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» LymeNet Flash » Questions and Discussion » General Support » insurance - the 9 yards

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Author Topic: insurance - the 9 yards
fighter
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Member # 20170

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as u know, i'm interviewing for jobs now. with the interviewing process comes discussion of benefits (aka insurance).

i feel like this is one good thing about the fact that lyme hit at the transition-to-workforce time: i get some choice in my medical insurance provider before starting on the lyme treatment.

so i'm wondering if all u seasoned people could share any info or experiences about different insurance companies.

- which ones have been good about paying for antibiotics?

- which ones have been good about IV stuff?

- which ones have been horrid for the above?

- which ones help with other things that are good for lyme. (for example, my current insurance would pay for some chiropracter, some alternative stuff and even part of a gym!)

- anything else i'd need to know, but don't even know to ask

also, what's the deal with 'preexisting conditions'?
i've read that insurance companies can deny claims during the first year or so because they can claim it's a preexisting condition.

does anyone know anything about that?

please, give me all the info you've got on insurance companies.

i hope it's okay to do this here. if not , please pm me with the info.

thanks [Smile]

Posts: 34 | From Airmont NY | Registered: May 2009  |  IP: Logged | Report this post to a Moderator
bettyg
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fighter,

our state retiree plan pays for our meds; we pay up to $250 MAX/YR. they pay the rest; lyme meds were covered.


pre-existing condition means you know you have lyme now, when you make out paperwork you have to DISCLOSE THIS to them; they can turn you down right then & there to cover you for insurance!!

that means health, life, disability, long term care for nursing homes.

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fighter
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bettyg-

i'm not retiring quite yet... i'm asking if anyone knows which medical insurance companies would be best to choose (ex. cigna, aetna, united healthcare etc), if given an option of employers who offer medical benefits.

also - can they turn me down if i'm applying as part of a group?

besides, according to ID docs, i'm completely cleared of lyme, so since the insurance companies seem to trust their judgement in treatment protocol...perhaps they should trust ID's judgement in this pre-existing conditions thing as well [Razz] .

Posts: 34 | From Airmont NY | Registered: May 2009  |  IP: Logged | Report this post to a Moderator
fighter
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anybody?!?

can u PLEASE share your insurance experiences?

which are good to try to get onto?

which to avoid?

Posts: 34 | From Airmont NY | Registered: May 2009  |  IP: Logged | Report this post to a Moderator
Tincup
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Each company has a variety of "sub-plans" that you often are not allowed to decide on.

They sort of stick you where they do in the plan of their choice... like it or not.

No insurance is 100 percent.. and each is different in each circumstance for each person.. and each disease.

Also.. what state you are in makes a difference.

It is pretty much a pot-luck deal.

If you get insurance... the best you can do is wait and see what they pay.

If they don't pay, you need to accept it or fight it.

Even if you try to ask in advance you will NOT get a straight answer.

They will say it is a case-by-case basis... or some such hog-wash.

Good luck with the job interviews.

[Big Grin]

--------------------
www.TreatTheBite.com
www.DrJonesKids.org
www.MarylandLyme.org
www.LymeDoc.org

Posts: 20353 | From The Moon | Registered: Jun 2004  |  IP: Logged | Report this post to a Moderator
Tincup
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PS..

Asking folks to share their insurance details can be risky.

Many tend to shy away from these types of questions.

Sorry.

--------------------
www.TreatTheBite.com
www.DrJonesKids.org
www.MarylandLyme.org
www.LymeDoc.org

Posts: 20353 | From The Moon | Registered: Jun 2004  |  IP: Logged | Report this post to a Moderator
sammy
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Fighter, unfortunately your questions are not easy ones to answer. Insurance companies offer many different plans under the same name. They often tailor their plans specifically to meet the needs of your company.

For example, I have had a couple different plans under the same insurance company over the past couple years. Each plan has been different. All have had different copays, deductibles, requirements for PCPs, requirements for referrals to specialists, drug tiers and costs, pharmacy plans, some require mail away RX for meds, etc. All these differences and yet they were from the same company.

It would be best to see what your employee offers. If you have options then you will be able to review the benefits packages carefully before you chose.

Talk with your employer. He or she should be able to tell you which plan most of their employees have been happy with and maybe share some specific experiences if you ask. Often the more liberal or flexible plans will cost you a little more so that might be a clue also when considering which one to choose.

Preexisting conditions are usually covered under group plans but sometimes you have to wait a certain time period (i've heard 3mo-1yr) before they will pay for services on that condition. As mentioned above, it will vary by plan and provider.

Fighter, i'm sorry I don't have any better answers. I hope that i've been able to in some small way.

Good luck in your job search:)

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carly
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It would be a pre-existing condition if you get diagnosed- or even tested- by an LLMD before your insurance coverage date begins.

That's something to watch out for.

Posts: 797 | From New York | Registered: Feb 2008  |  IP: Logged | Report this post to a Moderator
   

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