Some Questions about Insurance Issues

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DrBenway - 28 Nov 2004 04:55 GMT

Hey Guys
I read an older post in this group about someone who suggested that if
you are diagnosed as having Hep and then change policies
The new company may refuse to pay for treatment as this is now
considered an "existing condition" Can anyone shed any light on this?

I'm presently on my 2nd week of as many as 48 weeks
I'm just wondering if there are any potentially quirky area's
related to loosing coverage, (moving, changing your HMO etc )

Or even as others have suggested if you don't see the 99% drop
after (in the case of 1A) 12 weeks changing to an alternate medication
anyone have any problems with their coverage?.

Or if you need supplemental drugs for Thyroid or blood counts
Any issues or personnel experiences that us newer slayers need to be
aware of? (how about costs for the supplemental RX?)

Any legal groups protecting us (we don't get the same coverage as the
HIV folks)

Seems like a good topic and I don't see this in most the threads
It's still support just leaning towards the practical rather than the
emotional type.

BTW I've already had a lot of "fun" dealing with my HMO
but as someone pointed out those type gripes may sound
annoyingly pointless to someone without any coverage.

Thanks in Advance
DB

Thanks
DrBenway
(not a Dr nor did I play one on TV,
but used to play DR as a kid a lot if that counts)

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Gordo Mondragon - 28 Nov 2004 22:29 GMT

[....]

> Or if you need supplemental drugs for Thyroid or blood counts
> Any issues or personnel experiences that us newer slayers need to be
> aware of? (how about costs for the supplemental RX?)

I wonder if you can get a "workplace disability accomodation" for Hep
C? It should be the same as someone who has cancer who is getting
treatment, it might turn out to be something you should know about if
working becomes difficult. That's essentially what I've been doing -
working from home and with very flexible hours.

Also knowing what your company's disability policy is - where I work we
get up to 12 weeks of short term disability, which is fully paid and
where you don't lose your position. I saved that for the end of
treatment and I'm very glad I did.

Gordo

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Thomas Wagner - 29 Nov 2004 02:29 GMT

>Hey Guys
>I read an older post in this group about someone who suggested that if
>you are diagnosed as having Hep and then change policies
>The new company may refuse to pay for treatment as this is now
>considered an "existing condition" Can anyone shed any light on this?

That depends on your state and on your group contract. Usually,
pre-existing conditions are not excluded by HMO's, in some cases there
may be a waiting period until you get full coverage for it. I have no
experience with other insurance forms (PPO's etc.). My company changed
carriers twice, and I had no problems with any of them.

>Or even as others have suggested if you don't see the 99% drop
>after (in the case of 1A) 12 weeks changing to an alternate medication
>anyone have any problems with their coverage?.

That's pretty new and experimental - the insurance may balk in that
case. Usually, though, HMOs will pay if the doctor puts enough pressure
on them. If s/he writes a nice letter explaining that this exact
treatment is medically necessary, most will relent. Maybe it will take
two letters, but if your doc does it, it has a lot more weight than if
you try to get them to pay for anything.

>Or if you need supplemental drugs for Thyroid or blood counts
>Any issues or personnel experiences that us newer slayers need to be
>aware of? (how about costs for the supplemental RX?)

Again in my experience with two HMO's, no problem as long as your doc
deems it medically necessary & tells that to the insurance in writing.

Thomas

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DrBenway - 30 Nov 2004 00:50 GMT

Thanks everyone
I'll do some more research for my locality and post what I find
and keep my eyes/ears peeled for any kind of clearing house for these
"legal/insurance rights" issues for us slayers in particular.

I suppose it' may be a good sign that I'm not seeing a centralized
site with this info, hopefully there hasn't been a rampant load of
problems and issues in this area.?

If the number of "sleeping" cases is as big as predicted
Big business is seldom known for it's humanity. So the problems will
come when someone figures just how to cut corners.
(Paranoia, another reason to get treated early <Grin>)

Maybe I look on and HIV website?, I'm assuming they're a lot higher
profile and have a lot of legal support/advice.

BTW don't get me wrong I really haven't had any problems yet
just would like to know the score in case it's needed.
When/if the fog arrives it not be as easy to research

Be Well
DB

Thanks
DrBenway
(not a Dr nor did I play one on TV,
but used to play DR as a kid a lot if that counts)

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Gordo Mondragon - 30 Nov 2004 01:01 GMT

[...]

> Maybe I look on and HIV website?, I'm assuming they're a lot higher
> profile and have a lot of legal support/advice.

I think that a cancer support website might be better. Finding out you
have HCV is more like finding out you have cancer, and the treatment is
a lot like cancer chemo - a possibility of being sick during treatment,
and a possibility of a cure or at least remission.

HIV is different in that there is no treatment that even has the
possibility of cure, and there are enough treatments that there's not
really the equivalent of the HCV tx possible need for time off from
working. It wouldn't hurt to look at some of the disability information
- www.thebody.com is a good site to start with, I think.

> BTW don't get me wrong I really haven't had any problems yet
> just would like to know the score in case it's needed.
> When/if the fog arrives it not be as easy to research

That's a really smart idea. Do as much research as you can now.

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