Insurance problems

4kidsmom

New member
Thursday October 20, 2005 6:15 PM (NEW!)


We are having insurance problems right now. My husband started a new job on 1/10/2005 and we now find out that the primary insurance will not cover anything CF related until 1 year after the 90 day probationary period which is 1/07/2006 so we are his talking insurance would then pick up on 1/07/2007. We are pretty scared, seeing that his medications alone this year so far are $18,500. He does have medicaid, but I just had a meeting today and she suggested me quiting my job in order to keep it. Is anyone else in this situation? My job is really good with me needing time off for sick kids, etc., I feel like I really don't have an option. It is either my sons health or a little extra money by working. It is so aggravating because you can't seem to get ahead with this disease!

Angie
Step-mom to Brittany 13 no cf
Mom to Tyler 12 cf carrier
Brady 4 with cf
Taylor 3 no cf, but has chromosome 9q deletion q21.2 q22.1
 

anonymous

New member
As long as you currently have medical coverage (and have had for the past year) HIPPA, the healthcare portability act should kick in. Check out this web site to see if you meet the qualifications.

<a target=new class=ftalternatingbarlinklarge href="http://www.cms.hhs.gov/hipaa/hipaa1/content/qa-con.asp">http://www.cms.hhs.gov/hipaa/hipaa1/content/qa-con.asp</a>
 

julie

New member
Angie, I actually don't think that they can do this if you have had consistent coverage on your CFer prior to this insurance coverage. HIPPA, Health Insurance PORTABILITY Privacy Act-I'm going to do some searches and post what I find here. I recommend that you also (if you can find any time <img src="i/expressions/face-icon-small-smile.gif" border="0"> ) look up information on pre-existing conditions under the hippa regulation.

Additionally, would contact BETH SUFIAN (of Suffian and Passamo) who is a lawyer in Texas who has CF and is always helping out other's with CF related matters. She may be able to offer guidance as to where you can go and find further information.

If I find anything, I'll post it or the links here.
 

Emily65Roses

New member
I just would like to second Julie's mention of Beth Sufian. She fought for more than two years and finally won me SS benefits. And she only required 25% of my backpay. So out of almost $15,000 I only had to pay her $3,500. Totally worth it. And she did a great job, put a lot of work in.
 

julie

New member
"For each triggering event, a special enrollee is regarded as a regular enrollee and not a late enrollee. Therefore, the maximum pre-existing condition exclusion period that may be applied to a special enrollee is 12 months. The 12 months are reduced, day for day, by the special enrollee's creditable coverage. In addition, a newborn, adopted child or child placed for adoption cannot be subject to a pre-existing condition exclusion period if the child is enrolled within 30 days after birth, adoption or placement for adoption and has no subsequent significant break in coverage after that time."

"HIPAA provides for portability rights in three circumstances:

a) When you leave a job where you had group health plan coverage, and move to another job with group health plan coverage. (This also applies if you are covered as a dependent of the person who changes jobs.)
b) You lose group health plan coverage, you meet the definition of a HIPAA eligible individual and you wish to purchase individual health insurance coverage. c) You have individual health insurance coverage or any other type of creditable coverage, and you enroll in a new group health plan."

" No, HIPAA's group market protections do not automatically apply to all employment-related group health plans. The following situations trigger some exceptions:

1) Very small plans. In most cases, if you are in a group health plan that only covers one current employee, State law will determine whether you have HIPAA group market protections. Check with your State insurance department to find out if HIPAA group market protections apply to you.
2) Non-federal governmental plans. If your eligibility for your group health plan is based on your or someone else's employment with a State or local government agency, HIPAA protections should apply to you unless your plan has notified you that it is exempt from some or all HIPAA requirements. However, even if the plan is exempt from other requirements, it must always provide you with a certificate of creditable coverage when your coverage ends. You also can ask your plan administrator if you are not sure which protections apply, or you can check the 'Searchable Database of Sponsors Electing to Opt-Out' for a list of non-federal governmental plans.
3) Federal governmental plans. If your eligibility for your group health plan is based on your or someone else's employment with a Federal government agency, HIPAA itself does not apply directly, but the government affords similar protections.
4) Church plans. If your eligibility for your group health plan is based on your or someone else's employment with a church or group of churches, you should check with your plan administrator to find out whether HIPAA's group market protections apply to you.
 

anonymous

New member
Angie,

Does your clinic have a social worker? This person may be able to help you through some of the red tape of HIPPA.
 

julie

New member
Angie, a few more things worth looking into.....

-<a target=new class=ftalternatingbarlinklarge href="http://www.irs.gov/publications/p907/ar02.html#d0e455">http://www.irs.gov/publications/p907/ar02.html#d0e455</a>
"Earned Income Credit
This credit is based on the amount of your earned income. But you can get the credit only if your earned income for 2004 was less than:
$11,490 ($12,490 for married filing jointly) and you did not have a qualifying child,
$30,338 ($31,338 for married filing jointly) and you had one qualifying child, or
$34,458 ($35,458 for married filing jointly) and you had more than one qualifying child."
THOUGHT THIS MIGHT BE HELPFUL TO KEEP IN MIND, HOPEFULLY YOU ARE ABOVE THIS THREASHOLD BUT IF NOT, KEEP IT IN MIND.

-"Child and Dependent Care Credit
Generally, if you pay someone to care for either your dependent under age 13 or your spouse or dependent who is not able to care for himself or herself, you may be able to get a credit of up to 35% of your expenses. To qualify, you must pay these expenses so you can work or look for work.
You can claim the credit on Form 1040 or 1040A. You figure the credit on Form 2441 (Form 1040) or Schedule 2 (Form 1040A).
For more information, see the instructions for Form 1040, line 47 or Form 1040A, line 29. Publication 503, Child and Dependent Care Expenses, contains more detailed information."
JUST GOOD INFORMATION TO KNOW, IT MIGHT COME IN HANDY.


-"Dependent Care Benefits
You can exclude from income benefits provided under your employer's qualified dependent care assistance plan. You may be able to exclude up to $5,000. The care must be provided for your dependent under the age of 13 or your spouse or dependent who is not able to care for himself or herself.
For information about excluding benefits on Form 1040, see Form 2441, Child and Dependent Care Expenses, and its instructions. For information about excluding benefits on Form 1040A, see Schedule 2 (Form 1040A), Child and Dependent Care Expenses for Form 1040A Filers. IF YOUR EMPLOYER DOESN'T HAVE A PLAN LIKE THIS, WHERE YOU CAN PUT MONEY AWAY EVERY MONTH THAT MIGHT ALLEVIATE WHAT THE MEDICAID PEOPLE COUNT AS "INCOME", I WOULD SERIOUSLY ASK THEM TO COSIDER IT.


-"Itemized Deductions
If you file Form 1040, you generally can either claim the standard deduction or itemize your deductions. You must use Schedule A (Form 1040) to itemize your deductions. See your form instructions for information on the standard deduction and the deductions you can itemize. The following discussions highlight some itemized deductions that are of particular interest to persons with disabilities.
Medical Expenses
You can deduct medical and dental expenses for you, your spouse, and your dependents.
Medical expenses include payments you make for the diagnosis, cure, mitigation, treatment, or prevention of disease and for treatment affecting any part or function of the body. They also include the cost of transportation for needed medical care and payments for medical insurance.
You can deduct only the part of your medical and dental expenses that is more than 7.5% of your adjusted gross income shown on Form 1040, line 37.
The following list highlights some of the medical expenses you may have for special items and equipment related to a disability. For more detailed information, see Publication 502, Medical and Dental Expenses.
Artificial limbs, eyeglasses, and hearing aids.
The part of the cost of Braille books and magazines that is more than the price of regular printed editions.
Cost and repair of special telephone equipment for hearing-impaired persons.
Cost of equipment that displays the audio part of television programs as subtitles for hearing-impaired persons.
Cost and maintenance of a wheelchair or autoette.
Cost and care of a guide dog or other animal aiding a person with a physical disability.
A therapist or other person who gives ?patterning? exercises to a mentally retarded child.
A special school, if the main reason for using the school is its resources for relieving a mental or physical disability. This includes the cost of teaching and the cost of remedial language training to correct a condition caused by a birth defect.
Premiums for qualified long-term care insurance, up to certain amounts.
Improvements to a home that do not increase its value if the main purpose is medical care. An example is constructing entrance or exit ramps."

THIS ALSO INCLUDES ADDITIONAL EXPENSES FOR EXCESS FOOD COSTS, i CAN SEND YOU INFORMATION ON THAT IF YOU ARE INTERESTED. I KNOW THIS HAS OGHINT TO DO ITH YOUR INITIAL QUESTION, BUT SOMETIMES IT HELPS TO LOOK OUTSIDE OF THE PEOBLEM, ANY HELP IS ALWAYS GOOD.


GOOD LUCK
 

anonymous

New member
Julie:

Do you know much about SSI? My two youngest kids receive it. I had thought that if they get that they automatically get the Medicaid??? They told me yesterday this is not the case. We live in Ohio.
Thanks,

Angie
 

cfmom2rt

New member
We faught tooth & nail to get SSI for Reece it took almost 2 1/2 yrs. For the Medicaid, it finally kicked in when he came out of the hosptial for the 3rd time & that visit was a doozey (sp) !!! I understand what your going through, my husband kept saying why cant we get any help for our sick child, oh you make to much money,( like $75 too much) anyway we FINALLY got it thank the Lord!!! Good luck!!<img src="i/expressions/angel_ani.gif" border="0">
 

julie

New member
Angie, I'll look into it and get back to you.

I know for SSDI (someone who has worked, or a child who has a grandparent/parent who recieves retirement social security can recieve 1/2 of that parent/grandparents social security benefit)- you get mediCARE after 24 months.

My gut and research tells me that MedicAID should be automatically granted upon approval/reciept of SSI but I will look into it before I post that for sure.

Julie
 

julie

New member
Angie,
I found some information for you but it's not what you are going to want to hear:

<a target=new class=ftalternatingbarlinklarge href="http://ssa-custhelp.ssa.gov/cgi-bin/ssa.cfg/php/enduser/std_adp.php?p_faqid=633&p_created=1020959088&p_sid=bHhc4ESh&p_lva=&p_sp=cF9zcmNoPTEmcF9zb3J0X2J5PSZwX2dyaWRzb3J0PSZwX3Jvd19jbnQ9NyZwX3Byb2RzPSZwX2NhdHM9MCZwX3B2PSZwX2N2PSZwX3NlYXJjaF90eXBlPWFuc3dlcnMuc2VhcmNoX25sJnBfcGFnZT0xJnBfc2VhcmNoX3RleHQ9bWVkaWNhaWQgYW5kIFNTSQ**&p_li=&p_topview=1">SSI and Medicaid</a>

Medicaid is a jointly funded, Federal-State health insurance program for low-income and needy people. It covers children, the aged, blind, and/or disabled and other people who are eligible to receive federally assisted income maintenance payments.

Thirty-two states and the District of Columbia provide Medicaid eligibility to people eligible for Supplemental Security Income (SSI ) benefits. In these States, the SSI application is also the Medicaid application. Medicaid eligibility starts the same months as SSI eligibility.

The following jurisdictions use the same rules to decide eligibility for Medicaid as SSA uses for SSI, but require the filing of a separate application: Alaska, Idaho, Kansas, Nebraska, Nevada, Oregon, Utah, Northern Mariana Islands.

<b>The following States use their own eligibility rules for Medicaid, which are different from SSA's SSI rules. In these States a separate application for Medicaid must be filed: Connecticut, Hawaii, Illinois, Indiana, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, Virginia. For more information, please see: </b> <a target=new class=ftalternatingbarlinklarge href="http://www.socialsecurity.gov/work/ResourcesToolkit/Health/medicaid.html">http://www.socialsecurity.gov/work/ResourcesToolkit/Health/medicaid.html</a>

STATE CONTACT INFORMATION FOR MEDICAID: <a target=new class=ftalternatingbarlinklarge href="http://www.cms.hhs.gov/medicaid/allStateContacts.asp">http://www.cms.hhs.gov/medicaid/allStateContacts.asp</a>

AGED, BLIND AND DISABLED INFORMATION FOR THE STATE OF OHIO: <a target=new class=ftalternatingbarlinklarge href="http://www.nasmd.org/eligibility/statesummary.asp">http://www.nasmd.org/eligibility/statesummary.asp</a>

Hope this helps a bit and at least gets you started. Let me know if I can help out more!
 
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