Job and Insurance woes

Discussion in 'General Parenting' started by klmno, Apr 16, 2008.

  1. klmno

    klmno Active Member

    Hello! I've never posted over here but I now have an insurance problem. My employer had been paying mine and difficult child's medical insurance- it is an HMO and I had a $10 co pay for regular dr's and $20 copay for therapist's and psychiatrist's. Since I haven't been able to work full time hours for the past year due to difficult child issues, they informed me today that they will no longer pay for either of our insurance, until I go back to full time hours, which is impossible right now.

    So, I can either pay them the $900 per mo. to keep on that policy or get my own (which I'm sure would be as high or more, if I could even get difficult child on it). Or, I was wondering if difficult child could get medicaid/medicare (whichever one is for kids) or is there something else available? Is there a waiting period for these?

    What would be pros and cons of each option- if it is government assistance, do they "dictate" your medical treatment? difficult child is on probation- would this allow the PO to find out more about difficult child or woould it be the same?

    I'd greatly appreciate any info, experiences, or advice you can offer!
  2. flutterbee

    flutterbee Guest

    Here is information re medicaid for your state:

    If you don't qualify due to income and/or asset limitations, you may still be eligible for the buy-in.

    As far as the PO having more information, the answer is no. The doctors have to follow the same confidentiality laws the same. And, no, they don't dictate your medical treatment. However, your current psychiatrist and therapist may not take medicaid. Around here, the only ones that do are at the county mental health center.
  3. klmno

    klmno Active Member

    Thanks, so much Heather! I'll look thru this- but I'm glad you brought up about which dr's would accept it. I refuse to see the tdocs or psychiatrists at our county agency- they are horrible here and we have already been there done that. Not only are most of them interns (or new in the field) with no real experience, the ones who are supposed to know what they are doing don't- they refuse to let you change if you aren't happy with the therapist you started out with, they lost records, more than once, for over 2 months, and no matter what time your appointment is, you can expect to be there up to 4 hours or more waiting. The therapist we had spent 2 + mos asking about family history even though he had the file and kept assuring me he could help then ultimately said "well, I don't know what to do". So, that is the end of them for me!!
  4. flutterbee

    flutterbee Guest

    The behavioral health center at our children's hospital may take medicaid, but I'm not sure. Children's takes medicaid for medical reasons so I assume they take it for psychiatrists and tdocs, too. So you may want to look that and also if you have a university hospital.
  5. klmno

    klmno Active Member

    I'm looking through these links now. If you go with FAMIS and choose an MCO, does that mean that anyone who accepts that regular insurance from that company would accept FAMIS? One of the MCO's listed is the company our insurance is with now.

    The Children's hospital is a good idea. And it looks like some things might be covered by this type of insurance that isn't covered with private. That would be good!
  6. flutterbee

    flutterbee Guest

    Not necessarily. It may be the same insurance company, but reimburses at different rates. An MCO is just managing the FAMIS and is reimbursing at medicaid rates. IOW, FAMIS does not purchase coverage through the MCO. The state contracts with the MCO to manage the medicaid.

    Clear as mud?
  7. klmno

    klmno Active Member

    What a mess!! LOL Just like the rest of our health care system, huh....

    I really do appreciate your help. I just wish my employer had given me more notice- I guess I have to fork out the money for next month's coverage so we don't lose it because I don't think I can get all this checked out and get on another policy before the end of this month.

    difficult child issues can really be stingers, you know.
  8. Marcie Mac

    Marcie Mac Just Plain Ole Tired

    I think if you can't get medi-care/medicade to pick up the coverage, you will have a problem due to "pre existing conditons" for maybe,mmmm, I think 6 months or more (I do insurance for a living but not medical). Looks like they are offering you a cobra which is good till you get something else, but I don't think the terms may be the same.

    When SO lost his job because of illness, he couldn't get any insurance at any price and if he found someone, there was the pre existing coverage thing with him as well. After two years he finally got on Social Security, and then the hunt was on to find a doctor who even took medi care and never was able to find a psychiatric doctor. difficult child has the same problem with the pre existing conditions after he turned 18 and was no longer eligable for any programs.

    Can you not apply for social security for him ??

  9. klmno

    klmno Active Member

    Thanks, Marcie! What does it take to qualify a child for social security? What are the pros and cons for it?
  10. Marcie Mac

    Marcie Mac Just Plain Ole Tired

    I can't help you with what qualifies - SO illness is pretty terminal but even then we had to get affidavits from his doctors stating that :( and he was still turned down - had to get the local congressman involved. My difficult child was qualified in the IEP process and had services until he was 22 unless he graduated or got his GED - there were dual services thru the school and the Dept of Mental Health.

    I would check the website for your state and look under the Social Services section. Ca has a program called Healthy Families or Healthy Kids - daughter has her three kids on that and even though she makes decent money, because she is the sole support she qualified - maybe your state has something like that??

    But whatever you do try and not let the Cobra lapse until you have something else in place. I think it was good that Congress passed the Cobra law, but they should have gone a step further and said you would not pay such high premiums. If you are covered under the group when you take Cobra, you should get benefit of the same premiums everyone else does.

    I know some of the moms on here have benefits for their kids so someone may know how to proceed

  11. flutterbee

    flutterbee Guest

    If you have continual coverage, the pre-existing condition clause does not come into effect. You have to have no insurance for 63 (maybe 62) days before it's considered a lapse in coverage. And medicaid counts as insurance coverage.

    COBRA is the same coverage as what you had - there is no difference in what is covered and copays. The only difference is you foot the entire premium rather than your employer and you're only eligible to do this for 18 months (3 years in the case of divorce). After that, you have to buy your own insurance.
  12. klmno

    klmno Active Member

    Thanks, Heather!! I have been trying to read thru some of the forms on the links you posted. I can't figure out the income requirements with the method they are listing (I'm not that bright, I guess!). But, it looks like I should just go in and talk with someone and see what they can do. I'll just pay the premium for next mo ($900 ARGHHH) so, something better give QUICK...