WHAT IF YOU LOSE YOUR INSUARANCE?

HI all,
I have not posted in a few weeks. I get my St. Jude Pacemaker this Friday morning.
I guess i thought if i didn't think about it.....it would just go away.
I am so tempted to cancel...I realize you all didn't want one either.
So of course I am sitting here trying to think of why I should NOT get it.
BUT......I really do need to find the answer to this....if any of you have had this issue arise.
WHAT IF......I lose my INSURANCE ? I would have a PM that needs maintenance and I will need check ups and on and on...it's a never ending bill!
Does your EP see you if you have lost your insurance?

I was already told that a pacemaker will not entitle me to SSI.
Thats fine...I don't want SSI unless I need it....but..I may.

I will not be able to return to my job....ever. Soooo,, Thats my QUESTION....
What kinds of INSURANCE issues might I be facing?
Thank you for all of your help....you have helped me so much already.
I am sure next week I will be back with all of my fears and will need a shoulder to lean on.......Thank You in advance!!

Holly

7 Comments

Insurance

by notnomalteen - 2008-07-20 11:07:32

Ok I am only 18 but I am a medical Billing specialist


An insurance company CAN not deny you insurance due to a preexsiting clause, depending on the insurance company you have, u might just have some forms that need to be filled out. The insurance should not give you any major problems, one minor one is depending if you have an HMO or and PPO u might have to find a new EP, you have to go to a doctor in your network. Hope this helps


stephanie

Just my own research and expereince

by swilson10 - 2008-07-21 01:07:57

My cardiologist and I were just talking about this issue last week during my visit. I think in theory you can not be denied coverage for pre-existing conditions, however you can be denied a policy or coverage if you don't follow some very specific and tricky rules. My understanding is that this depends on several factors including what state you live in. My research (I live in CA) has also revealed that unless I go from one group plan to another with no more than something like a 60 day lapse in coverage I can be denied several critical benefits. I believe that in CA there is some type of program for people with serious chronic health conditions who do not have insurance or who have been denied coverage, but again it is a very lengthy application process with a lot of fine print items, including the fact that you have to be denied coverage by a certain number of companies and demonstrate proof. You also have to demonstrate that you do not have any COBRA benefits available, etc.

The short answer to what the doc said when we talked was "unfortunately you live in a country where you are somewhat trapped by your health insurance". My job provides me excellent health coverage, but not excellent job satisfaction.......I could not have ever guessed that at 30, with a post graduate degree, a strong work ethic, and a fairly impressive resume I would be "stuck" in a job and a city I didn't want to be in. I am interested to hear if other people have had different experiences or success in losing their health insurance and getting new coverage over a period of time. The few companies I contacted (and they were the big ones) to see how much it would cost if I wanted to be self employed and self insurance flat out said "no, with a heart condition such as yours our underwriters would never offer you a policy".

Sorry for the less than up lifting news about the health insurance. On the other hand, I have had 4 heart surgeries in the past two years related to my pacemaker and subsequent complications and with the exception 8 weeks one year and 10 weeks another I have been able to work a full time schedule and run a small business. Best of luck to you Holly. Keep us updated on how things go.

Unfortunetly

by gldoble - 2008-07-21 12:07:02

All of what everyone else has said is very true. I'm 51 the Docs want me to"retire" and do SSI, etc.

Well here is the crux from SSI, becuase I am working I am not considered "disabled" unitil I have been out of work for 6 months. California SDI will not kick in in for 6 weeks after I file. Cobra for me would be in the order of $1800 per month. Hummm. "retire" don't think so.

Then to top it off I have 3 small kids,

Work until the company changes or I can't anymore
yup. Does this entirely suck--- Big time.

No carrier I have spoken to will cover me as an individual. Even though the fed and state say I'm not disabled until I can't frig'n move.

So a word to the wise, save as much as you can. Becuase when we loose our grup insurance and the battery goes beep, I'm going to guess thats going to be our 5 minute warning.

Greg

Thank you..Stephanie

by LIVE_STRONG - 2008-07-21 12:07:34

Thank you for the insurance information....that is great to know.
What I was wondering is...what if I lose my insurance and can't afford health insurance.....and I have a PM.....

As of right now.....most of the expense should be covered by my BCBS.
BUT....if I lose it and go without health insurance like I have had to in the past.....what would I do?
Is there government help or something.....do they just say...don't know what to tell you?...and you have a pacemaker that needs adjustments or replacement..... kinda scary.

Holly

Insurance!

by tcrabtree85 - 2008-07-21 12:07:51

Hi,
I did not read through anybody else comments but I wanted you to at least know what I have faced. I lost my health insurance right after getting my pm also. I have had trouble getting health insurance b/c it is a pre-existing condition.
You can get coverage at any other job but they will not cover you pre-existing part normally for at least up to a year.
So what I have done without having health insurance is talk to my dr office they gave me paper work to fill out for assistance and have helped me out that way. I have assistance from my heart clinic for a year and then I would have to summit again. I would have not known about all of this without being in the health care. Talk to your dr office and hospital now and let them know now that you will be loosing your job which provides you health care.
You should be able to start the paperwork part now instead of waiting last minute like I did. I wish you luck and if you have any questions feel free to send me a private message.
Many thoughts and prayers!
Tammy

Health Insurance

by kiljake1 - 2008-07-23 06:07:12

The health insurance issue can be scarey. Check out Michel Moore's film SICKO to see what it could be like .
Jim

I am in CA, too

by auntiesamm - 2008-07-26 01:07:26



Another question: If you don't get a PM now because you are worried about followup, maintenance, etc. thank about this: What is you don't do it now while you are insured and then need a pacemaker and have no insurance? That would be a much more serious and scarey situation. I've had my PM just more than 2years and have had absolutely no problems. I have an interrogation every 6 months.

Insurance: please go to the internet and research the HIPAA or Health Insurance Portability and Accountablity Act. This is what governs insurance coverge in this country. It supercedes any state regs. Basically, if you are covered under a group insurance plan and change jobs which provides group coverage there is NO EXCLUSION for pre-existing conditions. It is critical you learn as much about all this as possible.

Unless you have other significant medical problems and your physicians can attest to your need for SSD based on disability lasting more than 12 months you most likely will not qualify. You could choose to appeal a decision against your claim but that can be a real long, drawn out situation with no guarantees. Doyou have others in your family on your group plan.

I worked many years in the hospital industry and it is a serious concern to not be insured. In CA we do have Medi-Cal which is the same as Medicaid. However with all the budget cuts it is getting harder to qualify and get funding. I think you are worrying way too much about the "after care" when you should be making plans to get the PM which can be a life or death decision. Good luck as you deal with all this and God bless you.

Sharon

You know you're wired when...

Your heart beats like a teenager in love.

Member Quotes

But I think it will make me feel a lot better. My stamina to walk is already better, even right after surgery. They had me walk all around the floor before they would release me. I did so without being exhausted and winded the way I had been.