I am considering leaving my job and getting private insurance. My company is bankrupt and I don't know that they'll have COBRA coverage, so I need to look into private options.
If I go private, which insurance provides the best coverage for lyme? Who should I look to go with?
Also, if I decide to stay with the company that is buying my current company out, they are switching our insurance to CIGNA. Can anyone tell me their experience with CIGNA?
Thank you, V
Posted by chiquita incognita (Member # 30381) on :
Hi VB Sure wish I could answer the above questions, but I can't.
However I came across this in a resource book for lyme patients, the book was in the library:
You can check there for updates about sources where you can get medical coverage in absence of insurance.
Best wishes, CI
Posted by WhitneyS (Member # 25666) on :
If youre being treated for Lyme or have ever been diagnosed by a Dr, I dont think you'll be able to get private health insurance. I certainly cannot get health insurance, and its not a matter of cost-- NO ONE will insure me. That pretty much goes for any pre-existing condition. Go with the COBRA, and make it last the 18 months, that prob as good as you'll get.
Posted by BackinStOlaf (Member # 23725) on :
but Lyme is supposed to be easily curable with 2 weeks of abx- so the fact that we have it shouldn't matter for our future BLAH BLAH BLAH
*rolls eyes*
Posted by Florence1 (Member # 22960) on :
its actually a question on the BCBS application now.....
I am in the same position except I am at the end of my 18 month cobra in June....and so exploring my options....
Posted by txgirl09 (Member # 21612) on :
I'm pretty sure almost any health company would decline you on an individual policy.
Even so, individual policies are do not offer the same coverage as group policies. Group policies are much broader.
Your best bet would be to opt for COBRA if its available.
Posted by WhitneyS (Member # 25666) on :
it doesnt matter that Lyme is "cured in 2 weeks", the minute you put down anything in the "medical conditions" section they ask for all of your medical records. You will have to send them EVERYTHING and then they will deny you by looking at the amount of appointments and treatment you've received.
If you dont include it and try to get treatment then they will revoke your care based on the fact that you did lied on your application.
Trust me I've been through this alllll. I was denied when I only had Celiac-- which required NO treatment and often doesnt effect long term health in any way.
Posted by chiquita incognita (Member # 30381) on :
When shopping around for health insurance, when I told them of the lyme (good news) they said they are seeing more and more lyme diagnoses. (Not that we ever want to hear of people being sick ,but the fact that several insurance co's---Blue Cross and Blue Shield----both told me that they are seeing more and more lyme cases, surely indicates that the illness is gaining a bit more recognition, eh?)
They did *not* refuse me coverage but they *did* automatically double if not triple my estimated rates. It would not have been funny, the "Cheapest" we could find would have been about $800 a month for me, plus deductibles, plus...you know teh whole gammut. Greed knows no bottom.
What we ended up doing is putting me on to my husband's group plan at work. That way we got a "reasonable" rate with Kaiser for about $400 per month, plus a high deductible. Eee gadz.
I don't know if in your situation it is still possible, but thought I would throw this in there.
Best wishes, CI
Posted by Beth22 (Member # 30232) on :
Your company's bankruptcy should not affect your Cobra at all. That said, after cobra, it will be very expensive if you can get it. I have been denied for Bell's Palsy alone! (why??) I wasn't diagnosed at the time I applied, so I didn't put lyme on there. I can't appeal it now, because by the time they rejected my app, I was dx'ed w lyme.
Posted by VB (Member # 16824) on :
I didn't think they could deny you for a pre-existing condition as long as you've not had a lapse in coverage. Is this not the case?
"An important feature of HIPAA is known as �creditable coverage.� Creditable coverage is health insurance coverage you had before you enrolled in your new health plan, as long as it was not interrupted by a period of 63 or more days. The amount of time you had �creditable� health insurance coverage can be used to offset a pre-existing condition exclusion period in your new health plan.
The bottom line: If you had at least a full year of health coverage at your previous job and you enrolled in your new health plan without a break of 63 days or more, your new health plan cannot subject you to the pre-existing condition exclusion."
Posted by philly78 (Member # 31069) on :
HIPAA pertains to employer backed insurance or group plans....not for those in the individual market. Some more info.
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The law defines a preexisting condition as one for which medical advice, diagnosis, care, or treatment was recommended or received during the 6-month period prior to an individual�s enrollment date (which is the earlier of the first day of health coverage or the first day of any waiting period for coverage).
Group health plans and issuers may not exclude an individual�s preexisting medical condition from coverage for more than 12 months (18 months for late enrollees) after an individual�s enrollment date.
Under HIPAA, a new employer�s plan must give individuals credit for the length of time they had prior continuous health coverage, without a break in coverage of 63 days or more, thereby reducing or eliminating the 12-month exclusion period (18 months for late enrollees). -------------------
Those in the individual market do not get the same protections. Here is something I found.
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How does HIPAA apply when changing from group health coverage to an individual insurance policy?
HIPAA also protects those who are otherwise unable to get group health insurance.
The law guarantees access to individual insurance policies and state high-risk pools for eligible individuals. They must meet all of the following criteria:
Had coverage for at least 18 months, most recently in a group health plan, without a significant break;
Lost group coverage but not because of fraud or nonpayment of premiums;
Are not eligible for COBRA coverage; or if COBRA coverage was offered under Federal or state law, elected and exhausted it; and
Are not eligible for coverage under another group health plan, Medicare, or Medicaid; or have any other health insurance coverage.
The opportunity to buy an individual policy is the same whether a person quits a job, was fired, or was laid off. -------------------
Finding individual insurance when you have a pre-existing condition is tough but not impossible.
"We have been successful," said Kevin Lembo, a state health care advocate with the state of Connecticut. "There are options out there."
1. Become a group of one.
In about a dozen states, you can be a group all by yourself for insurance purposes. What this means is that you become, in effect, just like any other company, and insurers can't deny you insurance or charge you higher premiums because of your pre-existing condition, according to Lembo.
"You'd be surprised at the number of folks who open their own landscaping business" to get the group of one, he says.
To find out whether your state will allow you to become a group of one, see this list from the Kaiser Family Foundation (look at the column headed "Definition of Small Group," and look for "1-50").
For more information on becoming a group of one, see this advice from the American Diabetes Association.
In states where you can't become a group of one, you can become a group of two.
"You can hire your brother-in-law to become a subcontractor for your landscaping company," Lembo said. "It's horrible, but what else are you going to do?"
An important note: Under these rules, an insurance company might be allowed to exclude coverage for your specific condition for a short period of time, usually about six months.
2. If you've been laid off, get COBRA.
3. When you lose your employer-related insurance, apply for new insurance within 63 days.
4. Find out whether your state has a high-risk pool.
Posted by VB (Member # 16824) on :
Thanks for the info! It's all so confusing. I decided to stay with the company that is buying my old company out, so will be going with a CIGNA 80/20 plan. Not ideal, but no choice in the matter.
Anyone have experience with CIGNA and lyme?
Posted by Abxnomore (Member # 18936) on :
If you are eligible for COBRA it would be foolish not to take advantage of it, unless there is some reason it won't work for you.
Posted by philly78 (Member # 31069) on :
quote:Originally posted by VB: Thanks for the info! It's all so confusing. I decided to stay with the company that is buying my old company out, so will be going with a CIGNA 80/20 plan. Not ideal, but no choice in the matter.
Anyone have experience with CIGNA and lyme?
Another thing you can do is find out if your employer offers a flexible spending account. I have one and I love it. You can take up to $5000/yr annually out of your paycheck before taxes. The way it works with me is I get a 'check card' with the preset 5k limit (or whatever amount you choose) on it in the beginning of the year. Then, each week money gets taken out of my paycheck before taxes....the 5K divided over a 12 month period. One downfall is you lose whatever money you don't use, so I did start off getting smaller amounts but worked my way up depending on what I spent the previous yr.
When I get prescriptions filled, or have copays or even doctor visits that are not covered by insurance, I use the 'debit card'. You need to just fax in a copy of the receipt after each purchase. Not too big of a deal considering.
There are other things that you can use the money on as well. Here is a qualifying expense list which may vary slightly but will give you a general idea. I urge everyone whose employers off the FSA to get one.