Early Surgery

Hey ya'll.. newbie here (new to the forums). I've had a pacer since I was 16 and have had a few pacer replacements since then (the last being in May of 2002). Back in February, I had a checkup and they said I had about a year and a half left on the current one I have.

Since then, an opportunity has come up for me to takeover a small restaraunt business, but unfortunately as you're probably all aware, I'm conflicted, because it would cause a lapse in my health insurance. The insurance issue has always had me scraed and kept me from chasing my own dreams and instead working for "corporate america". Now, my (soon to be) in-law family has dangled this carrot of an opportunity in front me to be able to get out there and do my own thing. The business is well established, brings in great $$, but insurance is my biggest fear.

I'm trying to get my doctor to "okay" me having my replacement done earlier, before I leave my job to pursue this. Also, I'd like to know if anyone has advice or knwos of a good insurance company that will insure the self-employed at a "reasonable" rate.

Any help would be great.. I'm a hard-working guy, I'd prefer to have my own insurance rather than let the gov't take care of it... especially with all the stuff that's been going on in the news lately with the "O" administration, there's just too many unknowns to have to worry about whether or not I'd be eligible for Medicare/Medicaid, not to mention, a little (perhaps too) prideful to go the "disability" route.

Thanks for hearing me out! :)

Derek
aka
"Pasquale"

7 Comments

plans

by Tracey_E - 2009-08-11 01:08:39

I found it's not even a matter of cost but of coverage. I was not able to get an individual plan that would cover cardiac at any cost. Either they turned me down completely, or they would give me coverage that excluded cardiac.

I don't see any reason not to tell the doctor the truth- you may be changing coverage and would like to do it sooner rather than later. It's not insurance fraud, it's simply timing. Some insurance companies make you wait until your device is EOL, but most leave it elective. I've done mine early to accommodate summer vacation, no questions were asked.

Lots of professional organizations and some state agencies help their members get group plans. Joining with the other family businesses is a great idea, could bring the price down for everyone. And everyone runs into this at some point! My parents are self employed also. Dad had back surgery, mom has afib so they struggled to keep private coverage until they were old enough for Medicare. Dad ended up offering insurance to his employees that he really couldn't afford, but it gave him enough people on the plan to get the group policy.

Sure was easier when we were kids on mom and dad's plan, huh? I remember my first rude awakening. I went into business for myself within two years of graduating college and was shocked to find no one would cover me. I was healthy! What's a little heart condition that never bothers me? I was engaged at the time so I was able to stay on Cobra long enough for the wedding and to get on my husband's plan.

insurance woes

by Tracey_E - 2009-08-11 10:08:40

It's tough being self employed when you have a pre-existing condition! Others here who are self employed have found insurance on their own, hopefully they will step in with advice. I have not personally had luck with it. I am self employed, my husband works for a large company and I am on their group policy. He briefly considered going out on his own, but we nixed the idea when we couldn't get insurance for me. Unless things change drastically in the insurance business, one of us will always work for a company large enough to have a group plan.

I assume the restaurant doesn't have enough employees to get a group plan? That's really the only way to get insured, a group plan doesn't look at pre-existing conditions. Does your future wife work somewhere that you can be on her plan after you're married? Medicaid isn't an option if you own assets, you're probably too young for Medicare. You're not disabled, so that route is likely closed. You might want to check with SBA, your state, the Chamber of Commerce to see if they have any plans. Restaurant owner's associations would be another place to check. Sometimes they have opportunities for small businesses to pool together to make a group plan.

Getting the replacement early is probably a good idea, esp if you think there is any chance you may end up uninsured. I've never done one a year early, but I've done them a few months before it was necessary so I could time it with school breaks when my mom can take my kids. My doctor was fine with it, just tell him when I want it and he gets me on the schedule.

Don't even get me started on the talk going on in Washington over reform! LOL The only good thing I've heard is talk that insurance companies may be forced to ease up on pre-existing conditions. The rest scares me.

re: SBA idea..

by Pasquale - 2009-08-11 12:08:23

you know what?.. that's a really good idea.. her brother also owns one in the area as well as her father, etc.. (Greek's and pizza places.. HA HA!.. go figure :) )

maybe, I could talk to them as well as the Chamber of Commerce.. thank you so much for that idea (sorry, I missed it the first read-through)

Also, I do have an appointment on the 14th of Sept. to meet with my Doc for my next exam.. any ideas on how to "word" it when approaching this?.. Ie: I don't think it would sound good saying "Hey Doc, I'm about to leave my job and I won't have insurance, can you change my pacer out now, even though it's not quite ready?".. I'm wondering if that loosely translates to "hey Doc, can you commit insurance fraud for me?"

am I wrong?.. can I be that blatant, or should I choose my wording carefully?.. aye.. it was so much easier back when my parents took care of all this part of it (I'm 33 now..*sigh*.. if only I could be a child again)

The insurance stuff actually freaks me out more than the surgeries themselves..LOL!

(well, except the part where last time they didn't seem to sedate me enough and I wounnd up going through post-surgery therapy for PTSD for a few months.. that's another story alltogether though)

re:

by Pasquale - 2009-08-11 12:08:48

TraceyE.. thanks.. Yeah, I've actually discussed that possible route with my sig. other.. I think that may wind up being the route we may have to go (a group plan for all my employees), even if I could get insurance on my own, it may still be cheaper to go with the group plan.

Thanks for the info.. I've been perusing the board this morning and it looks like quite the helpful site. :)

Derek

A thought!!

by Hot Heart - 2009-08-13 06:08:20

Can you not form a company and get it to employ you?

HH

HH

by Tracey_E - 2009-08-13 09:08:11

Yep, he sure can, but he needs enough employees so that the insurance co considers him a group plan.

Have you considered this. . . .

by sugarleaf4 - 2009-08-17 03:08:18

participating in a clinical trial for people who need a pacemaker. There is a current clinical trial that is open for participants who need a pacemaker. It is sponsored by Biotronics and you can find the information on "clinical trials .gov". There are recruiting centers all across the country so you might be able to find one near your location. This route would enable you to get the PM and the follow-up at no cost to you in exchange for your participation (of course).

I know time is of the essence. I suggest you talk with your doctor and request to have the surgery at your convenience because of insurance issues. I think he/she will understand.

You know you're wired when...

Muggers want your ICD, not your wallet.

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Today I explained everything to my doctor, he set my lower rate back to 80 and I felt an immediate improvement.