Help employer changing group health insurance Oct. 1st

15 years ago

I am mainly a lurker here but I just have to blow off some steam. My right knee starting really hurting in April, 2007. Went to specialist and he said severe osteoarthritis. I was downsized from my job the following month, could not afford Cobra. I finally got a job with health insurance that went into effect this past Feb. My knee has gotten so bad that I can't walk far at all and it hurts all of the time. I went back to the specialist and he said all that would help me would be a total knee replacement. On September 16th I went ahead and scheduled surgery for October 18th. On the very next day I had a message to pick up my insurance renewal packet at work. They had changed health insurance companies beginning Oct. 1st and mine being a pre-existing condition will not be covered until next February. I am in such pain I cannot wait four months I just don't know what to do. I just turned 60 so waiting for medicare is out of the question. Thanks for listening, I live alone and needed to vent. Marcia

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Comments (21)

juellie1962
15 years ago
Marcia, it could vary from state to state, but I'm pretty sure if you've had continuous coverage, they can't deny you because of pre-existing conditions. Do you have an HR department? I'd start there. Make sure when you change insurance companies you get a "continuous coverage certificate". Good luck!
malexia
Original Author
15 years ago
I am in NC and continous coverage is 18 months which I have only had eight months. Since being downsized from my job three years ago this is the first job I have had that offered ins. even though I pay 200.00 monthly, $2000.00 deductable, then ins. pays 80%. I am going to check with my HR Dept. this morning. Thanks for your help.
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bee0hio
15 years ago
Checking with HR is probably the best thing to do. Pre-existing exclusions is one of the fixes that the recent health care legislation has taken care of, but I don't know when it goes into effect.

Perhaps your ortho dr can give you an injection into your knee that could help you limp along for 4 more months. Otherwise, it is very $$$$ to have the TKR surgery & follow up therapy, plus you never know what complications might arise that would add even more $$$ to the final cost. I'm sorry you are in such a tough spot.
azzalea
15 years ago
Have you talked to your surgeon? I know time is short, but sit down with him, let him know the problem, maybe there's some way the surgery could be done immediately, under your current coverage? Most drs I've dealt with understand the financial aspects, and are willing to work with you. when DH needed a biopsy a couple of years ago, his dr. could only do it after the 1st of the year. That would have been VERY expensive, since we'd already met our deductible for the previous year. The office worked with us, and one of the other associates was able to fit him in between Christmas and New Year's, so that the bill was paid by our insurance, rather than mostly coming out of our pocket.

You need to start talking to anyone who can make a difference,. And if you don't get help with your HR dept, insurance company, drs', give your state insurance commissioner a call to see what he/she can suggest. Good luck.
kacram
15 years ago
((((((((Marcia)))))))))))))))

Check out Azzalea's idea!
Tally
15 years ago
Are you sure the packet you received isn't for enrollment for 2011? Most experiences I've had require you to fill out your selections in the fall for the next year.

If that's the case, then perhaps your current coverage actaully lasts through the end of 2010.

Check with your HR department. You may still have time to get this fixed before the new plan kicks in.
kathyg_in_mi
15 years ago
I agree too, call your surgeon right away and let them know the situation. A lot of times surgeries are cancelled for one reason or another. You might "get lucky".
Kathy G in MI
susanjf_gw
15 years ago
you'd be amazed how fast surgeons can fit you in to get paid, lol...and mine was a complete hyst!
ritamay91710
15 years ago
Feel lucky that you still have insurance, my hubby's company just cancelled theirs.....they paid half, they actually used to pay the whole thing, then went to half. Now we can't afford it.
I agree though, check with the dr. they might be able to get you in sooner. Good Luck.
Vickey__MN
15 years ago
When an employer changes insurance companies, it is considered open enrollment and pre-existing conditions applies differently. Double check with your HR on this, but I'm sure you don't have to worry. It's not like you chose to change insurance, your employer did, and there are different "rules" when this happens.

Vickey
heather_on
15 years ago
I was going to suggest you call the surgeon and at least let them know in case there is a cancellation.
malexia
Original Author
15 years ago
I appreciate all of your responses and am following your suggestions. I called the HR person Monday morning and she said she would see what she could find out and call me back on Tuesday. I had a cortisone injection in my knee on Sept.2nd and it did not help at all. The new coverage starts on Oct. 1st and I really resent the fact that the company did not let us know they were looking at changing companies. I work the overnight shift and haven't been able to sleep for stressing over this. Again thank you all for your help. Marcia
azzalea
15 years ago
Thanks for letting us know where you are. Hope you get it all worked out, and get relief sooner rather than later. Keep us posted.
malexia
Original Author
15 years ago
I will keep you posted. Thanks, Marcia
malexia
Original Author
15 years ago
I am going to check the HIPPA law and see if I have any protection there. Marcia
janie_ga
15 years ago
Also check with your insurance commissioner's office. I have had to get their help when I had problems with the insurance company. They should have an ombudsman or patient representative that you can at least talk to.
malexia
Original Author
15 years ago
Good News! Found out Friday that the information we were given applied to less than fifty employees. We have more than that so I am covered.
juellie1962
15 years ago
That is wonderful news Marcia!! Hope your stress level is lowered now!!! :) btw - sometimes the 2nd cortison shot works much better than the first. Might want to try another while you wait for surgery.
Vickey__MN
15 years ago
YEA!!!...

Vickey
gadgets
15 years ago
How relieved you must feel!! Thanks for updating us. I hope your upcoming surgery/recovery goes very smoothly.

Shirley
ritamay91710
15 years ago
glad that worked out.

Help employer changing group health insurance Oct. 1st

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juellie1962

malexia
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