15 replies to this topic

[0vercast]

First let me say, I'm not looking to start a political war about the Affordable Care Act a.k.a. ObamaCare.  I was just dx at age 29 about 6 weeks ago, and the initial shock and worry has worn off.  Now I need to plan on a life with an expensive pre-existing condition.

I would like to know what experiences people here have had with their pre-existing condition of leukemia and how/if it has affected their health insurance coverage in the past in ways such as denial of coverage, waiting periods before coverage begins, lifetime limits, higher premiums, higher out-of-pocket maximums, etc?

Thanks, Joe

[Susan61]

Hi Joe:  I am assuming you have not had any type of insurance prior to your diagnosis.  If you were insured then your care will be paid for through your insurance.  Whenever you switch insurances you have to be sure that you go from one to another with no lapse, or thats when the pre-existing problem arises.

     If you have no insurance now, I think there are other options for you to get your care paid for. Wait to see if somebody else can offer you some information.  I hope I read your message correctly.

[Marnie]

Hi, Joe. . .you just need to make darned sure that you never have a lapse in coverage.  I've seen no change in services. . .however, you do have to become your own advocate and even become pushy and nasty on the phone sometimes.  I have had to switch insurance carriers 3 times since diagnosis, due to emplyer changes in coverage, and it has been a pain every time.  Be prepared to spend lots of time on the phone. . .keep careful records of who you talk to and when you talk to them. 

Marnie

[0vercast]

Thankfully, I do have good, stable insurance through a union.

[Susan61]

Hi:  If you have insurance, then don't worry about it.  Like we have said, just do not let it lapse at anytime.  I am under my husbands insurance.  I was diagnosed in 1998 with Leukemia, and have never had a problem with any payments.

Once when my husband was out of work with no other job to go to, we just payed into the COBRA which is just a transfer from your insurance to COBRA until you pick up another insurance.  It cost us a ton of money to have the COBRA, and I would not recommend anyone switching jobs unless their insurance can get moved into the new job right away.  Just be sure if you decide to make any job changes that you check out how the insurance comes into play.

    You should be just fine.

[chriskuo]

As long as we are part of a large group that continues on, we should be in good shape relative to pre-existing conditions.

Getting individual coverage is likely to be difficult or extremely expensive to obtain.

We have to hope that the groups providing our coverage don't stop subsiizing our coverage. 

If we were to switch to a small employer which provides health care coverage, we are likely to blow their premiums out of the water.

We have a lot riding on the decision at the end of June.

[mscl]

I'm fairly certain (not 100 percent sure) that health care reform eliminated life time maximums in 2010.  Plans can impose an annual maximum though.

[Happycat]

While I like the pre existing conditions clause in OCare, the whole "advisory panel" in charge of keeping down costs scares the cr@p out of me!  I keep,thinking about the NICE board in Britain nixing tasigna and sprycel coverage.

Mscl, I believe you are correct on the lifetime maximums being eliminated with OCare, but not sure about the annual maximum. I hope not. Gee, what happens if you are dx'd with cancer in January?  Treat until June, then take 6 months off until the new calendar year?  I sure hope not.

Traci

[chriskuo]

Not advocating the British approach, but in January, NICE approved Tasigna for first-line treatment (Novartis offered a discount, BMS did not on Sprycel).

[CallMeLucky]

NICE's rejection was never about the drug - it was negotiation tactic to get the drug company to cave on their pricing - it worked with Novartis but failed with BMS.  Sadly they were all willing to play chicken with CML patient's lives.

[jenz]

question,

If you end coverage with company on 3/31, go onto cobra through 5/31, and start new coverage with new company on 6/1.  That is not considered a lapse in coverage correct? But do you get your evidence of insurance from insurance company you had through 3/31 or Cobra? I thought Cobra coverage is the same exact coverage you already with the SAME company? Is that not the case?

there is a chance I am going to be making a job change soon and will be going into this situation. I'm so afraid knowing what my medication costs are alone on top of my medical care.

[CallMeLucky]

What you describe would not be a lapse in coverage.  You are correct that COBRA is a continuation of your existing coverage, the only thing that changes under COBRA is that your employer no longer pays their share of the premium so you have to pay the whole thing which is why it is so expensive.

You should discuss with the HR people where you are leaving and where you are going.

With where you are going, you may not want to lead in with "I have CML and need coverage".  You may just want to go with, "I have a special need in my household and need to ask some questions about coverage to ensure there are no lapses" or something like that.

[jenz]

I've found a great website for information about Cancer in the workplace. 

www.cancerandcareers.org

I did find this tonight on their website.

"If you're offered a group plan through your work, your eligibility can't depend on current or past health status. Just because you have had cancer, you can't be refused coverage under a plan offered by your employer. But when you join, the plan can exclude coverage for a pre-existing condition temporarily. That waiting period is typically no longer than 12 months and sometimes is briefer."

I didn't think 'ever' if you sign up for health coverage through your employer during open enrollment they could exclude coverage for pre-existing conditions even temporarily? Has anyone experienced a waiting period when switching employers OR insurance companies?

[Happycat]

Yes, I understand that. That's why it is so scary. Would rather decisions be made on efficacy and patient needs, not as part of cynical negotiating tactics.

Traci

[Happycat]

My company is self insured, and when I was hired, way back in 1995, there was a one month waiting period for coverage. Not sure if they still do it, but they did back then.

Traci

[PhoenixPat]

There's a new Pre-Existing Condition Insurance Plan program that provides coverage for those in the US who have been denied health insurance because of a pre-existing condition or who have been uninsured for at least six months. There's more information here: https://www.pcip.gov/

While I know people who have coverage under this program, I have not met anyone with CML who is using it. If anyone reading this does know how this works with CML I would appreciate more information, especially on co-pay rates. You just never know when you could lose your insurance coverage.

Thanks,

Pat