Questions!! On Insurance Hunt.

SleepySparky · Post by **SleepySparky** » Sat Jan 19, 2008 8:07 pm

Hello All,
You all have helped me many times. I hope asking one more time will not be "too much". I have been without insurance for many years, since hubby is self employeed and there is 5 of us, it was too expensive and we could not afford it. Well now I have OSA, and narcolepsy (untreated for 10 years), and I have two kids recently diagnosed with ADD. I am spending about $500.00 a month in meds. alone. I went looking for insurance and thought if I could find a decent policy for about $500.00 or so it would be ok. Well here is my delimah, no one I have found so far will cover any pre-existing for 12 months. Well I can not afford to pay for the meds. and another $500 a month for the insurance policy. So what I need to know is this. Does anyone know of a company that will allow pre-existings and cover them in less than 12 months? Do you know of a way to get a policy that will cover the current condititions and pay for the meds.? I know back in 1996, we were with no insurance and hubby started a new job when I was 3 months preggers. I called the new insurance and asked if the pregnancy would be considered pre-exisiting, and they said NO, just find a cover Dr. and go. I know pregnancy is different from an actual medical condition. But according to everything I have read I am not having any luck finding any one who will cover the OSA, or ADD for either of us for 12 months. Can any of you chime in and tell me of any one that might cover the ADD and OSA or even who you would recommend looking at or staying away from? Any input would be greatly appreciated.
Thank you,
Tina

sleepycarol · Post by **sleepycarol** » Sat Jan 19, 2008 8:56 pm

I don't know of any that will cover preexisting conditions unless you have coverage and can proof that you had medical coverage prior to obtaining the new policy.

Have you checked with your local health (here it is the county health nurse) department. In Missouri they have a state health insurance policy a parent can obtain for their children that is really reasonable. It is called MC+. Your state may have something similar.

There are alternatives to treating ADD with meds. Have you tried different techniques with your kids? Meds, in my opinion, is often not the answer as usually they have to learn to cope as adults with ADD. With my son we did behavior modification, diet changes, and therapy. He learned how to function without meds (I refused to put him on meds) and is now very successful in his business and is respected within our community. I teach school and so can speak from a teacher's point of view as well.

Some drug companies will give price breaks for those without insurance coverage if they meet certain criteria -- you may want to check with your pharmacy.

Wulfman · Post by **Wulfman** » Sat Jan 19, 2008 9:09 pm

Are you currently employed?
See if you can get a job with a government agency (county/state/federal).....they probably won't have any pre-existing conditions for new employees.

Den

cflame1 · Post by **cflame1** » Sun Jan 20, 2008 7:48 am

Not sure if this would help anything either... but I know around here 2 of the big grocery/drug stores (HyVee and Dahls) and Walgreens all have a deal where you join a prescription club and you can get a list of generics for $4 a script.

sleepycarol · Post by **sleepycarol** » Sun Jan 20, 2008 3:12 pm

I know our county doesn't have diddly squat for coverage. My husband worked for our county road department for a couple of years and the insurance was sooooo baaaad and by the time you paid the premiums and the copays, deductible, etc. that I paid for coverage through my employer to the tune of several hundred dollars a month for our coverage since our coverage was better and you had better benefits.

He ended up finding a better job with better benefits.

If you want really good BENEFITS go with the FEDERAL government -- their benefits are great or was when my dad worked civil service!!!

I think for many it depends upon how "wealthy" your state, county, city government is. In the bigger (more populated areas) cities and states they probably do have better benefits but rural areas don't have the tax base and therefore aren't as great about paying. Our sheriff deputies qualify for food stamps due to low wages, along with many other county and city workers.

SleepySparky · Post by **SleepySparky** » Sun Jan 20, 2008 9:12 pm

Thanks for the suggestions. Unfortunately we make just over what the maximum requirement to qualify for the CHIPs program (state insurance for the kids). I do have the Walgreen's medication club card. I got my card in the mail and that is definitely a help. I saved more than twice what the card cost the first time I got my old son's and my meds. as well as the 10ct. script of new meds we were trying for my youngest. Unfortunately the meds. we are on are not included in the generic formulary the stores around here have for $4.00. I wish like heck they were. But Adderall and Daytrana are not on the list. No, unfortunately I do not work, been laid off of way too many times due to the narcolepsy. Not only that, the jobs I could get right now are not going to pay enough to cover the day care, gas and maintence on the car. I have not worked in 10 years, I stayed home when I got pregnant with my 2nd child as we did not want the kids raised in day care and were doing ok money wise. Bob was employed by a neighoring city and we had insurance at the time. Actually truth be told we were fine without insurance until we all had to be put on meds at the end of last year. We have tried numerous different avenues for the ADD before finally putting them on meds. Alex's anger was getting so bad, and he was hyper and his grades were really getting so bad that in order for him to graduate and get in a decent College or Trade School we really do not have much choice. My middle one was so hyper and unattentive he was not even able to sit in a desk to do his work at school, his reading was so bad we were scared that he would not pass the State Test (TAKS) that he HAS to pass (state mandated) to go to 6th grade next year. (We had that problem last year and got lucky and since he attended summer school he was able to advance to the 5th grade) His teachers were concerned. We were doing everything we could think of, as they knew I was very much against putting him on meds. I even took him to congnative therapy twice a week to the tune of over $1200.00 last year. To help him learn to read in a way he could understand the information and retain it. His Dr. explained it as he basically has 6 TVs running at the same time, and knows what is on each one. But he does not focus or is unable to focus on any one for very long. Now that he is on meds. he is focusing better, and he is sitting in his desk at school. His teachers seem to be impressed with his improvements. (He only takes his meds during the week, does not take them unless he is going to school, so his resistance does not build up so quickly) Cody is a highly intellegent child, his grades in everything except reading and subjects that include a lot of reading were poor. I know he has the intellegence and love of school to do really well and easily get a scholarship and I do not want the ADD to prevent him for getting what he deserves. So I went against what I wanted and put him on meds. So the meds. that the three of us are taking are really killing our finances, and insurance would help but I can not pay for the meds and the insurance for a year. Why do these manufactures who supposidly help people pay for the meds. they need not take into consideration that you are paying for three people to take these high price meds. My income right now is not good, home building is at an almost stand still because of the economy so sluggish right now. Hopefully there will be a light at the end of the tunnel real soon. Thanks for listening to my rant. I do hope do not sounds too much like I am whinning. That was not my intent here. Just hoping that someone might know of a way to get through this delimah, soon.

sleepycarol · Post by **sleepycarol** » Mon Jan 21, 2008 3:43 pm

Is hubby willing to go to work at a job that pays benefits?

Sometimes we have to take a hard look at our priorities and do what we don't want to do in order to get from point a to point b.

Many people work, not because they want to, but because they have to in order to receive benefits, specifically insurance.

I don't want to sound mean but my husband is an example. He is working a job that he would not normally choose due to the benefits offered. He weighed the options and decided this is what he must do in order to have insurance and benefits as we are getting older. He has always worked heavy construction. He is now working for an energy company due to the benefit package they offer.

I know you said you have health concerns, many of us. Many of us still manage to hold down a job in order to have benefits and insurance coverage. I have several health concerns and cannot afford to quit working -- I need the insurance coverage.

Your family has made a choice to be uninsured for several years. You have saved the cost of premiums that you would have paid for those years without coverage. The trade off is that now that you need coverage they are not going to insure those preexisting conditions that you have for 12 months. If coverage is going to cost you approximately $500 a month look at this way -- how many months did you go without paying the $500 a month premiums what were your savings? If you were without coverage for over a year your still ahead as far as cost go.

I am not saying these things to be mean -- but trying to look at things realistically.

Maybe hubby could go to work elsewhere until the economy picks up.

dieselgal · Post by **dieselgal** » Mon Jan 21, 2008 4:06 pm

My husband is a mobile diesel mechanic and we have our own small business. I decided that I was going to quit work and for about 5 years I did, but I never let my insurance lapse. For a while I had Cobra and then I went to Texas High Risk through Blue Cross. I couldn't get any other individual plan because I am overweight and have high blood pressure. My husband was in very good shape so he was able to get insurance through a regular insurance company. The problem is that the rates kept going up every year for both of us and we kept having to raise our deductible to even afford the monthly premiums. For just the two of us we were paying $600.00 a month and both of us had $5,000 deductible. Which means that we were not able to use the expensive insurance we were paying for.
In the end I ended up going back to work at a low paying job for a company that has good insurance so I basically work for the insurance. I had to make that decision because I felt like I was not pulling my weight with the money and putting a big burden on my husband, and that wasn't fair since I am not crippled. Now through my company they pay for my insurance and I just have to pay for my husband and the benefits through the company are fantastic compared to what we had before.
Once you start getting older you really need the insurance but you can't wait till you really need it to get it. Even though I don't love insurance companies I can see why they have the rules they have. If they didn't, none of us would get insurance until we were diagnosed, then we would all join up and where would the money to cover the charges come from since there would be no money put in before we needed to use it.

jules · Post by **jules** » Mon Jan 21, 2008 5:05 pm

I think both sleepycarol and dieselgal are on target here.

I know where I worked (I am a retired state employee), many were like dieselgal and carol's husband. They worked to provide insurance benefits for their family. The take home pay would have been better working in the private sector, but the insurance coverages offered them more than just the $$$ at the end of the month. Sometimes, they drove 50 miles each way to work to have this.

As far as coverage for a family of 5 for $500 / month, that sounds pretty unrealistic to me even without preexisting conditions. I pay close to $ 200 a month for coverage for my spouse under the group policy (state). We still have good sized deductibles, copays and more we have to pay for besides the insurance premiums. We do have a stop loss for hospital and doctor visits if we can find in network providers, but the copays for prescriptions are getting to be high and no stop loss there.

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I think one lesson I have attempted to learn along the way in this life is we have to accept the consequences for our choices. Sometimes that choice is choosing not to do something.

sleepycarol · Post by **sleepycarol** » Mon Jan 21, 2008 5:50 pm

Actually $500 a month for a family is reasonable in my opinion.

My employer pays a flat $300 a month towards our premiums leaving me with $207 withheld from my check for the total premium cost. Our total premium is $507.00 a month for one person. For a spouse is an additional $507.00 and if you add dependents it is another $400.00. Our insurance is Blue Cross and Blue Shield.

We have 5 kids and our premiums when they were growing up was approximately $500 a month back several years ago. Hubby worked heavy construction and as a diesel mechanic for a local construction company and was union. His employer paid $2.50 per hour for every hour worked for insurance benefits. Hubby usually worked 50 to 60 hours per week year round.

jules · Post by **jules** » Mon Jan 21, 2008 5:55 pm

$ 500 total - no employer paying anything towards the premium is what I based my statement on.

Mask