Insurance coverage through employer - how do you keep high useage from employer?

[believingjesus]

Thank you for that article! I just read the whole thing. I also talked to a person through the Dept. of Labor EBSA office, whatever that is and she said that my son could buy it privately also and not through the exchange, as you said. He would not qualify for the tax credits tho. She also told me the same thing I have come to find out that the employer CAN see who is spending the most on their insurance plan as they pay the majority but there should be no consequences come from that or that is illegal. I really thought the HIPPA law prevented employers from finding out that information. She said they would not know specifics but could see who is using the most insurance. That is very disappointing. Is your child that is covered under your husband's insurance the child that has CF? It has not been a problem with my son being on our insurance all these years and I pray it is not a problem for him if he chooses his employers insurance when he has to. Thank you so much for sending that article!

 

[2005CFmom]

Yes she is the one with CF. We chose to purchase insurance through the exchange so we could keep our doctors. His work plan is and HMO "Select", meaning that there are even fewer doctors included in the plan than regular HMOs....it really sucks. But we added her on so we could get some of her prescriptions through his plan because our exchange plan co-pay is increasing in January.

Edited to add: it really sucks that they can see who is using the most insurance. If they are legally not allowed to make a decision based on that information, why should they even get it? That is just crazy!

 

[believingjesus]

I totally agree. I feel is a major flaw in the HIPPA law. I am scared what the consequences r for ordering Kalydeco when it comes out as my son has DDF508 and Kalydeco is $300,000. Always something to be scared of with CF.

 

[2005CFmom]

Yes, my daughter is DDF508 also. Our exchange plan insurance specialty drugs like Kalydeco, Pulmozyme, Tobi... are going to a 10% copay! On my husbands plan it is a $150 copay. The only specialty drug she is on now is Pulmozyme. Right now we pay $15 per month for it, in January the copay would be about $500! So we have requested the copay assistant card, and will get help of $1500 per year. On my husbands insurance the copay is $150, but the assistance card will pay for $120 that so we will pay $30 per month.

 

[Ratatosk]

Years ago we had an HR person who told other employees that the reason our company's insurance rates were so high was because of ds. Grr! Didn't matter that there were also employees with ms, cancer, heart bypass surgeries, diabetes, and the list goes on. She was inappropriate and it was illegal to specifically reveal medical issues to other individuals. Fortunately she's no longer working at our company.

Our pharmacist refers to ds as an $80,000/year customer with Tobi, Pulmozyme and enzymes being the biggies. With our new HR person, she's worked with us and other employees when looking at trying to cut costs with different insurance packages. Last year they looked at a totally different company, but in the long run decided to stay with what we had after having several of us review the prescription drug coverage. Next year we're switching to a high deductible plan with a health savings account. Once we meet ds' deductible, which will probably be February, there won't be any additional charges. We also won't have to stick with one provider and will have flexibility. Currently we pay higher costs for seeing an out of network ENT in the City once a year.

 

[believingjesus]

OMG! 10 percent of those drugs would be tremendous! thats what I'm afraid of if he gets on the exchange. I'm afraid for the specialty medicines he takes would be unaffordable. Sometimes everything is so discouraging. I try to stay positive tho.

 

[2005CFmom]

At least drugs are included in the out of pocket max now. So if we used the exchange and paid their price, once we paid $4000 (platinum coverage out of packet max) there would be no charges for anything. I am hoping that the vertex drugs do get approved and that they have copay assistance. Then we could almost end up with everything covered by copay assistance. If pulmozyme covers $1500, and vertex covered $2500 per year that would cover our out of pocket. Also, if we were lower income, we could get $4000 in assistance from pulmozyme that would cover everything. So it could be a good thing.

 

[Jet]

I work for a large insurance company. We are not permitted to reveal to the company who the specific person is receiving treatment. They are permitted to see summary data on the claims dollars for their employees but the names are not shared. The limited information is usually released only to the HR departments. Most company's have their own privacy requirements as well.

Myself I have disclosed to my employer that I have CF. I don't tell everyone but have found for me its easier to let my managers know upfront. When I do need time off or have health related issues they've been understanding and accommodating. Sometimes I think they appreciate my productivity more knowing the challenges CF brings with it. Thankfully I've been able to work full time and carved out a good career.

 

[welshwitch]

Yes, what Jet said. That is how I have always understood how the health insurance works. Although, we may now know that not all plans are created equal.

That said, this whole situation really sucks. It doesn't seem fair that one should have to be singled out for meds. Sorry to those who are dealing with this.

 

[Jennyvb17]

I work in HR. There are only a few people who see actual names. They are out HR VP and the benefits manager. The rest of us, who do a lot of the regular day to day work don't see that. I see a lump sum each month of what we spend. We are self insured, so yes, if something costs a large amount it can go across the benefits managers desk first before being paid.
I have never felt like they blame me for my expenses. I have never felt like my job was in jeopardy due to my benefit costs. They budget for that. I'm sure I'm also in the budget for long term disability payments. They aren't stupid they know I will use it.
It's part of being an employer- take the good with the bad.
They also know a lawsuit when they see one, they shouldn't be dumb enough to term someone because of that.

 

[welshwitch]

Yeah. Also, many people have large expenses and illnesses (cancer, diabetes, MS, the list goes on and on). Why blame ourselves for something that we can't control? Everyone has something. I try not to think that I'm doomed with employers because of my disease.

I know a guy at my work whose 2 year old son had bone cancer and eventually died. It was a very public process (all the health processes, etc.) Once his son passed away our work supported him. I don't think there was ever a thought through any of that that "he's draining our resource pool."

Oh, and this guy eventually got promoted!

 

[welshwitch]

Oh, and another big expense: pregnancy!

 

[Printer]

Mr. Printer: My son would not lie to his employer in order to get insurance coverage. He is entitled to keep his health information privat as is everyone. I have read many forums and you thrive on being mean-hearted to people and I believe you relish the comments you receive back. My son doesn't want to take their insurance because of the fact that his employer want to keep expenses low. The fact of the matter is he has to take it as he has to stay healthy. I wanted to know from others who also work how they are able to keep it private when they have employer insurance. You having CF too makes me wonder where in the world your heart is. I had a father-in-law that reminded me of you. You thrive on being cold.

Dear Mrs. Believingjesus:

Your question was " how do you keep high (insurance) useage from employer. I only suggested that you do what Jesus would do.

As a CF Patient who owned a business and who had to make a weekly payroll, I would strongly suggest that you follow my suggestion. Group insurance is "usually" paid in part by the employer and part by the employee. The employer "usually pays from 50% to 80% of the premium. At the end of the year there is a joint, employer, insurance agent meeting. The insurance company then tells the employer, you paid this much for insurance (A) and we paid out this much in claims (B). If B is larger than A, the premium for the following year increases.

The employer is told who spent what amount of the insurance coverage, not what illness but what amount.

So the hard cold answer to your question is, the employer is paying the bulk of the costs and he/she is entitled to know who is spending his/her money.

ps All business owners want to keep expenses low. Those who don't go into bankruptcy and the employees collect unemployment insurance (which the employer paid 100% of the contribution).

Mr. Printer
Bill

 

[believingjesus]

Dear mr. Printer or Bill or whoever u r: I may be new to u but I am not new to this forum as I have been reading your smart ?!@ comments since 2007 every day and
furthermore CF for 25 years almost. U said nothing I didn't know, duh! I see u must be offended n my sign-in name of Believing Jesus. don't bother blabbing your mouth about it as I will still use that as my sign-in. I do believe in Jesus and I trust Him that whatever happens He works all things for the good, not just for me but those I pray for also, just as He will for u. Too bad I'm not as righteous as u r trying to portray me as I can't stand to hear you smart off. U may be 74 but I'm 50 and u can keep your smart @"! comments to yourself.

 

[Printer]

Jean:

Now I'm back!!

Bill

 

[believingjesus]

Tattling-telling? Impressive at your age. The truth hurts or in your case it makes you feel good.

 

[believingjesus]

Don't take that as a compliment. You reference Jesus as that is part of my sign-in. You have no conscience. Furthermore your only advice 100% of time of - Contact an accredited CF center - is maybe helpful to .1% of the population, 99.9% of the population would be told that from their doctor as even in "backwards Kansas" we were told that in 1994 from our doctor. I guess you can continue to give your one advice tho as it may be helpful to somebody and so I guess it is worth it. You are still on your throne, Mr. Printer or Bill, with your infinite wisdom and advice.

 

[Printer]

Actually I was thinking of what Jesus said: Give onto Caesar those things that are Caesar's and give onto God those things that are God's

God bless you,
Bill

 

[believingjesus]

You are an agitator Mr. Grumpy Old Man. You love mouthing off your comments with no care for the person at the other end. I do not care about money and neither does my son. We live with CF which changes your perspective on life especially when the person who has it you love more than anything. My son is the most honorable, responsible, loving, intelligent, ambitious, and most wonderful son. I do not care about money and frankly I do not care if you are looking out for the "business world" as one day you will pass away too and then what do you have? I would go to the ends of the earth for my two children, literally. Jesus said the verse you quoted in Mark 12:17 and He meant exactly that. He did not mean that a person with CF has to go to their employer and spill the beans about their whole life as it is none of their business. Even though you try to get me agitated, you do it to everyone. Jesus still loves you. I don't personally care for your grumpy mean personality but God bless you too! Please learn to pick on yourself and not everyone else!

 

[Ratatosk]

Please, let us get back to the original topic and not resort to personal attacks and name calling.