

[Halbleib1]

If your daughter becomes eligible for SSI she will receive Medicaid, not Medicare. The new legislation is a big tangle of problems and you most likely will not see the provisions that interest you in effect until at least January 2011. There is already a safety net in place for people like your daughter. Even before she receives a decision about SSI she should apply for Medicaid through the state. That is traditionally what people in this situation do. Usually the big problem is hitting the limit before the individual turns 18 and then it is much more difficult to qualify for assistance.

Actually in PA you have to apply for SSI and get denied before they will give you medicaid unless you are elgible based on low income. Once denied for SSI there is a loophole in the medicaid law that says that they can not deny you so long as you have a disability. Have been through this with my son. If you get SSI you get medicare not medicaid. Thus the reason why the state has you apply for SSI first.

 

[Halbleib1]

The way Medicaid works is that they usually deny you the first time then you have to appeal and then they give it to you. Not sure why but that is usually the case.

Not sure about other states but usually in PA they do not deny you unless it is for a valid reason. Most people that apply and qualify get it right away. Now SSI is another story. Most the time they deny you until you get a lawyer and appeal it.

 

[cm8]

, I hope that your daughter is eligible for medicaid and ssi asap. I am so sorry that you are dealing with all the financial and insurance nightmares especially all at once.

 

[dclfun]

Pat- HUGS, and welcome to my nightmare.I can relate as I'm in your shoes, and the prospects are bleak. Meanwhile you should be worrying about Bridget's health and well-being, not her medical bills- so I'm really angry at your insurance company for forcing you to go through so much stress. David, as you know, is in renal failure and on dialysis. It took over 2 years for him to get on the waitlist for a transplant due to insurance issues. For anyone who doesn't know, once a person is in renal failure, there is a special Medicare plan that covers dialysis. The coverage stops the MOMENT you get a transplant, so you have no coverage when you're in the hospital and recovering. How stupid is this? My son was employed and worked hard at age 17 and 18 but he is not able to work right now, esp being on dialysis for 6 hours a day, 3 days a week. As for the new healthcare plans, even though you can add a dependent up to age 26, they are no longer considered a "child" at age 18, so the pre-existing conditions clause applies to them for the following four years. I don't see much help for people like Bridget and David with the "reform". The "reform" is so watered down-I was really pullling for universal coverage like my relatives in Canada receive. Just think of the lowered stress they have not having to be worried about losing their homes over medical bills that are NO fault of their own. Bridget and David didn't ask to be so sick- and of course both our families have wage-earners and have been taxpayers all our lives and played by the rules. As to Medicaid, the "waivers" are only for those that are developmentally disabled, which would cover Sean but not Bridget. Your best bet is to talk to the hospital social worker. She should be eligible for spend-down Medicaid since her bills are, I'm sure, over the limit to qualify. If you are taking her as a tax deduction then they may look at your income, but again, her bills will probably be high after such extensive surgery/hospitalization. If not, then there's no shame in a medical bankruptcy that would allow you to keep your home- I doubt you will need to pursue such action though as Medicaid should apply now that you've reached your insurance limits. NO ONE in America should have to take this journey, but unfortunately we're two of many- the silent voices who are just too tired to raise them in anger at a country where lawmakers really don't care. If you're a child, then there is always coverage, once you've turned 18 the unspoken message is that your life is expendable and worthless. Am I bitter? You bet. Hang in there Pat and don't let this get you down- Bridget needs you right now probably more than ever. I'm so sorry to hear she's required more surgery. She's been through way too much in her short lifetime and I'm proud of her for thinking of going to college this fall despite all the pain and hard work of therapy.---Kathy

 

[blondietink]

Actually in PA you have to apply for SSI and get denied before they will give you medicaid unless you are elgible based on low income. Once denied for SSI there is a loophole in the medicaid law that says that they can not deny you so long as you have a disability. Have been through this with my son. If you get SSI you get medicare not medicaid. Thus the reason why the state has you apply for SSI first.

SSI = Medicaid
SSDI = Medicare 2 years after you are approved

Unless one of the parents is retired or deceased when you apply for Social Security benefits for your daughter, she will be eligible for SSI as long as her disability is on their magic list. You can go to the social security website ssa.gov and apply.

 

[A Mickeyfan]

Our country's health insurance programs stink in plain English..
I love the way people who aren't even doctors who sit on boards decide how much coverage is the limit.. regardless if the person still needs treatment of not.. coverage hit the limit.. sorry .. your are done. I went thru this why myself and PT. Insurance said my PT was maxed out, meanwhile I still could not lift my arm over my head due to rotator cuff surgery.. I was lucky, my doc let me continue to go FREE.. he knew I needed it. My case was a minor case of what happens due to the poor health insurance policies.. I just hope this new law really works and helps us.. not hurts us. I pay thru the nose for my premiums too..

 

[luvthatdisney]

Just to throw out another option...

My DS (19) has melanoma. You cannot get individual insurance with this diagnosis period, until you have been out from diagnosis and treatment for many years.

DS aged out of our plan (age 19) as he was not enrolled in college full time - he only goes part-time and works. So we had no other choice, but to enroll him in Cobra ($500 a month), but I could not let him go without insurance, you just never know with melanoma.

Anyways, we were getting to the point where we where having problems paying for the Cobra, so I started looking around and found our state's high risk pool coverage, Inclusive health (we are in NC). The premiums are half ($258) so it will save us alot of money and once he can get a full time job he will be able to afford it (if he cannot get on an employers plan).

Part of Obama's new health reform, is that it established a high risk pool in many states that did not have them. It also makes changes to the pools already in place.

Might be an option for you if the SSI does not pan out or is not quick enough getting to you.

 

[MG3G]

OP - I am in Canada and we have 3 children all of whom have had various health problems. My middle son has 8 seperate and distinct disorders/diseases/diagnosis right now. Although I can not imagine the stress of not having "free" health care (we do pay for part of our medication, vision and dental expenses) I CAN relate to the stress of having a chronically ill child. I just wanted to say that you will be in my prayers and I hope that a solution is found quickly so that you can concentrate on your daughter and not her insurance.