Guest guest Posted July 8, 2005 Report Share Posted July 8, 2005 , I have BCBS PPO in California, but am a resident in NJ and their $1,000 limit was based on my $10 co-pay per visit. If that is your case you can visit 100 times vs. the 60 times HMO. www.bluecard.com is BCBS website. My provider had a contract with BCBS so for some reason my visits were not counted, but payments were made directly to the OT minus my deductible. Contact your employers' human resource benefits administrator to request which plan works best for your family. See if they can attach a rider to your existing plan that covers speech pathology, occupational therapy and physical therapy. You may suggest you will pay the rider (if economically feasible). If your husband's employer does not have answers request a name of someone from BCBS that can help you. all the best, Joanne ---------------------------------------------------- This mailbox protected from junk email by MailFrontier Desktop from MailFrontier, Inc. http://info.mailfrontier.com [ ] Help with Insurance > Hi everyone, > > I have been reading posts on this board for a long time now. My > husband is starting a new job in September and will have Illinois Blue > Cross Blue Shield options. When I read the info, the PPO offers only > $1000 annually for speech therapy, but the HMO offers 60 combined > visits for PT, OT and ST. I have never used an HMO and wonder if > anyone knows if he will be able to continue with his current > therapist. His pediatrician is a member of the HMO and previously > (several years ago) referred him to his current therapist. Also, does > anyone have any experience with BCBS doctors in the Northwest > suburbsof Illinois? I would like to make an informed decision, but I > am not sure where to get the information I need. The $$ difference > between $1000 and 60 visits is substantial!!! > > Thanks for any help you can provide > > > wife to Mike, mom to Adam 5 (apraxic, but talking more every day), > Shaun 17 and Jim 19 > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2007 Report Share Posted November 9, 2007 Do you live in NY? Why can’t you get speech, ot and ABA through the school district? On 11/9/07 12:51 PM, " pamtk2000 " <pamelatk@...> wrote: I would appreciate some help with insurance issues. My son with autism has been on a cobra policy for 3 years. It is due to run out in December. My husband's employer is located in New York City and we will switch my son to Empire Blue Cross. Currently, through the cobra plan, we get unlimited out of network speech and ot reimbursed at 80% and through the mental health coverage they will cover some ABA (up to 4 hours from a BCBA or liscenced psychologist). The cobra plan has also covered Krigsman and DAN dr. vistits as well as compounds from the pharmacy. What are the rules for NY? I was told by the insurance broker for my husband's current employer that they would cover OT only in network and for only 30 visits per year. They say they don't cover ABA and I am unclear about speech. The broker is cooperative and has a son on the spectrum. She is repeating what the insurance company tells her. Thanks, Pam Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2007 Report Share Posted November 9, 2007 - I live in New Jersey. The school district does cover services in school, but we always got 4 days of OT after school covered, minimal speech, and minimal ABA. My son requires a lot of ot. I am also worried that other needs like DAN and compounded medication wont be covered. I am hopeful to find out what the New York law is and if an insurance company that services business in New York must pay for anything related to autism or not. thanks! -- In EOHarm , christine <christine@...> wrote: > > Do you live in NY? Why can¹t you get speech, ot and ABA through the school > district? > > > > > On 11/9/07 12:51 PM, " pamtk2000 " <pamelatk@...> wrote: > > > > > > > > > > > I would appreciate some help with insurance issues. My son with autism > > has been on a cobra policy for 3 years. It is due to run out in > > December. My husband's employer is located in New York City and we will > > switch my son to Empire Blue Cross. > > > > Currently, through the cobra plan, we get unlimited out of network > > speech and ot reimbursed at 80% and through the mental health coverage > > they will cover some ABA (up to 4 hours from a BCBA or liscenced > > psychologist). The cobra plan has also covered Krigsman and DAN dr. > > vistits as well as compounds from the pharmacy. > > > > What are the rules for NY? I was told by the insurance broker for my > > husband's current employer that they would cover OT only in network and > > for only 30 visits per year. They say they don't cover ABA and I am > > unclear about speech. The broker is cooperative and has a son on the > > spectrum. She is repeating what the insurance company tells her. > > > > Thanks, > > Pam > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 1, 2010 Report Share Posted March 1, 2010 I was diagnosed with RA in May 2009, ended up on Short-term disability in June and lost my job in September. I've been on Cobra since then, but just found out that has been discontinued because my ex (who was on my policy by divorce agreement) bounced a check to them. My Rheumy had just suggested on my last visit that I apply for permanent disability. I had just started my first Remicade infusion (because nothing else has worked), which is obviously out of the question now that I don't have insurance. I have worked all my life with insurance and have no idea where to go - I just read on SSDI website that Medicare doesn't kick in until 2 YEARS after you are on SSDI (assuming they even approve me) so now I'm starting to really freak out. Are there any meds for RA that are even remotely affordable without insurance? I'm not even sure my rheumy will see me because I just found out the claim for the infusion was denied because they had cancelled the insurance as of then. Does anyone have any suggestions? from California Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 1, 2010 Report Share Posted March 1, 2010 Once you apply for disability i believe that the state medical insutance will kick in. Apply with your local welfare office. Â Â From: nancymillerellis <nancymillerellis@...> Subject: [ ] Help with Insurance Date: Monday, March 1, 2010, 5:17 AM Â I was diagnosed with RA in May 2009, ended up on Short-term disability in June and lost my job in September. I've been on Cobra since then, but just found out that has been discontinued because my ex (who was on my policy by divorce agreement) bounced a check to them. My Rheumy had just suggested on my last visit that I apply for permanent disability. I had just started my first Remicade infusion (because nothing else has worked), which is obviously out of the question now that I don't have insurance. I have worked all my life with insurance and have no idea where to go - I just read on SSDI website that Medicare doesn't kick in until 2 YEARS after you are on SSDI (assuming they even approve me) so now I'm starting to really freak out. Are there any meds for RA that are even remotely affordable without insurance? I'm not even sure my rheumy will see me because I just found out the claim for the infusion was denied because they had cancelled the insurance as of then. Does anyone have any suggestions? from California Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 1, 2010 Report Share Posted March 1, 2010 I went through the same thing. Check with Medi-Cal to see if you qualify. There also may be other insurance opportunities based on your income. Many of the biologic treatments have plans you can get on for a year if you cannot afford the prescription . Also discuss your treatment options with your Rheumatalogist , I am going on my third year with RA but I am still not taking any of the " designer " drugs, everything I do take such as MTX is not so expensive that I couldn't afford it out of pocket. Don't delay, it takes time to find and be accepted on any insurance plans. Hope this helps. Stan Seattle, Cloudy. [ ] Help with Insurance I was diagnosed with RA in May 2009, ended up on Short-term disability in June and lost my job in September. I've been on Cobra since then, but just found out that has been discontinued because my ex (who was on my policy by divorce agreement) bounced a check to them. My Rheumy had just suggested on my last visit that I apply for permanent disability. I had just started my first Remicade infusion (because nothing else has worked), which is obviously out of the question now that I don't have insurance. I have worked all my life with insurance and have no idea where to go - I just read on SSDI website that Medicare doesn't kick in until 2 YEARS after you are on SSDI (assuming they even approve me) so now I'm starting to really freak out. Are there any meds for RA that are even remotely affordable without insurance? I'm not even sure my rheumy will see me because I just found out the claim for the infusion was denied because they had cancelled the insurance as of then. Does anyone have any suggestions? from California Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 1, 2010 Report Share Posted March 1, 2010 Welfare ssi. Medicaid Disability. Ssd. Medicare Ssa soc sec admin Deb rn Sent from my iPhone Quote Link to comment Share on other sites More sharing options...
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