insurance question

July 12, 2000

Hi Stephany:

There is a lot of evidence that early treatment for OCD is the way to go.

I know that insurance can be a worry, but IMO it is more important to get

help for OCD now while your friend's child is young and the OCD has less of

a grip and can be turned around.

YOu would need to check with specific insurance plans to see how they would

deal with " pre-existing " conditions. There is always a lot of political

action re: this problem. I have been able to find health insurance with a

" pre-existing " condition (cancer) by working for a corporation which has a

company health plan which insures the group rather than individuals.

Perhaps your friend can find something similar.

Good luck, take care, aloha, Kathy (H)

kathyh@...

You wrote:

A friend of mine has a child with emotional problems, many of which

>>sound like they could be related to OCD. She is concerned that if

>>she takes her child in for professional help, it will be documented

>>on his medical records and it will make it difficult for him to get

>>medical insurance later. The little boy is only four now. What

>>experiences do you have with this? Is OCD as a mental illness, or a

>>mood disorder considered a " pre-existing condition " that would

>>significantly affect future medical coverage? Thanks for your input.

>>

>>Stephany

July 22, 2000

In a message dated 7/22/00 12:44:47 AM Pacific Daylight Time, DOTSAM@...

writes:

<< have started making homemade soaps, bath oils and gels. I am selling

wholesale and retail. I have the ingredients listed on my labels. Do I need

to carry insurance in case some claims their skin was damaged by the use of

the products? Thank you in advance for any response.

>>

I would like to hear about this also. In addition, I am trying to interpret

the FDA guidelines---For example, are we prohibited from listing something on

the label such as, " Moisterizing Lotion " or can we refer to ingredients such

as shea butter as--'a healing, soothing butter'????

Angie

July 22, 2000

>the FDA guidelines---For example, are we prohibited from listing something

on

>the label such as, " Moisterizing Lotion " or can we refer to ingredients such

>as shea butter as--'a healing, soothing butter'????

I found some " Guidelines for Cosmetic Advertizing and Labelling Claims "

online put out by the CCTFA, Advertizing Standards Canada and Health Canada

that I'm finding quite helpful, I imagine the US versions of these agencies

must have something similar. It really simplifies things in that it has

columns for Acceptable (cosmetic) Claims and Unacceptable Claims (drug) and

lists different substrate types (hair, nails, skin), different product

types and the typical claims made under each category.

In relation to what you mentioned Angie, it says that " Moisturizes " ,

" Relieves Dry Skin " , " Soothes Dry Skin " , " Protects Against and Alleviates

Chapping, Cracking and Roughness Due to Drying " and " Moisturizes the Skin

so that Complexion Looks Revitalized (radiant) " are all acceptable claims

for a skin moisturizer product, but " Heals " , " Therapeutic Effect " and

" Relieves or Soothes Abrasions/Bites/Insect Bites/Cuts/Nicks/Irritated

Skin/Inflamed Skin/Rashes " would all be unacceptable claims.

Warmly,

Sherri

Oshun Spirit Arts Ltd. Mission, BC Canada

http://oshun.bc.ca mailto:sherri@...

Soap & Cosmetic Ingredients, Packaging, Bulk Toiletries and more...

Spring 2000 Catalogue with over 500 products online and downloadable

October 30, 2000

In a message dated 10/30/00 3:31:38 PM Pacific Standard Time,

Rosemaryni@... writes:

> I am in the process of looking for insurance which I have not obtained yet

> but will soon. My business partner and I were discussing this and I told

> her

> I could get sued because the business is in my company name. I told her I

> do

> not want to lose my house because someone makes some story up. She says

> that

> couldn't happen because it's in the company name. Is this true?

>

> Rose

>

I am not sure I understand your question, but anyone or business can be sued.

If you have a corporation for your bath and body products, your personal

assets are protected somewhat, but not completely against liability. Many

people who make bath and body products in their homes purchase a very

inexpensive insurance policy through RLI that will protect both your products

and protect you against a lawsuit. At least this in in theory. I don't know

of anyone that has ever been sued and this policy put to the test....but

anyway it is what I am currently using and it cost $150. for the annual

premium for I think $300, 000. of product liability. Look up RLI on the web

and email./

Angie in SC

October 30, 2000

Well, Rosemary, there's the concept of limited liability, and then there's

reality.

First, I am assuming that you are incorporated. If you are not

incorporated, but operating as a sole proprietorship or a partnership, you

have NO limit on your legal liability. In other words, having a company

NAME is irrelevant - there is no separate legal entity. Legally in a

business partnership, BOTH parties are jointly AND severally liable for any

debts, etc. incurred by either party. In other words, without

incorporation, both you and your partner could lose everything.

Now, assuming that you are incorporated, you might think that your personal

assets are protected. Think again.

The concept of limited legal liability is to protect the shareholders of a

company from losing anything other than the value of their investment. So,

as a shareholder in your incorporated company you might think you're

safe.....you're not.

Recent court rulings have found DIRECTORS of corporations to be fully or

partially legally liable for the actions of the company. One classic

example in Canada is the case of Bata Shoes, a large shoe manufacturer and

retailer. They caused some environmental damage and the directors of the

company were found liable and had to pay whopping huge fines and cleanup

costs. Similar rulings have affected smaller businesses. And YOU are the

director(s) of your corporation.

Even IF you were protected by incorporation (and I think I've demonstrated

how you might not be), the legal costs of a suit could well bankrupt the

company...I don't know about you, but I'd rather have the tax-deductible

expense of liability insurance and a viable business than the cost of a

lawsuit. Even if you won the suit, victory has a bitter taste when it is

accompanied by bankruptcy. And a small company is statistically more likely

to be sued than a 'big guy' because it is perceived as an easier target.

Note that even the " big guys " have liability insurance along with their

battalions of attorneys...

Hope that's of help,

Jules in Vancouver (the accountant)

> Date: Mon, 30 Oct 2000 18:29:30 EST

> From: Rosemaryni@...

>Subject: Insurance Question

>

>I am in the process of looking for insurance which I have not obtained yet

>but will soon. My business partner and I were discussing this and I told

>her

>I could get sued because the business is in my company name. I told her I

>do

>not want to lose my house because someone makes some story up. She says

>that

>couldn't happen because it's in the company name. Is this true?

>

>Rose

>

>________________________________________________________________________

>

_________________________________________________________________________

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November 6, 2000

I am by no means an expert in the insurance business, but my

experience with HMO versus PPO is that PPO just stands for Preferred

Provider Organization and HMO stands for Health Maintenance

Organization. HMO's usually give you a low copay but you have to go

to that select group of doctors, providers, and hospital facilities.

PPO usually refers to the providers that are on the plan. You can go

to any one of them as long as they are on the plan. You may have

higher copay than HMO, but usually no more than you 10 or 20% out of

pocket after deductible is met. Also, HMO's have been landblasted as

of late.

Are all of the docs on both plans???? If so, I would contact

benefits department and just ask them to explain the particulars.

They are usually very helpful.

Angie

> Hi Everyone,

>

> I have a question regarding insurance, as we have 2 new options

available to

> us beginning in January. Currently, we have Trigon/Blue Cross Blue

Shield,

> using the Bluecare 200 plan. Under this plan we pay 20% of

everything, well

> visits and vision care are not covered. The reason for the new

options is

> due to employees at my husband's job complaining. We do have

prescription

> coverage that will not change no matter which plan we choose. Our

new

> options are still with Trigon, only the plans are Keycare 20 (PPO)

and

> Healthkeepers (HMO). These 2 plans seem much better than what we

have now,

> and will definitely save us lots of money, but I'm not sure which

of them is

> better. I'm reading all the info my husband brought home, but its

soooo

> confusing! Does anyone have any clue what the difference between

PPO and HMO

> is, and which one is " better " ? I've checked the directories for

> participating providers and fortunately all of Kelsey's (as well as

the rest

> of the family's) doctors/therapists are included. Any advice

and/or

> suggestions will be GREATLY appreciated ) Thanks!

>

November 7, 2000

-

I just switched my kids from my husband's HMO to my PPO. I think you pay a

little more out of pocket for the PPO, but you often have more choices.

Also, with my husband's HMO, every time we had to take to a specialist,

we needed a referral from her primary care provider prior to taking her. It

can be hard to get certain tests and treatments okayed. Just seemed like a

lot of red tape.

Diane

November 7, 2000

> -

>

> I just switched my kids from my husband's HMO to my PPO. I think

you pay a

> little more out of pocket for the PPO, but you often have more

choices.

> Also, with my husband's HMO, every time we had to take to a

specialist,

> we needed a referral from her primary care provider prior to taking

her. It

> can be hard to get certain tests and treatments okayed. Just

seemed like a

> lot of red tape.

>

> Diane

Thats what we did too. About 3 years ago my husband's blue cross

switched to an HMO style. It was a PITA, for us. When the Human

Resources dept chose to revert back to a blue cross/blue shield PPO

plan the following year, nearly all the employees, including us, at

his hospital chose that PPO.

I do prefer the PPO. We do pay more up front and out of pocket

expenses, but we don't need those referrals nor do I find myself

arguing with medical management at the PPO everytime needs new

braces or when she needs therapy that is not a part of the state

services she already receives. I used our insurance to pay for the

braces since it would take about 3 weeks from the fitting to us

having them as opposed to using the state services which could take

up to 3 months.

has been recieving Early Intervention PT/OT and speech since

she was 17 months old. She just 'aged out' this past August after she

had turned three years old. Now she recieves related services through

the Board of Education " CPSE (Committee for Preschool Special

Education) as a " Preschooler with a Disability " . She goes to nursery

school 5 mornings week and while there she has her PT/OT and speech.

She could concievably continue with related services all the way

through high school.

April 26, 2001

I received a notice from BC/BS of Al indicating no coverage for my anesthesia

and Dr. R, but when I called them and then faxed them a copy of my

precertification letter...they said it was denied in error and they would

resubmit to claims and that it would be paid. This just happened within the

last 2 weeks (1 one week and 1 the next) so I don't have any news on whether

it really will be paid.

Rebekah in Mobile, AL

3/15/01

April 26, 2001

In response to your question, when filed my

claim with BCBS-NC they refused to pay saying it was

currently under investigation. I have not heard from

either on the matter yet, but I did get an insurance

statement saying that they paid Durham Surg.

Physicians around $7500. It seems that they pay

depending on the whim of the claim examiners!

Debbie

2/20/01

--- Drea352@... wrote:

> Hi group,

> Has anyone heard anything about being denied

> insurance coverage once you've

> had the MGB? One of the postops told me she heard

> this and we haven't been

> able to confirm or diasavoy so I told her I'd post

> the question.

> in Atlanta

>

> [Non-text portions of this message have been

> removed]

>

__________________________________________________

April 26, 2001

Call you State Department of Health and see if they regulate insurance. If

they do not, ask who does and advise to proceed.

Debra in Tulsa

April 26, 2001

Contact your state Department of Health and see if they regulate you

particular insurance. If they do not regulate, then ask them who does and

what actions can be taken.

Ask you insurance if they have or currently pay claims on any other

" investigational " or treatments and or medications that are not FDA approved

for a specific treatment. An example is the medication Brethine. It has a

drug classification as a sympathomymetic. It is commonly used as a tocolytic

agent. A tocolytic agent are medications used to stop premature labor.

Brethine is FDA approved for treatment of asthma, but not to suppress labor.

Brethine is commonly used in the Labor and Delivery Units of hospitals versus

Yutopar. Even though Yutopar is FDA approved to suppress labor, it is very

very expensive where Brethine works just as well, but very very inexpensive.

My point is that if they are paying for other " investigational " or

medications or treatments that are not approved by the FDA for that specific

use, then they are discriminating!

The Billroth II is the perfect example of a treatment for other condition(s)

but has the end result of the goal of weight loss; therefore, as stated above

if they are paying benefits for other " investigational " or medications or

treatments that are not FDA approved, then they are discriminating.

According to my attorney, it all hinges upon the contract that the insurance

company has made with your employer. My attorney stated that the law is

based upon that contract, but if the insurance company has a contract with

other employers that specifically state they will not pay benefits for

" investigational " or non-FDA approved for a specific use, then the insurance

company has established a new contract; therefore, it can be challenged. The

key is knowing your rights.

My attorney also state to get your HR benefits Department involved because if

the insurance plan that they are paying big bucks for is not following the

contract, they may very well have the company attorney plead the case. Why?

If your employer is not getting what they are paying for, they will be very

unhappy. I can assure you that employers look for plans that contractually

provide the best possible care and keep it's employees healthy; therefore,

lessening sick days. Sick days are very expensive to your employer.

Since I am a RN and not an attorney I must cover my backside: I am not an

attorney and the above does not represent advise as an attorney. The above

advise is information I have gleamed from my attorney regarding the above

situation, my own life experiences, work experience in acute care hospitals,

and as an experienced self-employed with employees in regard to insurance.

If you have any questions, please feel free to e-mail me.

Debra Washburn, RN, MGB-Dr.RR on 0314/01

April 26, 2001