I am in the process of moving out of state and having to pick up a new health insurer. I am finding that I will be likely paying out of pocket for quite a bit of my care, where as before in New Mexico using BC/BS, I payed nothing for perscriptions and about 15% of every hospitalization. My monthly rates were/are pretty high at $570/mo. I am wondering what different monthly premiums other CFers are experiencing, and if they find one type of insurance (HMO, PPO, etc.), or insurance company (Health Net, BC/BS, etc.) better than the next whether if coverage is acquired through employment or not. Thanks.
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Health Insurance
- Thread starter Beowulf
- Start date
My husband who is 39 and has CF, has ins. thru the company where I work. We have a PPO here and pay about $150/ month in premiums. We also have an RX plans and we pay $10, $25, or $40 a month for each Rx depending on the drug. We have an excellent mail order RX plan where we can get 3 mos. supply for the amount of two months copays which saves cash at the end of the year. We have a ded of $450/ yr/person, and out of pocket max for the year of $1650/per yr/person. The only problems we have ran into lately is lack of doctors in the area that will treat adult with CF. We were traveling 2 hrs away to see his regular primary dr who is a pediatrician. But was dropped back in Nov. 04. I guess a lot of the pediatricians in this area are now dropping their adult Cfers. Perhaps for obvious reasons. We have not been able to locate a local doctor to treat my husband as of yet. We were also traveling to the Adult CF center at Univ of Florida but recently my PPO network changed at work and they are no longer in our network. I am now battling the ins. company to get this covered as in network as we do not have a local dr. or anyone to treat Tim right now.
So there are a lot of complications with insurances. I am starting to wonder if Tim should just try and apply for SSI? He is currently still working. I heard it was very difficult to get approved esp. if the CFpatient can still work at least to some extent?
Janet, wife of Tim, 39 yo, CF, CFRD
So there are a lot of complications with insurances. I am starting to wonder if Tim should just try and apply for SSI? He is currently still working. I heard it was very difficult to get approved esp. if the CFpatient can still work at least to some extent?
Janet, wife of Tim, 39 yo, CF, CFRD
SSI is based off of income of both the SSI recipent and spouse. SSDI is based on the money they make/made at there job and current income of anyone else is not a factor. I have a lot of info saved on SSI/SSDI I could email to you if you are interested. My husband and I just won his SSI/SSDI case after 28 months. FILE asap, and if they deny you, apeal, don't apply again. If you appeal you are elgible for back pay from the initial date you filed. There are specific rules/regulations that CFers have to meet to be elgible for benefits-again I can email that info to you and share what worked for us.
Julie (wife to Mark 24 w/CF)
Julie (wife to Mark 24 w/CF)
Janet, I forgot my email address...
division902@hotmail.com
Also, you can look up CF doctors on www.cff.org and see if there are any in the area. You might be able to use some of the info they put on their website to fight the ins co to get a qualified doctor to see your husband. Do you see the pediatrician 2 hours away for both CF and not CF issues? Also, looking into all local pulmonary clinics might be of some assistance as well.
Email me if you would like
Julie
division902@hotmail.com
Also, you can look up CF doctors on www.cff.org and see if there are any in the area. You might be able to use some of the info they put on their website to fight the ins co to get a qualified doctor to see your husband. Do you see the pediatrician 2 hours away for both CF and not CF issues? Also, looking into all local pulmonary clinics might be of some assistance as well.
Email me if you would like
Julie