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Q: Health Insurance Overlap
asked by: jdeline on September 22nd, 2007
New User
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?
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Replies(3)
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lintek
replied on October 14th, 2007
Experienced User
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
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jdeline
replied on October 15th, 2007
New User
Things Have Settled Down a Bit
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.
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lintek
replied on October 16th, 2007
Experienced User
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,

Linda
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