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My girlfriend needs health insurance
mrflippy
Registered User regular
Registered User regular
My girlfriend is 20. She lives in Illinois. Her parents for whatever reasons haven't been on the ball with getting her health insurance. Her dad did sign her up for some (Blue Cross Blue Shield IIRC) in December of 2009, but she was then rejected due to pre-existing conditions: History of depression and medication and she is currently prescribed drugs for ADHD. (Which I guess her mom is paying for out-of-pocket now) She's still living at home with her mom, doesn't have a job (which would still not be a guarantee of insurance anyway) and can't pay for insurance even if she could get it.
She's had knee pain for the last few months to the point where it hurts to walk after even short distances. We haven't gotten it checked out because of the insurance and money situation, and because we didn't want even more pre-existing conditions diagnosed.
Do you guys have any suggestions for what we can do? Are we down to paying out-of-pocket for everything now?
I've looked at the Illinois CHIP site. Theoretically she might qualify for that, but it looks to be at least twice as expensive as comparable private insurance. :?
She's had knee pain for the last few months to the point where it hurts to walk after even short distances. We haven't gotten it checked out because of the insurance and money situation, and because we didn't want even more pre-existing conditions diagnosed.
Do you guys have any suggestions for what we can do? Are we down to paying out-of-pocket for everything now?
I've looked at the Illinois CHIP site. Theoretically she might qualify for that, but it looks to be at least twice as expensive as comparable private insurance. :?
mrflippy on
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Or you could just get married, if you have insurance through your job that is. But that's not for everyone obviously.
The reason that CHIP is a shitload more expensive is because it's the high risk pool. Basically the private insurers are cheaper because they are able to push off the bad risks to the state. So yeah, it sucks, but it's pretty much the only option shy of employer sponsored coverage.
http://www.insurancecompanyrules.org/pages/illinois_rules/
A) Get married if you provide insurance. However, this is a BIG decision, etc. My wife and I were already going to get married when I lost my insurance, and so I only had to make it 3 months before I got onto hers. However, in this case, depending on the insurance, they can rush through everything to get her coverage.
As far as the pre-existing condition thing, I don't know. I'm willing to bet most insurance has some clause so you can't join up and immediately have all this stuff done.
Nope. Thanks to HIPAA, the only things that can be denied as "pre-existing conditions" are things that have actually been diagnosed and/or treated by a medical professional.
So long as she hasn't talked to a Doctor about her knee problem she is golden once insurance kicks in.
But I could have sworn there was some kind of waiting period to catch pre-existing stuff. That's awesome if not.
Basically, when you fill out an individual health insurance policy app, they ask you to give your full and complete medical history for like 10 years. If you omit something deceptively or in error, they can cancel your policy retroactively because you didn't disclose that bronchitis you had in 2002. The fucked up thing is that they flag you for investigation based on how much cash you're costing them and will term you for the Bhronchitis even though the thing that's costing them $TEXAS is unrelated.
There's been talks about limiting the time that companies can use this bullshit tactic, and I think it's in the Senate Bill, but I'm not sure about specific limits for Illinois.
But IANLITHIITRJ*
(I am no longer in the Health Insurance Industry thank Raptor Jesus)
Here's a handy flowchart:
Does it help the American people?
Yes
It won't make it.
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No
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It might make it.
That would be awesome, but that isn't in either bill. What you're referring to is "community rating". Howard Dean has been a huge proponent of it.
My mom no longer has health insurance. She has had numerous skin cancer surgeries, invasive and otherwise, and after two years she looked at her bills versus what her doctor would have charged her out of pocket. She was paying almost $6000 more over three years. Keep in mind this is with pre-existing coverage and all, so she was paying somewhere in the rage of 5-700 a month depending on the year (grew higher as her surgeries grew more costly).
Now she just pays it out of pocket and still goes to the doctor just as regularly. Is this a good idea for your lady? I honestly don't know. I'd call the doctor's office and run the numbers.
If you guys are in or near Chicago, I can vouch for this clinic as a good place for low-income patients with no insurance, though I have to admit that I don't know if they include the parents' income when figuring eligibility in a case like hers.
If you're anywhere near Schaumburg I might be able to help with psych recommendations - I work for a psychiatrist in Arlington Heights and we get asked for low/no cost treatment options in the area fairly often.
Right, but insurance companies check to make sure that you haven't had any lapses in coverage. This prevents people from signing up for insurance, getting a hefty diagnosis (that they knew they had), and milking their insurance for it. The insurance company is likely to still deem this a pre-existing condition due to her lapse in coverage unless she waits for a long time (can't remember the time period) to get it looked at by a doctor.
Thanks, I'll check that out. She sees a counselor now, but I'm not sure what the damage is on those visits. (Again, mom pays out of pocket I think) I'll have to check on that. (Though, we're not near Schaumburg at all)
Yeah try talking to the doctor if you decide to go un-insured and see if htey will let you pay weekly instead of one lump sum. I would shop around different insurances in her area and see what the different plans/rates are. Do you guys at your job have to be married to get her on your insurance or is it just living together. Up here I know that when you get extended benefits it is done so that you can be common law (living together for 3-6 months) and they can be on your insurance.
That makes sense, but it isn't true. You could have a tumor the size of a bowling ball that's been growing out of your neck for ten years, but unless there's a medical record of a doctor diagnosing you with Stage IV Super cancerAIDSitis, it doesn't count as a pre-existing condition.
Lapses come into play when you have insurance and a condition, you lose insurance for 60+ days, and you get insurance again. When that happens, anything you were treated for under the old insurance can be a pre-existing condition again. Pre-HIPAA, carriers were able to fuck with people like that when their jobs changed carriers.
Check this out if you want your mind to be motherfucking blown...
http://www.ins.state.ny.us/website2/hny/rates/xml/ny.xml
These are the rates in NYC for the SUBSIDIZED INCOME RESTRICTED plans. $600+ for two people (ignoring Atlantis, because their network has like 5 doctors in it).
For Flippy, I hope you guys can get something worked out. I had an Overextended knee 1.5 years ago and that shit sucks. Also a reason to not take Judo with a beolved if either of you are at all competetive. Fourtunatley for me it was acute and with rest has mostly healed. How does her knee feel if she wears a brace on it? I find if I use a Neoprene brace (the one I use has to velcro to secure it top and bottom and another behind the knee) when I am at work (I am in retail and we move alot!) It does not bother me on teh days I don't use it. Maybe as a stop gap mesure she could try a brace? Look sround at the ones in your pharmacy perhaps.
EDIT:
Crap I just noticed the mental health issues. Those are way more important than a knee. When we were having money issues and neither of our jobs offered prescription my doctor had trial packs of antidepressents (fourtunatley the ones I was on) that he gave me to get me over the hump untill we could afford them again. I just can't wrap my head around being denied coverage for mental health issues. It's someting you NEED to get taken care of. See if a Community Health or Mental Helath or something has a prescription plan or something you can get on. I am not sure how it works there but here you can have a prescription plan that covers just mental health drugs and many even be free if you qualify for a subsidy. Maybe a communtiy outreach has a subsidized place you could go to get prescriptions.
Hugs and lots of love from me to you guys.
My employee health isn't too terrible price-wise just for me, but I guess family members aren't subsidized.
She has knee braces, but she doesn't wear them very often. I think now that she's been officially denied coverage, I might as well get her to a doctor to figure out exactly what's wrong and what we can do to fix things.
Just a correction here, but a form of community rating as well as guaranteed issue is in both the Senate and House healthcare bills. I think that is one of the primary motivations for the exchanges. The health insurers are allowed to vary the price of premiums for plans in the insurance exchanges based on age, but not based on medical history, and there are limits on the difference in prices they can impose between young and old. The Senate bill was a laxer ratio allowed for variation on age than the House bill, but the both had this.
The purpose of the individual mandate in the bills was to deal with the same thing that the pre-existing condition limitations are supposed to deal with: someone not buying insurance until they get sick and need it.
Anyways, health insurance rules and regulations vary a lot by state. Your girlfriend is going to have trouble getting affordable insurance as it is now in states that allow medical underwriting, and I believe the bulk of them allow it to a varying extent. Some states have high risk pools, which appears to be the case with ICHIP. High risk pools tend to be rather expensive because the health insurance companies offload as much of the chronically ill and really expensive people onto the high risk pool that they can get away with. Employer provided coverage and ICHIP seem like the likely options you have.
The other possibility might be Medicaid, but from what I could tell a lot of the family and child assistance in Illinois had an age cut off of 19 for children, which is rather unfortunate for your girlfriend. You might want to poke around that a little more and see if she could be eligible for that.