Guest guest Posted January 3, 2002 Report Share Posted January 3, 2002 Hi I am psoriatic 20 years and counting. Finally deciding to go on methotrexate after much destruction. Is anyone just on methotrexate alone and having good results - no destruction or pain? What side- effects are you experiencing? What about fatigue and job performance ? Has anyone applied for SS disability and been successful - Mainly as a route for access into job market and insurance with the possibility of enbrel. Could use as much information as possible. Thanks. Merry Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2002 Report Share Posted November 11, 2002 Yes I finally found out that persons with Kleinfelters are gouped in High Risk along with persons who have MS, Diabetes,Epiletsie. What a crock of shit. > Hello all: > > I have been diagnosed for about two months. I am not on any type of > medication or hormone therapy yet. > > I am running into problems with my health insurance. They turned > down the genetics testing, along with most of the hormone testing and > blood work. > > Any of you have similar experinces? > > Sb Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2002 Report Share Posted November 11, 2002 > Yes I finally found out that persons with Kleinfelters are gouped in > High Risk along with persons who have MS, Diabetes,Epiletsie. What a > crock of shit. Where I can find the list of high risk diseases? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2002 Report Share Posted November 11, 2002 Why does " being in a high risk group, " mean that your insurance company won't pay for hypogonadism related services? I've never heard of that before. I can see them not wanting to cover you at all, or even charging you a higher premium, but once you're covered, don't they have to provide you with the same services they provide everyone else? Re: Insurance Issues > Yes I finally found out that persons with Kleinfelters are gouped in > High Risk along with persons who have MS, Diabetes,Epiletsie. What a > crock of shit. > > Hello all: > > > > I have been diagnosed for about two months. I am not on any type > of > > medication or hormone therapy yet. > > > > I am running into problems with my health insurance. They turned > > down the genetics testing, along with most of the hormone testing > and > > blood work. > > > > Any of you have similar experinces? > > > > Sb > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2002 Report Share Posted November 11, 2002 Hrj, You might start with your state's Commissioner of Insurance. High risk is not limited to " diseases " but other, life-threatening conditions. When I was living in Illinois...a Friend's lover's blood vessels were almost clogged completely with cholesterol/plaque and was having frequent cardiac complications. At that time, late 1980, the high-risk pool had a cap and you might have to wait until a position became available. I have High Risk Blue Cross Blue Shield in Texas because of my HIV/AIDS. Good luck, Consider reporting back what you find out Just my experiences... OR eon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2002 Report Share Posted November 11, 2002 I worked for a health insurance company for 2 years until Friday when I was laid off...Sign of the times. You can make an appeal to your insurance carrier. If the first appeal is not accepted you can make a second appeal. If still not accepted you can appeal to the plan sponsor, (the company you work for that is providing the insurance. Is your insurance self funded or insurance company funded? If self funded you have more leverage to be able to persuade them to cover you. Murray > Hello all: > > I have been diagnosed for about two months. I am not on any type of > medication or hormone therapy yet. > > I am running into problems with my health insurance. They turned > down the genetics testing, along with most of the hormone testing and > blood work. > > Any of you have similar experinces? > > Sb Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2005 Report Share Posted October 15, 2005 >>>> Has anyone had any success in getting Houston enzymes and/or > Brainchilds Spectrum Support products covered by their insurance co? > We have Blue Cross Blue Shield PPO. At the very least, how about > getting some reimbursement through a Flex plan? My husband's work started a plan a few years ago for all employees where you could deduct certain non-prescription health items. Enzymes and certain other supplements are deductable in this plan if you are spending a certain minimum $$ amount on them. I don't know if this is the employer's program only, or the insurance company offers it to all its client businesses. You might ask your employer if they have a plan seperate than the actual insurance coverage. We didn't end up using it because my kids were on the 'recovery' side of our adventure (sure could have used it earlier though). Maybe check any wellness programs that many businesses are doing these days. . Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2005 Report Share Posted October 15, 2005 I've never seen insurance cover vitamins unless they were a presciption item, like Mephyton for vitamin K or some prenatals. However, if your doctor writes a prescription for them, they should be deductible for income tax purposes. Peace, Kathy E. Kathleen_E@... > > We are also Blue Cross Blue Shield PPO and our insurance has never paid > for any of my dd's therapies. They did not even cover her speech > therapy way back when because they would not cover anything to do with > autism. Every plan is different though. As far as flex plan goes, this > has been our first year using a flex plan and no vitamins or > supplements are covered. They do cover lots of other medical out of > pocket but not these items. You may want to call and ask if a doctor > prescibes it will they cover for a final answer. Also, I was hoping > they would cover tutoring expenses on the flex plan but of course the > answer is no because it is not part of a medical treatment. HTH, Jackie > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2005 Report Share Posted October 15, 2005 Hi, Debi! The Houston Nutraceuticals newsletter is going to do a series of articles on financial assistance for supplements, with the first article ready in a few weeks (hopefully!). That article will be on enzyme customer co-ops. We'll tell how this is being done by parents and how you can start one yourself for a great savings on HNI products. The following two (or more?) newsletters will cover what information we can find regarding insurance and other sources of assistance. If you try the doctor prescription route, you'll probably have much better luck approaching it from an " enzymes to support digestion " angle. My experience has been that insurance companies are not going to be as accomodating when they see things written up as " autism treatments " . You can also check with your state regional centers, some may cover supplements. A mother in my local parents group who has experience with this told me that parents should contact their state support system and specifically ask about " Non-insurance covered prescriptions " . Then you will need to have your doctor write it up as a prescription. I hope to have more details on these topics in the next few weeks and would love any info anyone else can offer! You can sign up for the newsletter here: http://216.114.78.114/webcenter/sites/hni/ . Scroll down to find the sign-up box. Please email Devin privately if you end up not being able to get financial assistance from other means. > > Has anyone had any success in getting Houston enzymes and/or > Brainchilds Spectrum Support products covered by their insurance co? > We have Blue Cross Blue Shield PPO. At the very least, how about > getting some reimbursement through a Flex plan? > > We have 2 ASD boys and as you can imagine the costs are beginning to > sufficate us. We are working with a DAN! dr and I think that I could > get him to write a prescription for these things but am not positive. > > Thanks in advance! > Debi > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2005 Report Share Posted October 15, 2005 > However, if your doctor writes a prescription > for them, they should be deductible for income tax purposes. We could get a prescription w/no problem, even specifying they had to be HNI enzymes. But wouldn't my kids' insurance company require that the pharmacy fill the prescription with the cheapest available substitute, and we'd end up getting something like generic Lactaid being all that the insurance company would " approve " ? About 10% of our income goes to enzymes, so that would be amazing. Life with a bad substitute wouldn't be worth anything, though. We've had accidental enzyme-free days, and based on those experiences, I'd live under a bridge to keep my kids on them. Amy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2005 Report Share Posted October 16, 2005 I used to work for an insurance company that administered FSAs (Flexible Spending Accounts). Check with the group that does the FSA. The IRS states that vitamins are not covered but some plans may allow them if you have a letter of medical necessity from the dr. So you may want to tell them that you have a letter and wonder if would covered. It is also up to the employer group if they elected to have the o.t.c medicines in their plan. Just because the IRS states o.t.c. medicine is covered- it is up to the group if they want to allow them. Do you have a SPD (Summary Plan Description) for the flex plan? There is one and if you participate in one..... you should have been given one. This is how you know what is covered and excluded. HTH, Jackie--- >> However, if your doctor writes a prescription >> for them, they should be deductible for income tax purposes. > > We could get a prescription w/no problem, even specifying they had to > be HNI enzymes. But wouldn't my kids' insurance company require that > the pharmacy fill the prescription with the cheapest available > substitute, and we'd end up getting something like generic Lactaid > being all that the insurance company would " approve " ? > > About 10% of our income goes to enzymes, so that would be amazing. > Life with a bad substitute wouldn't be worth anything, though. We've > had accidental enzyme-free days, and based on those experiences, I'd > live under a bridge to keep my kids on them. > > Amy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2005 Report Share Posted October 16, 2005 > We could get a prescription w/no problem, even specifying they had to > be HNI enzymes. But wouldn't my kids' insurance company require that > the pharmacy fill the prescription with the cheapest available > substitute, and we'd end up getting something like generic Lactaid > being all that the insurance company would " approve " ? Depends on if the doctor writes " do not substitute " on the rx. Then either it won't be covered by your insurance, or it will be covered at the regular " brand name " prescription percentage which is usually a higher co-payment. Dana Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2005 Report Share Posted November 18, 2005 Wow...the stories I am hearing are scarey. I dont have a clue what our insurance will cover--but my firat appt with the " out of network " LLMD is the Monday after Thanksgiving...and were told to bring $500 cash since our deductible is not yet met. We pay over $500 a month just to have health insurance. Our deductible out of pocket is going to be $3K per person (family of 5)...then insurance will pay 70/30 until we are out of pocket $8K...ouch. I am going to apply for disability so I can eventually get medicare, but I know that I will not be able to get SSI since I have always been a homemaker. I was pregnant with my 3rd child when I graduated college so I became a stay at home mom. We homeschooled for 8 years...and just this past spring the LD had gotten so bad I could not keep up with my own lesson plans and I knew it was time to call in help. My husband has been amazing our whole marriage in that I have been able to be home with the kids. We are not rich my any stretch of the imagination--we just made a lot of sacrifices to be able to do it...but now it looks like I will be penalized for being a homemaker and not in the workforce...because I have been married for 14 years (with 2 months of work experience in that time with a christmas season cashier job)...and then prior to that I had 2 years of part time work while I was in college. Beyond that I had work scholarships for school....so since I was able to work at age 16 I have probably less than 4 years paid work experience...and the rest of my life I have been a full time wife to Brad and mother to 3 kids. So SSI will probably laugh at my work history. I always feel bad each year when the social security office sends out their statements each year about how much you have contributed to your SSI benefits...and I always tell my husband that " I received the letter from the government today telling me that I am a useless member of our society! " ....I know everyone gets those letters but that is how it felt to me to see $0 contributed over the last 14 years. I am blown away that the SS office (or whoever classifies one disabled) will not allow treatment for that disease... I am learning this disease is a real hot potato in the political arena...why must everything be so political? Good grief, I just want to feel better. I am thankful for the suppt of my husband because getting help for this is looking more bleak by the minute. Dawn Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2005 Report Share Posted November 18, 2005 In a message dated 11/18/2005 3:36:26 P.M. Eastern Standard Time, gratefulwife2brad@... writes: Wow...the stories I am hearing are scarey. I dont have a clue what our insurance will cover--but my firat appt with the " out of network " LLMD is the Monday after Thanksgiving...and were told to bring $500 cash since our deductible is not yet met. Usually your first appt with the LLMD is the most expensive hon ....because of all the bloodwork and time he/she will spend with you as a new patient ....after that it should be pretty normal. I pay around $70 if I buy no supplements and the insurance I tagged on to my medicare....aetna reimburses me $39 . So ..once a month that is not TOO bad ...where you get hit is at the pharmacy on the way home. Even if you are just paying co-pays ..they add up ! Sheesh !!!! I hope you are feeling well today ! Kat Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2010 Report Share Posted August 31, 2010 Jeannne, I received the information on apraxia in the mail. Thank you so much! You've been extremely helpful. I wanted to see if anyone in the group has Empire Blue Cross Blue Shield of NY. We are trying to get more therapy visits for the apraxia diagnosis covered, but they aren't really budging. Just wanted to see if anyone else was in a similar situation, and how they handled it. Thank you, Meredith Meredith.crain27@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2010 Report Share Posted August 31, 2010 We have Cigna but we are not getting any coverage for speech at all for my son. I am applying for grants as this is our only hope right now. From: [mailto: ] On Behalf Of jeannne buesser Sent: Tuesday, August 31, 2010 1:47 PM ApraxiaNetworkOfBergenCountyegroups; Subject: [ ] insurance issues Jeannne, I received the information on apraxia in the mail. Thank you so much! You've been extremely helpful. I wanted to see if anyone in the group has Empire Blue Cross Blue Shield of NY. We are trying to get more therapy visits for the apraxia diagnosis covered, but they aren't really budging. Just wanted to see if anyone else was in a similar situation, and how they handled it. Thank you, Meredith Meredith.crain27@... <mailto:Meredith.crain27%40gmail.com> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 1, 2010 Report Share Posted September 1, 2010 Depending on the reason for the denail from Cigna, or the limit on Empire BCBS, you may want to look at the 2004 Michigan Insurance Commission's ruling on apraxia in a BCBS case. It is available for free on the web, just google it. ; ApraxiaNetworkOfBergenCountyegroups From: shannonstilwell@... Date: Tue, 31 Aug 2010 16:06:35 -0500 Subject: RE: [ ] insurance issues We have Cigna but we are not getting any coverage for speech at all for my son. I am applying for grants as this is our only hope right now. From: [mailto: ] On Behalf Of jeannne buesser Sent: Tuesday, August 31, 2010 1:47 PM ApraxiaNetworkOfBergenCountyegroups; Subject: [ ] insurance issues Jeannne, I received the information on apraxia in the mail. Thank you so much! You've been extremely helpful. I wanted to see if anyone in the group has Empire Blue Cross Blue Shield of NY. We are trying to get more therapy visits for the apraxia diagnosis covered, but they aren't really budging. Just wanted to see if anyone else was in a similar situation, and how they handled it. Thank you, Meredith Meredith.crain27@... <mailto:Meredith.crain27%40gmail.com> Quote Link to comment Share on other sites More sharing options...
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