Last year we had a PPO and pay had to do a tune up so with all the co pays and out of pocket for the hospital we paid out over $6000. But this year we have HMO hubby changed jobs just to get this ins. We only pay $10 for doc appt and $5 for generic and $10 for other meds and our clinic started giving us all our inhalers and vitamins and neb cups. We still have to get polmozyme and HTS at the pharmacy.
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Insurance Coverage
- Thread starter Tiffado
- Start date
Last year we had a PPO and pay had to do a tune up so with all the co pays and out of pocket for the hospital we paid out over $6000. But this year we have HMO hubby changed jobs just to get this ins. We only pay $10 for doc appt and $5 for generic and $10 for other meds and our clinic started giving us all our inhalers and vitamins and neb cups. We still have to get polmozyme and HTS at the pharmacy.
Last year we had a PPO and pay had to do a tune up so with all the co pays and out of pocket for the hospital we paid out over $6000. But this year we have HMO hubby changed jobs just to get this ins. We only pay $10 for doc appt and $5 for generic and $10 for other meds and our clinic started giving us all our inhalers and vitamins and neb cups. We still have to get polmozyme and HTS at the pharmacy.
Last year we had a PPO and pay had to do a tune up so with all the co pays and out of pocket for the hospital we paid out over $6000. But this year we have HMO hubby changed jobs just to get this ins. We only pay $10 for doc appt and $5 for generic and $10 for other meds and our clinic started giving us all our inhalers and vitamins and neb cups. We still have to get polmozyme and HTS at the pharmacy.
Last year we had a PPO and pay had to do a tune up so with all the co pays and out of pocket for the hospital we paid out over $6000. But this year we have HMO hubby changed jobs just to get this ins. We only pay $10 for doc appt and $5 for generic and $10 for other meds and our clinic started giving us all our inhalers and vitamins and neb cups. We still have to get polmozyme and HTS at the pharmacy.
<br />
<br />
Some insurance companies have maximums on coverage whether it be annual or lifetime.
This could be anything from $$ amount to the # of enzymes allowed in a month. YES that happened with an HMO & to a family that had 2 kids with CF. The HMO was only allowing X number of enzymes per day. The finally one the fight over that, but it was a headache.
CF meds are expensive & plentiful so we are quite draining on insurance companies. Then you throw in the equipment, testing etc & it all adds up very quickly!
Healthcare in general is pricey so when you have a chronic illness that requires care 24/7......**wipes brow** DANG!
This could be anything from $$ amount to the # of enzymes allowed in a month. YES that happened with an HMO & to a family that had 2 kids with CF. The HMO was only allowing X number of enzymes per day. The finally one the fight over that, but it was a headache.
CF meds are expensive & plentiful so we are quite draining on insurance companies. Then you throw in the equipment, testing etc & it all adds up very quickly!
Healthcare in general is pricey so when you have a chronic illness that requires care 24/7......**wipes brow** DANG!
Some insurance companies have maximums on coverage whether it be annual or lifetime.
This could be anything from $$ amount to the # of enzymes allowed in a month. YES that happened with an HMO & to a family that had 2 kids with CF. The HMO was only allowing X number of enzymes per day. The finally one the fight over that, but it was a headache.
CF meds are expensive & plentiful so we are quite draining on insurance companies. Then you throw in the equipment, testing etc & it all adds up very quickly!
Healthcare in general is pricey so when you have a chronic illness that requires care 24/7......**wipes brow** DANG!
This could be anything from $$ amount to the # of enzymes allowed in a month. YES that happened with an HMO & to a family that had 2 kids with CF. The HMO was only allowing X number of enzymes per day. The finally one the fight over that, but it was a headache.
CF meds are expensive & plentiful so we are quite draining on insurance companies. Then you throw in the equipment, testing etc & it all adds up very quickly!
Healthcare in general is pricey so when you have a chronic illness that requires care 24/7......**wipes brow** DANG!
Some insurance companies have maximums on coverage whether it be annual or lifetime.
This could be anything from $$ amount to the # of enzymes allowed in a month. YES that happened with an HMO & to a family that had 2 kids with CF. The HMO was only allowing X number of enzymes per day. The finally one the fight over that, but it was a headache.
CF meds are expensive & plentiful so we are quite draining on insurance companies. Then you throw in the equipment, testing etc & it all adds up very quickly!
Healthcare in general is pricey so when you have a chronic illness that requires care 24/7......**wipes brow** DANG!
This could be anything from $$ amount to the # of enzymes allowed in a month. YES that happened with an HMO & to a family that had 2 kids with CF. The HMO was only allowing X number of enzymes per day. The finally one the fight over that, but it was a headache.
CF meds are expensive & plentiful so we are quite draining on insurance companies. Then you throw in the equipment, testing etc & it all adds up very quickly!
Healthcare in general is pricey so when you have a chronic illness that requires care 24/7......**wipes brow** DANG!
Some insurance companies have maximums on coverage whether it be annual or lifetime.
This could be anything from $$ amount to the # of enzymes allowed in a month. YES that happened with an HMO & to a family that had 2 kids with CF. The HMO was only allowing X number of enzymes per day. The finally one the fight over that, but it was a headache.
CF meds are expensive & plentiful so we are quite draining on insurance companies. Then you throw in the equipment, testing etc & it all adds up very quickly!
Healthcare in general is pricey so when you have a chronic illness that requires care 24/7......**wipes brow** DANG!
This could be anything from $$ amount to the # of enzymes allowed in a month. YES that happened with an HMO & to a family that had 2 kids with CF. The HMO was only allowing X number of enzymes per day. The finally one the fight over that, but it was a headache.
CF meds are expensive & plentiful so we are quite draining on insurance companies. Then you throw in the equipment, testing etc & it all adds up very quickly!
Healthcare in general is pricey so when you have a chronic illness that requires care 24/7......**wipes brow** DANG!
Some insurance companies have maximums on coverage whether it be annual or lifetime.
<br />
<br />This could be anything from $$ amount to the # of enzymes allowed in a month. YES that happened with an HMO & to a family that had 2 kids with CF. The HMO was only allowing X number of enzymes per day. The finally one the fight over that, but it was a headache.
<br />
<br />CF meds are expensive & plentiful so we are quite draining on insurance companies. Then you throw in the equipment, testing etc & it all adds up very quickly!
<br />
<br />Healthcare in general is pricey so when you have a chronic illness that requires care 24/7......**wipes brow** DANG!
<br />
<br />This could be anything from $$ amount to the # of enzymes allowed in a month. YES that happened with an HMO & to a family that had 2 kids with CF. The HMO was only allowing X number of enzymes per day. The finally one the fight over that, but it was a headache.
<br />
<br />CF meds are expensive & plentiful so we are quite draining on insurance companies. Then you throw in the equipment, testing etc & it all adds up very quickly!
<br />
<br />Healthcare in general is pricey so when you have a chronic illness that requires care 24/7......**wipes brow** DANG!
Our insurance won't cover vitamins -- so I pay $10 out of pocket each month for Vitamin K and I used to pay $15-20 for adeks, and a few months ago I paid $79 for three bottles of sourceCF chewables.
Had to fight for synagis shots and actually had to get an attorney before that was covered.
We go out of network for our CF care because our plan is limited to local clinics and one has an accreditted cf clinic but the care is very reactive instead of proactive.
Had to fight for synagis shots and actually had to get an attorney before that was covered.
We go out of network for our CF care because our plan is limited to local clinics and one has an accreditted cf clinic but the care is very reactive instead of proactive.
Our insurance won't cover vitamins -- so I pay $10 out of pocket each month for Vitamin K and I used to pay $15-20 for adeks, and a few months ago I paid $79 for three bottles of sourceCF chewables.
Had to fight for synagis shots and actually had to get an attorney before that was covered.
We go out of network for our CF care because our plan is limited to local clinics and one has an accreditted cf clinic but the care is very reactive instead of proactive.
Had to fight for synagis shots and actually had to get an attorney before that was covered.
We go out of network for our CF care because our plan is limited to local clinics and one has an accreditted cf clinic but the care is very reactive instead of proactive.
Our insurance won't cover vitamins -- so I pay $10 out of pocket each month for Vitamin K and I used to pay $15-20 for adeks, and a few months ago I paid $79 for three bottles of sourceCF chewables.
Had to fight for synagis shots and actually had to get an attorney before that was covered.
We go out of network for our CF care because our plan is limited to local clinics and one has an accreditted cf clinic but the care is very reactive instead of proactive.
Had to fight for synagis shots and actually had to get an attorney before that was covered.
We go out of network for our CF care because our plan is limited to local clinics and one has an accreditted cf clinic but the care is very reactive instead of proactive.
Our insurance won't cover vitamins -- so I pay $10 out of pocket each month for Vitamin K and I used to pay $15-20 for adeks, and a few months ago I paid $79 for three bottles of sourceCF chewables.
Had to fight for synagis shots and actually had to get an attorney before that was covered.
We go out of network for our CF care because our plan is limited to local clinics and one has an accreditted cf clinic but the care is very reactive instead of proactive.
Had to fight for synagis shots and actually had to get an attorney before that was covered.
We go out of network for our CF care because our plan is limited to local clinics and one has an accreditted cf clinic but the care is very reactive instead of proactive.
Our insurance won't cover vitamins -- so I pay $10 out of pocket each month for Vitamin K and I used to pay $15-20 for adeks, and a few months ago I paid $79 for three bottles of sourceCF chewables.
<br />
<br />Had to fight for synagis shots and actually had to get an attorney before that was covered.
<br />
<br />We go out of network for our CF care because our plan is limited to local clinics and one has an accreditted cf clinic but the care is very reactive instead of proactive.
<br />
<br />Had to fight for synagis shots and actually had to get an attorney before that was covered.
<br />
<br />We go out of network for our CF care because our plan is limited to local clinics and one has an accreditted cf clinic but the care is very reactive instead of proactive.
TestifyToLove
New member
Our insurance won't pay for vitamins, but his medical card will. His medical card, otoh, won't pay for Prevacid solutabs, so we just pay the co-pay after our insurance covers them. We had his medical card reject his TOBI last month. Because his medical card is an adoption subsidy, we have no PCP nor case manager, thus no one to ask questions TO and find out why they rejected his TOBI.
We are VERY fortunate. M has a medical card under his adoption subsidy. We are not obligated to use our primary insurance. However, we find that using our private insurance as primary and medicaid as secondary tends to cut through medicaid's red tape most of the time. And, having Medicaid as secondary often cuts through private insurance red tape.
Then again, after paying for a severe Hemophiliac for the last 3 years, I think our primary insurance has just raised the white flag on our family. Believe it or not, Hemophilia trumps CF on medical costs. Its about twice as expensive to treat Hemophilia than CF every month. And, surgical interventions only increase that difference. Our other son's Port surgery, which was an overnight procedure, cost our insurance $85,000. M's entire week in the hospital and all his testing didn't even come close to that cost. So, as I said, I think our insurance has raised the white flag on us.
Although, they did TRY yet again to hassle us. When they got charged by a Liver Transplant specialist, they suddenly demanded to know 1)whether he had other insurance and 2)whether he had insurance coverage for the last 12 months. We had to correct them 3 times that niether was relevant and niether would permit them to reject his medical costs because he's an adoptive placement and Federal law doesn't allow them to not cover him. Sucks to be them. But, we put up with a mediocre job in large part because of the kick-rear health insurance for the kiddos!
We are VERY fortunate. M has a medical card under his adoption subsidy. We are not obligated to use our primary insurance. However, we find that using our private insurance as primary and medicaid as secondary tends to cut through medicaid's red tape most of the time. And, having Medicaid as secondary often cuts through private insurance red tape.
Then again, after paying for a severe Hemophiliac for the last 3 years, I think our primary insurance has just raised the white flag on our family. Believe it or not, Hemophilia trumps CF on medical costs. Its about twice as expensive to treat Hemophilia than CF every month. And, surgical interventions only increase that difference. Our other son's Port surgery, which was an overnight procedure, cost our insurance $85,000. M's entire week in the hospital and all his testing didn't even come close to that cost. So, as I said, I think our insurance has raised the white flag on us.
Although, they did TRY yet again to hassle us. When they got charged by a Liver Transplant specialist, they suddenly demanded to know 1)whether he had other insurance and 2)whether he had insurance coverage for the last 12 months. We had to correct them 3 times that niether was relevant and niether would permit them to reject his medical costs because he's an adoptive placement and Federal law doesn't allow them to not cover him. Sucks to be them. But, we put up with a mediocre job in large part because of the kick-rear health insurance for the kiddos!
TestifyToLove
New member
Our insurance won't pay for vitamins, but his medical card will. His medical card, otoh, won't pay for Prevacid solutabs, so we just pay the co-pay after our insurance covers them. We had his medical card reject his TOBI last month. Because his medical card is an adoption subsidy, we have no PCP nor case manager, thus no one to ask questions TO and find out why they rejected his TOBI.
We are VERY fortunate. M has a medical card under his adoption subsidy. We are not obligated to use our primary insurance. However, we find that using our private insurance as primary and medicaid as secondary tends to cut through medicaid's red tape most of the time. And, having Medicaid as secondary often cuts through private insurance red tape.
Then again, after paying for a severe Hemophiliac for the last 3 years, I think our primary insurance has just raised the white flag on our family. Believe it or not, Hemophilia trumps CF on medical costs. Its about twice as expensive to treat Hemophilia than CF every month. And, surgical interventions only increase that difference. Our other son's Port surgery, which was an overnight procedure, cost our insurance $85,000. M's entire week in the hospital and all his testing didn't even come close to that cost. So, as I said, I think our insurance has raised the white flag on us.
Although, they did TRY yet again to hassle us. When they got charged by a Liver Transplant specialist, they suddenly demanded to know 1)whether he had other insurance and 2)whether he had insurance coverage for the last 12 months. We had to correct them 3 times that niether was relevant and niether would permit them to reject his medical costs because he's an adoptive placement and Federal law doesn't allow them to not cover him. Sucks to be them. But, we put up with a mediocre job in large part because of the kick-rear health insurance for the kiddos!
We are VERY fortunate. M has a medical card under his adoption subsidy. We are not obligated to use our primary insurance. However, we find that using our private insurance as primary and medicaid as secondary tends to cut through medicaid's red tape most of the time. And, having Medicaid as secondary often cuts through private insurance red tape.
Then again, after paying for a severe Hemophiliac for the last 3 years, I think our primary insurance has just raised the white flag on our family. Believe it or not, Hemophilia trumps CF on medical costs. Its about twice as expensive to treat Hemophilia than CF every month. And, surgical interventions only increase that difference. Our other son's Port surgery, which was an overnight procedure, cost our insurance $85,000. M's entire week in the hospital and all his testing didn't even come close to that cost. So, as I said, I think our insurance has raised the white flag on us.
Although, they did TRY yet again to hassle us. When they got charged by a Liver Transplant specialist, they suddenly demanded to know 1)whether he had other insurance and 2)whether he had insurance coverage for the last 12 months. We had to correct them 3 times that niether was relevant and niether would permit them to reject his medical costs because he's an adoptive placement and Federal law doesn't allow them to not cover him. Sucks to be them. But, we put up with a mediocre job in large part because of the kick-rear health insurance for the kiddos!
TestifyToLove
New member
Our insurance won't pay for vitamins, but his medical card will. His medical card, otoh, won't pay for Prevacid solutabs, so we just pay the co-pay after our insurance covers them. We had his medical card reject his TOBI last month. Because his medical card is an adoption subsidy, we have no PCP nor case manager, thus no one to ask questions TO and find out why they rejected his TOBI.
We are VERY fortunate. M has a medical card under his adoption subsidy. We are not obligated to use our primary insurance. However, we find that using our private insurance as primary and medicaid as secondary tends to cut through medicaid's red tape most of the time. And, having Medicaid as secondary often cuts through private insurance red tape.
Then again, after paying for a severe Hemophiliac for the last 3 years, I think our primary insurance has just raised the white flag on our family. Believe it or not, Hemophilia trumps CF on medical costs. Its about twice as expensive to treat Hemophilia than CF every month. And, surgical interventions only increase that difference. Our other son's Port surgery, which was an overnight procedure, cost our insurance $85,000. M's entire week in the hospital and all his testing didn't even come close to that cost. So, as I said, I think our insurance has raised the white flag on us.
Although, they did TRY yet again to hassle us. When they got charged by a Liver Transplant specialist, they suddenly demanded to know 1)whether he had other insurance and 2)whether he had insurance coverage for the last 12 months. We had to correct them 3 times that niether was relevant and niether would permit them to reject his medical costs because he's an adoptive placement and Federal law doesn't allow them to not cover him. Sucks to be them. But, we put up with a mediocre job in large part because of the kick-rear health insurance for the kiddos!
We are VERY fortunate. M has a medical card under his adoption subsidy. We are not obligated to use our primary insurance. However, we find that using our private insurance as primary and medicaid as secondary tends to cut through medicaid's red tape most of the time. And, having Medicaid as secondary often cuts through private insurance red tape.
Then again, after paying for a severe Hemophiliac for the last 3 years, I think our primary insurance has just raised the white flag on our family. Believe it or not, Hemophilia trumps CF on medical costs. Its about twice as expensive to treat Hemophilia than CF every month. And, surgical interventions only increase that difference. Our other son's Port surgery, which was an overnight procedure, cost our insurance $85,000. M's entire week in the hospital and all his testing didn't even come close to that cost. So, as I said, I think our insurance has raised the white flag on us.
Although, they did TRY yet again to hassle us. When they got charged by a Liver Transplant specialist, they suddenly demanded to know 1)whether he had other insurance and 2)whether he had insurance coverage for the last 12 months. We had to correct them 3 times that niether was relevant and niether would permit them to reject his medical costs because he's an adoptive placement and Federal law doesn't allow them to not cover him. Sucks to be them. But, we put up with a mediocre job in large part because of the kick-rear health insurance for the kiddos!
TestifyToLove
New member
Our insurance won't pay for vitamins, but his medical card will. His medical card, otoh, won't pay for Prevacid solutabs, so we just pay the co-pay after our insurance covers them. We had his medical card reject his TOBI last month. Because his medical card is an adoption subsidy, we have no PCP nor case manager, thus no one to ask questions TO and find out why they rejected his TOBI.
We are VERY fortunate. M has a medical card under his adoption subsidy. We are not obligated to use our primary insurance. However, we find that using our private insurance as primary and medicaid as secondary tends to cut through medicaid's red tape most of the time. And, having Medicaid as secondary often cuts through private insurance red tape.
Then again, after paying for a severe Hemophiliac for the last 3 years, I think our primary insurance has just raised the white flag on our family. Believe it or not, Hemophilia trumps CF on medical costs. Its about twice as expensive to treat Hemophilia than CF every month. And, surgical interventions only increase that difference. Our other son's Port surgery, which was an overnight procedure, cost our insurance $85,000. M's entire week in the hospital and all his testing didn't even come close to that cost. So, as I said, I think our insurance has raised the white flag on us.
Although, they did TRY yet again to hassle us. When they got charged by a Liver Transplant specialist, they suddenly demanded to know 1)whether he had other insurance and 2)whether he had insurance coverage for the last 12 months. We had to correct them 3 times that niether was relevant and niether would permit them to reject his medical costs because he's an adoptive placement and Federal law doesn't allow them to not cover him. Sucks to be them. But, we put up with a mediocre job in large part because of the kick-rear health insurance for the kiddos!
We are VERY fortunate. M has a medical card under his adoption subsidy. We are not obligated to use our primary insurance. However, we find that using our private insurance as primary and medicaid as secondary tends to cut through medicaid's red tape most of the time. And, having Medicaid as secondary often cuts through private insurance red tape.
Then again, after paying for a severe Hemophiliac for the last 3 years, I think our primary insurance has just raised the white flag on our family. Believe it or not, Hemophilia trumps CF on medical costs. Its about twice as expensive to treat Hemophilia than CF every month. And, surgical interventions only increase that difference. Our other son's Port surgery, which was an overnight procedure, cost our insurance $85,000. M's entire week in the hospital and all his testing didn't even come close to that cost. So, as I said, I think our insurance has raised the white flag on us.
Although, they did TRY yet again to hassle us. When they got charged by a Liver Transplant specialist, they suddenly demanded to know 1)whether he had other insurance and 2)whether he had insurance coverage for the last 12 months. We had to correct them 3 times that niether was relevant and niether would permit them to reject his medical costs because he's an adoptive placement and Federal law doesn't allow them to not cover him. Sucks to be them. But, we put up with a mediocre job in large part because of the kick-rear health insurance for the kiddos!
TestifyToLove
New member
Our insurance won't pay for vitamins, but his medical card will. His medical card, otoh, won't pay for Prevacid solutabs, so we just pay the co-pay after our insurance covers them. We had his medical card reject his TOBI last month. Because his medical card is an adoption subsidy, we have no PCP nor case manager, thus no one to ask questions TO and find out why they rejected his TOBI.
<br />
<br />We are VERY fortunate. M has a medical card under his adoption subsidy. We are not obligated to use our primary insurance. However, we find that using our private insurance as primary and medicaid as secondary tends to cut through medicaid's red tape most of the time. And, having Medicaid as secondary often cuts through private insurance red tape.
<br />
<br />Then again, after paying for a severe Hemophiliac for the last 3 years, I think our primary insurance has just raised the white flag on our family. Believe it or not, Hemophilia trumps CF on medical costs. Its about twice as expensive to treat Hemophilia than CF every month. And, surgical interventions only increase that difference. Our other son's Port surgery, which was an overnight procedure, cost our insurance $85,000. M's entire week in the hospital and all his testing didn't even come close to that cost. So, as I said, I think our insurance has raised the white flag on us.
<br />
<br />Although, they did TRY yet again to hassle us. When they got charged by a Liver Transplant specialist, they suddenly demanded to know 1)whether he had other insurance and 2)whether he had insurance coverage for the last 12 months. We had to correct them 3 times that niether was relevant and niether would permit them to reject his medical costs because he's an adoptive placement and Federal law doesn't allow them to not cover him. Sucks to be them. But, we put up with a mediocre job in large part because of the kick-rear health insurance for the kiddos!
<br />
<br />
<br />We are VERY fortunate. M has a medical card under his adoption subsidy. We are not obligated to use our primary insurance. However, we find that using our private insurance as primary and medicaid as secondary tends to cut through medicaid's red tape most of the time. And, having Medicaid as secondary often cuts through private insurance red tape.
<br />
<br />Then again, after paying for a severe Hemophiliac for the last 3 years, I think our primary insurance has just raised the white flag on our family. Believe it or not, Hemophilia trumps CF on medical costs. Its about twice as expensive to treat Hemophilia than CF every month. And, surgical interventions only increase that difference. Our other son's Port surgery, which was an overnight procedure, cost our insurance $85,000. M's entire week in the hospital and all his testing didn't even come close to that cost. So, as I said, I think our insurance has raised the white flag on us.
<br />
<br />Although, they did TRY yet again to hassle us. When they got charged by a Liver Transplant specialist, they suddenly demanded to know 1)whether he had other insurance and 2)whether he had insurance coverage for the last 12 months. We had to correct them 3 times that niether was relevant and niether would permit them to reject his medical costs because he's an adoptive placement and Federal law doesn't allow them to not cover him. Sucks to be them. But, we put up with a mediocre job in large part because of the kick-rear health insurance for the kiddos!
<br />