Everything in our health insurance world
was pretty much normal until last month.
I was covered by my employer with a
UnitedHealth policy and my wife was
covered by her by her employer under Blue
Cross/Blue Shield.
I’m over 65 and covered by Medicare Part
A (no part B). My wife has AFLAC for both
of us, including cancer coverage.
The following is the sequence of events
that occurred in chronological order:
1. Last month, I was given a preliminary
diagnosis of prostate cancer.
2. I was laid off of my job (downsizing),
and COBRA was offered to me.
3. My wife applied to have me added to her
BC/BS policy due my layoff event.
4. I began looking for a new job.
5. I have had doctors’ exams, CT scans
and a prostate biopsy. It was determined
that I do have prostate cancer.
6. I received a health insurance card from
my wife’s BC/BS policy, adding me to her
policy.
7. Today, I received and accepted a job
offer from a large company that has very
good health care benefits that begin
immediately upon employment.
8. I am scheduled for a bone scan next
week to see if the cancer has spread.
I will probably undergo some form of
radiation treatment in the future for the
cancer.
My questions are: who pays for what as I
go forward and how do I minimize my
expenses?
With United HealthCare, COBRA, BC/BS,
AFLAC, my new health plan and Medicare
Part A, there must be a bunch of overlap.
All I can get is conflicting and confusing
information from various government and
health care Web sites.
Does anyone have a suggestion?
|
lintek
Experienced User , Rather EHEALTHy
Joined: 03 Aug 2006 Posts: 50 Location: New York
Posted: 10-14-07 09:08am
dear jd,
first of all, I'm sorry to hear of your
diagnosis. You must be overwhelmed at this
time with all that happened at once.
between getting laid off, and then having
to find a new job on top of finding out
you have a malignancy.
it is wise of you to investigate which way
to go concerning the alternatives you have
for help.
being that you were laid off, you have the
right to make a claim for unemployment. we
have that here in NY, I dont' know if you
have this in your state.
you would have at least been getting some
money during the period you had to go for
dr's apptointment,s tests, and interviews.
I have found through my own experiences
that COBRA is very expensive and you have
to pay that out of pocket 100%. usually
your employer would pay half or a certain
percentage and you pay the other half
while you were employed with them. but
then you're responsible for the entire fee
once you've left the company.
you won't have to use COBRA if you are
going to be getting medical benefits as
soon as you're hired.
that's fantastic by the way. usually I"ve
had to wait at least 3 months to 6 months
till benefits become effective when I
start a new job.
so this is good that you have medical
coverage immediately upon hire.
the thing is, you have a coexisting
problem. I don't know if this new
insurance co. will pay for your expenses.
you have to speak directly with them. each
company is different.
another thing, you mentioned about your
wife putting you on her insurance.
that would mean her premium would be
double, unless her company pays all of her
health insurance and none of it comes out
of her salary.
you won't save money if she has higher
premiums to pay.
so the COBRA plan, or getting on your
wifes insurance will only cost you money
out of your pocket.
another thing you mentioned: AFLAC. they
have short term or long term disability,
right? most companies will ask if you have
insurance and they will only pay a certain
percentage of the bill and expect your
health insurance plan to pay the rest.
they will have to battle that out. but you
should receive a statement explaining all
this.
you also have to find out of the two
insurances, (the new one you'll be
getting), or medicare? which of these are
the primary and which one is the
secondary? usually medicare is the
primary.
both insurances will be picking up the
bills. you will have to probably pay a
co-payment for all procedures and visits.
It all can be very confusing if you don't
understand or have never worked with
insurance verifications and
authorizations.
I have some experience in it due to the
fact I worked in a doctors office and I
had to deal one on one with the
insurances. it was a tedious job and I had
to do some pulling for the patients if
they had a diagnosis and the
insurancesdidn't want to give
authorization for a procedure right away.
they need documentation and to speak
directly with the doctor at times and to
see if other less expensive approaches
were tried first. that's why it takes so
long to get approvals for tests and why
you have to go thru step A to get to step
D before they approve things.
I realize this post is a little outdated,
but not my much and I am hoping that
you'll already have figured this all out
by now and that things are running
smoothly for you.
I wish you the best outcome with your
health problem.
sincerely,
Linda
|
jdeline
New User, Becoming EHEALTHy
Joined: 22 Sep 2007 Posts: 2
Things Have Settled Down a Bit Posted: 10-15-07 12:13pm
Thanks for your response, Linda. You make
some excellent points.
I did COBRA for September only, just to be
sure there were no surprises when I was
placed on my wife's insurance. I'll be
going off my wife's BC/BS at the end of
October, again to have a month overlap
with my new company's insurance. And the
AFLAC cancer policy just sent me a check
for $7,000 - not bad.
So things have simplified somewhat. The
bone scan was negative, so the cancer has
not spread. A lot stress has been lifted,
and for that I'm thankful
Again, thanks for your response.
|
lintek
Experienced User , Rather EHEALTHy
Joined: 03 Aug 2006 Posts: 50 Location: New York
Posted: 10-16-07 09:02am
Hi Jd,
I am so relieved to hear your bone results
came out negative.
that is a reason for celebration. I'm sure
your family is very relieved too, and I
can't forget you either.
the aflac paid you a good sum of money
which I'm surprised to hear this.
so it does pay to join these benefits upon
starting a job.
I was paying into some other plan for
partial disability if something happened
and I wound up needing surgery that took
me out of work for over a month.
they hardly paid a cent. it was disgusting
and I was outraged and even told them this
over the phone. I couldn't believe they
even bothered to send me a ck for $26.00
they said that my insurance coverage had
to pay most of it but they don't tell you
this when you first sign up with them and
if it is said, it's written in tiny
letters that you can barely read.
have to go now.
blessings,
