Guest guest Posted October 21, 2003 Report Share Posted October 21, 2003 Tell him to cut back so you stay qualified for medi-cal until after the tuck...perhaps they could " hold " the $10 per week and give it later as a " bonus " . Jo > OK Folks. > > I'm in the process of researching insurances because I may be losing the > Medi-Cal. (yeah, he is making 10 bucks more a week. ) The insurances that > I'm researching include Bc/bs, healthnet, etc. I need this tummy tuck, and > Medi-Cal approved it, however, if I change insurance, how do I pick the one > that is more likely to approve the Tummy Tuck? Ideas are surely welcome! > > Thanks! > > > Melisa Rechenmacher > Pampered Chef Kitchen Consultant > Let's Party!!! > For more information or a free catalog e-mail me at: > KitchenStore2urdoor@y... > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2003 Report Share Posted October 22, 2003 What equipment are you looking to get funded? Are you using Bi-Pap, CoughAssist, PulseOx, etc. -or- orthopaedic stuff like seating, mobility, AFO's, etc.? It can make a difference where you seek funding depending upon what your needs are. Jerry > Dear All, > > I just found out that our insurance company (Aetna) might not pay for our equipment 100%. > > We live in a very small town where there are not many suppliers so our equipments (most of them) are ordered from larger cities. > > In the policy, Aetna said that they would pay for 100% of the expenses occurred in Area (which I assume our town). and out of the area would be only 80% coverage. > > Since many of our equipments are still on lease or rental, the cost that we will have to pay will be substantial. > > Can anyone advise us on what to do? We at this moment have no idea what is the best way to resolve this. > > Looking for hearing from any of you soon. > > Thanks > > catherine > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2003 Report Share Posted October 22, 2003 We went through the same in-network/out-of-network problem several years ago when we ordered one of my wheelchairs through Aetna. Like you, they told us it would only cover at the higher rate for providers that were within their care network. However, there were no providers in their directory in the whole Ohio area that sold electric wheelchairs. My husband wrote a letter directly to the president of Aetna explaining the situation. I believe he sent it certified mail. He said we were not *choosing *to use an out-of-network provider, we were *forced *to because one did not exist in our area. Apparently this had an effect because they paid at the higher rate. It was only 20 percent difference, but when we're talking about a $8,000 electric wheelchair its quite a bit. hichang Cho wrote: > Dear All, > > I just found out that our insurance company (Aetna) might not pay for > our equipment 100%. > > We live in a very small town where there are not many suppliers so our > equipments (most of them) are ordered from larger cities. > > In the policy, Aetna said that they would pay for 100% of the expenses > occurred in Area (which I assume our town). and out of the area would > be only 80% coverage. > > Since many of our equipments are still on lease or rental, the cost > that we will have to pay will be substantial. > > Can anyone advise us on what to do? We at this moment have no idea > what is the best way to resolve this. > > Looking for hearing from any of you soon. > > Thanks > > catherine > -- Jenn Malatesta -------------- My web page: http://www.isoc.net/brokeninside/nekrosys/ ------------------------------------------------------------ Philo of andria: " Be kind, for everyone you meet is fighting a great battle. " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 28, 2003 Report Share Posted October 28, 2003 Do either of the correspondents in this e-mail mind if I use this message as an example for a group project in my Social Work class? My part in focused on managed care health insurance. Please let me know. Also, if anyone else would like to add their two cents on managed care and/or medicaid and how it works I'd be more than happy for the input. -Anne Re: Insurance Question > We went through the same in-network/out-of-network problem several years > ago when we ordered one of my wheelchairs through Aetna. Like you, they > told us it would only cover at the higher rate for providers that were > within their care network. However, there were no providers in their > directory in the whole Ohio area that sold electric wheelchairs. My > husband wrote a letter directly to the president of Aetna explaining the > situation. I believe he sent it certified mail. He said we were not > *choosing *to use an out-of-network provider, we were *forced *to > because one did not exist in our area. Apparently this had an effect > because they paid at the higher rate. It was only 20 percent > difference, but when we're talking about a $8,000 electric wheelchair > its quite a bit. > > hichang Cho wrote: > > > Dear All, > > > > I just found out that our insurance company (Aetna) might not pay for > > our equipment 100%. > > > > We live in a very small town where there are not many suppliers so our > > equipments (most of them) are ordered from larger cities. > > > > In the policy, Aetna said that they would pay for 100% of the expenses > > occurred in Area (which I assume our town). and out of the area would > > be only 80% coverage. > > > > Since many of our equipments are still on lease or rental, the cost > > that we will have to pay will be substantial. > > > > Can anyone advise us on what to do? We at this moment have no idea > > what is the best way to resolve this. > > > > Looking for hearing from any of you soon. > > > > Thanks > > > > catherine > > > > -- > Jenn Malatesta > -------------- > My web page: http://www.isoc.net/brokeninside/nekrosys/ > ------------------------------------------------------------ > Philo of andria: > " Be kind, for everyone you meet is fighting a great battle. " > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2004 Report Share Posted August 19, 2004 You might look into what plans your state may provide. Some states provide help for those who cannot get reasonable coverage otherwise. Your course of treatment is one that several doctors tried on me unsuccessfully. I finally had lateral releases done on both knees to help alleviate the pain. I also am self employed and my wife had worked part time at a bank. The personal insurance we had was driving us to the poor house. My wife finally went to work full time mainly so we have access to the group insurance provided by the bank she works at, even though we have to pay the rates out of our own pockets. The rates are about half of what we were paying, with much better coverage. From personal experience, any fight you may have with your insurance is basically a lost cause, unless they are doing something blatantly illegal. If you believe this to be the case, call your state insurance commissioner. Mike MT Insurance Question > I am self-employed and have had Kaiser insurance for the past 4 > years through a group organization called SBSB. > > I was diagnosed with PFS in 2000. The good-for-nothing Kaiser > orthopedic doc first gave me a prescription for Motrin, sent me for > P/T and told me there was nothing that they could do for my knee. > Last year, same doc gave me Hyalgan injections. This past April, > same doc said that she was going to refer me to a surgeon. After an > MRI, same doc calls me up and says that she thought " we " should > remain conservative in treatments and just go with Hyalgan > injections again....which only lasted until June. > > Suddenly, my monthly insurance premium rates have jumped from > $350/mo to $635/mo. > > When I applied for Kaiser's " personal " insurance plan at a monthly > premium rate of $271, I was rejected based on a pre-existing > condition....which I think largely is due to the fact that I let the > orthopedic doc put off surgery. > > My question is: Does anyone else that is self-employed with this > pre-existing PFS/Chondromalacia condition have any reasonable > premium cost insurance company recommendations where I wouldn't be > rejected based on it being pre-existing??? Or where they would > classify it as pre-existing only for a year with no coverage? > > I'm guessing my best course of action is to get into some kind of a > group insurance program......any recommendations on that since I'm > self-employed??? > > I'm not ready to rush into surgery......but am now thinking maybe I > should keep my old Kaiser group plan for a couple of months, just > long enough to have surgery there, so I can get past being labeled > having a pre-existing condition. But then, I'm not sure that > surgery would do that for me??? > > Any help/recommendations/thoughts would be appreciated. > > Thanks. > > Lucinda > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2004 Report Share Posted August 19, 2004 Thanks, Mike, for your help and thoughts. You were fortunate that your wife was able to get health coverage at her place of work. I've already started searching the Ohio State Dept. of Insurance and have a glimmer of hope now.....and yes, a getting into a group of some kind is going to be my best option. Unfortunately, my husband is on S/S disability and medicare, so insurance through him is just not an option. I do believe surgery is inevitable as the pain is continually increasing.....but since I've been screwed over by the Kaiser orthopedic doc (telling me there was nothing she could do for two years; and then finally offering the Hyalgan injections), I'd really rather get different insurance lined up and go to a surgeon of my choice that will inform me fully of my condition and options. Thanks again. Lucinda Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 20, 2004 Report Share Posted August 20, 2004 Find out what the surgery would cost if you paid out of pocket (ask at different places), then divide that by your $635/mo and see how many months it would take you to pay for it. I may be being naive here, since I don't know how much various knee surgeries are, but it can't hurt to compare. I'm about to move out of state. In order to be covered there, I would have to switch my coverage to a PPO and pay about $5500/yr out of pocket just to have the damned insurance!! I'm going to stick with my HMO (my employer pays all the premium and I only have a reasonable copay to see docs), lie about where I live, pay for med in my new state out of pocket, and come back here for major medical. This is what we've been driven to. And we're the lucky ones. Ann Insurance Question > I am self-employed and have had Kaiser insurance for the past 4 > years through a group organization called SBSB. > > I was diagnosed with PFS in 2000. The good-for-nothing Kaiser > orthopedic doc first gave me a prescription for Motrin, sent me for > P/T and told me there was nothing that they could do for my knee. > Last year, same doc gave me Hyalgan injections. This past April, > same doc said that she was going to refer me to a surgeon. After an > MRI, same doc calls me up and says that she thought " we " should > remain conservative in treatments and just go with Hyalgan > injections again....which only lasted until June. > > Suddenly, my monthly insurance premium rates have jumped from > $350/mo to $635/mo. > > When I applied for Kaiser's " personal " insurance plan at a monthly > premium rate of $271, I was rejected based on a pre-existing > condition....which I think largely is due to the fact that I let the > orthopedic doc put off surgery. > > My question is: Does anyone else that is self-employed with this > pre-existing PFS/Chondromalacia condition have any reasonable > premium cost insurance company recommendations where I wouldn't be > rejected based on it being pre-existing??? Or where they would > classify it as pre-existing only for a year with no coverage? > > I'm guessing my best course of action is to get into some kind of a > group insurance program......any recommendations on that since I'm > self-employed??? > > I'm not ready to rush into surgery......but am now thinking maybe I > should keep my old Kaiser group plan for a couple of months, just > long enough to have surgery there, so I can get past being labeled > having a pre-existing condition. But then, I'm not sure that > surgery would do that for me??? > > Any help/recommendations/thoughts would be appreciated. > > Thanks. > > Lucinda > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2004 Report Share Posted September 21, 2004 , I have TriCare, but its active duty TriCare not retired TriCare and I think that makes a difference. [ ] Insurance Question I am currently changing all our medical insurance and wondering if anyone on this list has Medicare and Tricare (military) insurance coverage. If so, I would like some feed back on how well it works, any problems, etc. Thank you so much. Please feel free to email me privately. in Poulsbo, Wa. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 14, 2004 Report Share Posted October 14, 2004 Hi ... I found that I couldn't get private insurance because I'd had scoliosis surgery within 10 years of applying. Each policy is different. You should read yours carefully, especially in terms of not having disclosed a known condition for which you now seek treatment. If you haven't seen any medical professional for the condition in recent years, I'm GUESSING that future treatment will be covered. Regards, > > I'd like to know if anyone has private health insurance, and what it covers re: scoliosis surgery or even just doctor visits. > I no longer have state insurance, since I am not teaching full-time now. About eight months ago, my new husband and I became insured through a reputable company that insures small business owners. The hospital coverage is what was most important to us, in case of catastrophic illess, etc. The doctor visits they cover are minimal, they don't pay for 'routine' exams, and there is a prescription limit of $1,000 per year. This costs us about $6,000 per year. I didn't disclose that I had scoliosis, and need to check to see what the policy is for pre-existing conditions, as far as treatment and surgery goes. We are going to research other private insurance out there and compare before this year ends, to see if there might be something better. I'd like to know others experiences with and/or recommendations for any particular private insurance. Thanks! > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 14, 2004 Report Share Posted October 14, 2004 Thanks, ! I am impressed by how you respond with such knowledge and caring to so many posts. Perhaps we will meet someday in S.F. Re: Insurance question Hi ... I found that I couldn't get private insurance because I'd had scoliosis surgery within 10 years of applying. Each policy is different. You should read yours carefully, especially in terms of not having disclosed a known condition for which you now seek treatment. If you haven't seen any medical professional for the condition in recent years, I'm GUESSING that future treatment will be covered. Regards, > > I'd like to know if anyone has private health insurance, and what it covers re: scoliosis surgery or even just doctor visits. > I no longer have state insurance, since I am not teaching full-time now. About eight months ago, my new husband and I became insured through a reputable company that insures small business owners. The hospital coverage is what was most important to us, in case of catastrophic illess, etc. The doctor visits they cover are minimal, they don't pay for 'routine' exams, and there is a prescription limit of $1,000 per year. This costs us about $6,000 per year. I didn't disclose that I had scoliosis, and need to check to see what the policy is for pre-existing conditions, as far as treatment and surgery goes. We are going to research other private insurance out there and compare before this year ends, to see if there might be something better. I'd like to know others experiences with and/or recommendations for any particular private insurance. Thanks! > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2004 Report Share Posted October 15, 2004 Hi ... Thanks for your kind remarks. Are you in San Francisco? -- So in this world Of the simple and odd, The bent and plain, The unbalanced bod, The imperfect people And differently pawed, Some live without love... That's how they're flawed. from Flawed Dogs by Berkeley Breathed > > Thanks, ! > I am impressed by how you respond with such knowledge and caring to so many posts. Perhaps we will meet someday in S.F. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 21, 2004 Report Share Posted October 21, 2004 Hi I live about 3 1/2 hours from S.F. but have family and friends there. Re: Insurance question Hi ... Thanks for your kind remarks. Are you in San Francisco? -- So in this world Of the simple and odd, The bent and plain, The unbalanced bod, The imperfect people And differently pawed, Some live without love... That's how they're flawed. from Flawed Dogs by Berkeley Breathed > > Thanks, ! > I am impressed by how you respond with such knowledge and caring to so many posts. Perhaps we will meet someday in S.F. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 18, 2004 Report Share Posted December 18, 2004 HELP!!! I need some assistance! I know I don't post often, but I do read the e-mails every day. I had my surgury June 2003 and have lost 120 pounds. I am thrilled with the results and the way I feel. However, I don't know where to begin with the insurance. I filed the first claimed which was denied ( of course). I have a year from that denial to appeal the decision. I do not know the first thing about how I should approach my appeal. Prior to the surgery I had no real health issues. I was diagnosed with Sleep Apnea, which according to the doctor I still have because I have my tonsils. My blood pressure was beginning to rise but I was not on any medication yet. Of course my BMI was terrible and I knew health issues were inevidable. I considered hiring an attorney. I would be willing to give up a third just to get something back. Can anyone give me any direction or advice? Has anyone gone to an attorney and won? Please e-mail me at diabaz@.... Your input will be greatly appreciated!!! Thanks! Diane COFFEE > > > > ANYBODY OUT THERE HAVE THE PHONE NUMBER FOR COFFEE TAMER? I'M OUT AND HAVE LOST THE > NUMBER. > > THANKS, > LYN IN CHARLESTON > 10/30/03 > 305/155 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2005 Report Share Posted February 15, 2005 Dr. Rutledge, At one time it was 4 years. I don't know if that is still holding or not. Phyllis Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2005 Report Share Posted February 16, 2005 Thanks Phyllis, I was lucky I had the money and if my insurance company paid wonderful if not I still felt it was well worth it, but I know a lot of people might not be able to round up $17,000 and their only hope is health insurance. Hopefully one day these insurance companys will help people that need it. Thanks, ne > > Dr. Rutledge, At one time it was 4 years. I don't know if that is still > holding or not. Phyllis > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2005 Report Share Posted February 16, 2005 Mine was one year.... luckily.. i got reimbursed 3 months after surgery! they are horrible devils.. those insurance companies!!! Debbie in st. louis > > > > Dr. Rutledge, At one time it was 4 years. I don't know if that > is still > > holding or not. Phyllis > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 10, 2005 Report Share Posted June 10, 2005 I don't know how your insurance works but for me I had to get a referral to a bariatric doctor for fills from my pdoc. Hope this helps! rili2403 wrote: > I have a question about my health insurance and the band. I was > banded in MX 2/04 because my insurance (Cigna) excluded the LapBand. > They have now changed their position and will cover ther band! (The > same as RNY). I don't guess there is any way they will re-imburse my > surgeons fee from lst year, but should they start to cover my > fills/flouro? They do not list any bariatric surgeons on their > provider list as it is an HMO can they get out of covering it since > everyone is out of network? Also I no longer have a BMI that would > qualify me for the surgery but I need a fill as I have gained about 10 > pounds in the past couple of months-can they deny me since I don't > meet their qualifications at my current weight? > > > Thanks for any advice you might be able to offer. > > > > > > > > ------------------------------------------------------------------------ > * Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2005 Report Share Posted June 11, 2005 In general, HMOs that don't have an in-network specialist within a reasonable distance will pay for out of network services. Your contract will have the details. Given that you have to have the fill anyway, go get it, then send in a bill and see what happens. Don't ask in advance, it just gives them another chance to say no, and it is also likely that the person answering doesn't know the answer, in which case they're more likely to say no than to risk saying yes and being wrong. (People would be likely to take the yes answer as a promise.) If they decline the bill, file an appeal within the company and include a copy of the changed medical policy (a medical policy is a statement written by a staff or contracted surgeon that says what they will/will not cover -- when an ins co announces that they're now covering something like banding it means that they modified the medical policy). Steve PS This question belongs on the bandsterinsurance forum. You're more likely to get knowledgeable answers from the participants there than here. On 6/10/05, rili2403 <ljhamilton@...> wrote: > I have a question about my health insurance and the band. I was > banded in MX 2/04 because my insurance (Cigna) excluded the LapBand. > They have now changed their position and will cover ther band! (The > same as RNY). I don't guess there is any way they will re-imburse my > surgeons fee from lst year, but should they start to cover my > fills/flouro? They do not list any bariatric surgeons on their > provider list as it is an HMO can they get out of covering it since > everyone is out of network? Also I no longer have a BMI that would > qualify me for the surgery but I need a fill as I have gained about 10 > pounds in the past couple of months-can they deny me since I don't > meet their qualifications at my current weight? > -- Steve Kalman Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2005 Report Share Posted June 13, 2005 Thanks Steve I guess I am wooried that since any Bariatric surgery is only covered for BMI over 40 and since when my BMI was higher I didn't try to get my surgery covered (as it was expressly denied) that they will now say-you don't need any bariatric services-your BMI is normal! Guess I am a cynic about insurance companies-they seem to try to get out of paying anything they can anyway they can. I'll probably give it a try like you said I really have nothing to lose. > In general, HMOs that don't have an in-network specialist within a > reasonable distance will pay for out of network services. Your > contract will have the details. > > Given that you have to have the fill anyway, go get it, then send in a > bill and see what happens. Don't ask in advance, it just gives them > another chance to say no, and it is also likely that the person > answering doesn't know the answer, in which case they're more likely > to say no than to risk saying yes and being wrong. (People would be > likely to take the yes answer as a promise.) > > If they decline the bill, file an appeal within the company and > include a copy of the changed medical policy (a medical policy is a > statement written by a staff or contracted surgeon that says what they > will/will not cover -- when an ins co announces that they're now > covering something like banding it means that they modified the > medical policy). > > Steve > > PS This question belongs on the bandsterinsurance forum. You're more > likely to get knowledgeable answers from the participants there than > here. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2005 Report Share Posted June 13, 2005 Well, you're not asking for surgery, just followup care. If you had managed to lose weight via some other [temporary, probably] method and got below 40, then they'd deny it for sure. However, you're only looking for fills and such and that should be covered. Notice the should be. If this is a new insurance carrier, you might trip over the pre-existing conditions clause. If it is simply newly covered by the old carrier, then that won't be a problem. On 6/13/05, rili2403 <ljhamilton@...> wrote: > Thanks Steve > I guess I am wooried that since any Bariatric surgery is only > covered for BMI over 40 and since when my BMI was higher I didn't > try to get my surgery covered (as it was expressly denied) that they > will now say-you don't need any bariatric services-your BMI is > normal! > > Guess I am a cynic about insurance companies-they seem to try to get > out of paying anything they can anyway they can. > > I'll probably give it a try like you said I really have nothing to > lose. > > > > > -- Steve Kalman Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 24, 2005 Report Share Posted June 24, 2005 In a message dated 6/24/2005 12:24:44 AM Eastern Standard Time, Kbear0401 writes: checked at work (state farm insurance) with an underwriter and he stated that the communicator, though a unique item, can be considered insurable under a personal articles policy. i would definitely check into it with your homeowner or renters insurance agent. hope this helps, kerrie (mom to ben 20 ds) -- Kerrie did a great job of following up.. I wasn't the one who originally asked this so I'm posting her response back to the whole list. -Becky Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 24, 2005 Report Share Posted June 24, 2005 In a message dated 6/24/2005 12:24:44 AM Eastern Standard Time, Kbear0401 writes: checked at work (state farm insurance) with an underwriter and he stated that the communicator, though a unique item, can be considered insurable under a personal articles policy. i would definitely check into it with your homeowner or renters insurance agent. hope this helps, kerrie (mom to ben 20 ds) -- Kerrie did a great job of following up.. I wasn't the one who originally asked this so I'm posting her response back to the whole list. -Becky Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2006 Report Share Posted March 26, 2006 Ken, I do not know what your current financial condition is. You should make extra sure there is going to be no " pre-existing conditions " limitation if you are planning surgery in 2006...or whenever. What you need to do is figure out how much financial exposure your finances can handle and I don't think anyone can do that without the policies and that info in front of them. Where yous should start is looking at is what the annual catestrophic limits are with the two policies vs. the monthly payments. I think I can say categorically that you will come very close, or hit, that limit no matter what, if you undergo surgery in one calender year. Of course the other thing you should look into is if the doctors/hospitals you are considering will accept this insurance. I don't think it is relevant at all, but ...I had Federal BC/BS, PPO, 80/20 copay after the family deduct limit of $500....Hospital and surgeon were " in network " and my out of pocket for the year was just under the 4K limit for the year. My surgery was not the only family medical expense, but nothing else happened other than the usual kind of stuff you probably run into with a spouse and kid(s. I am guessing you will have to consider the treatment coverage for your daughter if you switch now. Also...you will probably be " resetting the clock " on your deductibles/copays after already paying some fairly heafty bills, no? You should also explore the coverage for rehab hospitalization, if you expect to use that service. Tha last thing you might want to consider is the effect of straddling two years for medical expenses. For example, I had my surgery in February and expected all my medical bill were going to fall in one year. This could have an effect on your income taxes, and you could run " the numbers " to see if it mattters (in the end I still didn't have enough medical expenses to schedule them on our 1040...but your milage may vary. The other thing is that some services, like PT may be subject to an annual limit....so if you can only have so many visits and you begin toward the end of one calender year you can roll over to the next calender year and continue PT with coverage, perhaps. All is to say, you really have to read the fine print on the policy..there is no getting around it. Between hopital, surgeon and rehab and then some PT, I think the gross billing was in excess of 150K. Thats motivation enough to make sure you have the right coverage! After I was confident that I understood the policy and that my annual limit, assuming I stayed in network, was 4K I called up BC/BS and went over my understanding to make sure I had it correct...so consider the policy holder as a source of info before you sign up. You write mortgages....how much worse can it be? !! Cam Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2006 Report Share Posted March 26, 2006 Hi Cam - Have you considered "hanging out a shingle" as a consultant? I am willing to bet that there are people who would gladly pay for your services... With boomer's turing 60 by the thousands, Who Know's?? Thanks for the insights to my question - As always you have given me good info and I will be researching this further!! Oh btw - I will stick to mortgages and real estate - Insurance always have given me a run for the money... Ken.cammaltby <cammaltby@...> wrote: Ken,I do not know what your current financial condition is. You should make extra sure there is going to be no "pre-existing conditions" limitation if you are planning surgery in 2006...or whenever.What you need to do is figure out how much financial exposure your finances can handle and I don't think anyone can do that without the policies and that info in front of them.Where yous should start is looking at is what the annual catestrophic limits are with the two policies vs. the monthly payments. I think I can say categorically that you will come very close, or hit, that limit no matter what, if you undergo surgery in one calender year. Of course the other thing you should look into is if the doctors/hospitals you are considering will accept this insurance.I don't think it is relevant at all, but ...I had Federal BC/BS, PPO, 80/20 copay after the family deduct limit of $500....Hospital and surgeon were "in network" and my out of pocket for the year was just under the 4K limit for the year. My surgery was not the only family medical expense, but nothing else happened other than the usual kind of stuff you probably run into with a spouse and kid(s. I am guessing you will have to consider the treatment coverage for your daughter if you switch now. Also...you will probably be "resetting the clock" on your deductibles/copays after already paying some fairly heafty bills, no?You should also explore the coverage for rehab hospitalization, if you expect to use that service.Tha last thing you might want to consider is the effect of straddling two years for medical expenses. For example, I had my surgery in February and expected all my medical bill were going to fall in one year. This could have an effect on your income taxes, and you could run "the numbers" to see if it mattters (in the end I still didn't have enough medical expenses to schedule them on our 1040...but your milage may vary. The other thing is that some services, like PT may be subject to an annual limit....so if you can only have so many visits and you begin toward the end of one calender year you can roll over to the next calender year and continue PT with coverage, perhaps.All is to say, you really have to read the fine print on the policy..there is no getting around it. Between hopital, surgeon and rehab and then some PT, I think the gross billing was in excess of 150K. Thats motivation enough to make sure you have the right coverage! After I was confident that I understood the policy and that my annual limit, assuming I stayed in network, was 4K I called up BC/BS and went over my understanding to make sure I had it correct...so consider the policy holder as a source of info before you sign up.You write mortgages....how much worse can it be? !! Cam Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2006 Report Share Posted March 27, 2006 --Ken, THe only advice I can give in this area is make sure the plan covers hospital stays,not limit them. We almost changed plans last summer that would have capped my days in the hospital, that would have been a financil nightmare for us.CHeck the tiny details about hospitilization....just my 2 cents.. <pa - In , Ken Leonard <kclnt777@...> wrote: > > Hello All - > > Some of you will recall that I was needing to wait to get 2nd, 3rd opinions until I could switch to a PPO... Well, It's finally Open Enrollment and while I know I want to switch from an HMO to a PPO - I am hoping for some advice (based on your personal experience) regarding the " type " of PPO....... > For Example: Higher Deductable/Lower Monthly Payment or Lower Deductable/Higher Monthly Payment... > > Thanks for any input on this... Ken. > > > --------------------------------- > New Messenger with Voice. Call regular phones from your PC for low, low rates. > Quote Link to comment Share on other sites More sharing options...
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