Student Health plan and individual health plan

[Physast]

Hello everyone. Here is my situation about my health insurance. I was just wanting some advice...

While under Student Insurance I went in for a physical at the school clinic because I was having nipple pains. The nurse completed the physical and ran some bloodworm (prolactin test) Everything came back normal and she did not find anything during the physical.

The next day my student insurance was over because I had graduated. Three months went by as I was doing job interviews and talks. I then purchased an individual insurance plan. Two days later I went in for another physical and blood work and my doctor found a lump on my testicle. I recieved an ultrasound and the rest is history.

According to my policy pre-existing can include any symptom of TC that I had checked out prior to obtaining the policy. Well I went in for nipple pain! I did not know at the time that this was a symptom, but I am afraid that my insurance will claim pre-existing on me.

What does everyone else think? Anything I can do other than wait and see what they say?

[Fish]

You should be covered, I personally think you can make a convincing case.

I sent you a reply to your PM

[fuse929]

As Fish said, I think you can make a claim convincing enough to get covered if the nipple pain was associated with the TC, but the fact that you went for a physical just days after starting a new insurance plan may look fishy to an insurance company. I wish you the best!

On an interesting side note, it is becoming more and more common for colleges who offer insurance to their students to start their policy year in August. This gives students who graduate in December and May (the two most common months for graduating) coverage until they have time to land a job (May to August = 3 months of coverage after graduation.) I encourage anyone currently receiving or administrating insurance to college students to look into and ask about this type of plan.

[Physast]

I just received a letter from my insurance wanting me to fill out a waiver for them to get my medical records and for me to list every doctor and pharmacy I have ever been to in the past 5 years.

I hope things work out with this insurance or I am out a lot of money.

EDIT: I might have found a loophole in Georgia law that might force them to pay. I think this might work.

[Physast]

I just learned that the HIPAA (health insurance portability act) does not apply to short-term insurance. This means I am back to square one. Now I have no leg to stand on with pre-existing clause.

Why would my school insurance offer this short term plan to me if I can't use HIPAA..

I am so frustrated with Health insurance in this country!?!?! This is so stupid that anyone has to go through this while already going through the stress of having Cancer.

I don't have a job, because it doesn't start until January 09. I can't get a job because I have to spend all my time dealing with my health insurance. I feel like I have no where to turn and everybody including my Government is on the side of the insurance company..

[Physast]

I am out of options.. I can not apply for medicad because I am moving in a few months to go to DC. And I had my surgery and stuff done at Duke which is out of state and they wouldn't help with it anyway.

In Georgia there are no programs to help me. They have a Georgia Cancer aid program for un-insured, but I have insurance and do not qualify even though they are not going to pay anything.

I have called the social workers at Duke to see if they can lower the bill some and what kind of payment plan options they have.

How am I suppose start a life when I am bombarded with Student loans and medical bills totaling over 70K?

I am ranting sorry

[Scott]

I am out of options.

Physast, have you tried contacting LIVESTRONG SurvivorCare? They may be able to recommend other possibilities for you.

[Physast]

Hi Scott,

So far I have called:

Livestrong: They gave me the number of Patient advocates, patient access network and Georgia cancer care. The best help I could find from these resources is if I am going through Chemo. They do not provide assistance for surveillance. Which I understand, if you are undergoing Chemo you need the assistance more than me.

I have contacted my local catholic services and the social workers at both hospitals that I have had treatment done. Both told me my best solution is to get married to someone with a group insurance plan. (My fiance did not like that solution very much)

I can't apply for medicad because the work was done in another state.

The kicker is my insurance still has not denied my claim (formally) but has told me over the phone that they will not cover it because of pre-existing. They told me they have 3 months to decide and that it might take longer than that.

The best therapy has been this Forum.. To be able to talk with others and know that I am not the only one out there. After spending 8 hours on the phone with people that don't care. It's nice to come here and be with people that do.

[Scott]

I find it so frustrating (though, I'm sure not nearly as frustrating as you do) that we haven't been able to do better than this. Far too many people struggle with the financial strain of a cancer diagnosis, and it's hard enough to deal with the physical and emotional strain. It's completely unacceptable, and we have to change it.

[Karen]

I find it so frustrating (though, I'm sure not nearly as frustrating as you do) that we haven't been able to do better than this. Far too many people struggle with the financial strain of a cancer diagnosis, and it's hard enough to deal with the physical and emotional strain. It's completely unacceptable, and we have to change it.

Amen! My husband, and his folks, had no medical insurance until he got a job at age 22. Thankfully he was never sick. This site has been a real eye-opener for me on what insurance issues people are struggling with...and come voting time this is a key issue in my mind.

Physest...we're here for whatever therepy you need...free of charge, insured or not!

[Les' Mom]

Scott,

I am far from an expert. My son was first diagnosed with TC in Arkansas visiting his dad. When he got home to NC he applied and was approved for medicaid. The hospital in Arkansas where he had his first surgery agreed to file NC Medicaid. Did someone tell you you couldnt get out of state stuff covered? I thought it wouldnt cover the Arkansas changes until my son's medicaid worker called them.

Hugs,
Pam

[Physast]

I have a question about Medicaid. I have $10000 dollars saved up (was suppose to be for a car) that I am know using to live off of (pay rent, student loans, credit cards, utilities and food) until I find a job. If I apply for Medicaid are they just going to take that money from me to pay for hospital bills then start giving help.

I ask this because I called one of the cancer places and they told me this is how they work. They take all your money to use first then start helping. This does not make any sense because then I will not have any money to live on adn will need to apply for more help.

If anyone has experience please let me know, I am very curious.

[veryworriedmom]

Physast

If your insurance told you they wont cover due to preexisting they need to put it in writing. Every state has an insurance commission, I started dealing with ours in maryland for another test they wouldnt cover and had to appeal it in CA as thats where our policy was issued. You can contact the state insurance and force the company to make a decision then you start the appeals process, if its urgent and treatment depends on the decision there is usually a hotline to call. Your pre existing is not clear cut or you would have had a denial by now. It depends what the first treating physician put in the report. Start harassing the insurance, you have nothing to lose.

[Physast]

veryworriedmom,

I contacted my insurance commissioner the other day. My case worker told me that living in Georgia gives me very few options. She said the laws in Georgia are there to help the insurance company and not the patient.

She actually told me that New York and Maryland had some of the best laws out there to protect the citizens and not the insurance company.

My last call to the insurance company (I call everyday), they claim they have not yet received my papers that they have requested from my doctor. Of course my doctor says they have mailed and faxed over a copy and of course did it again today when I called them. It's frustrating because I know the insurance company is just giving me the run around so they can take there time.

For example they claim that it took Duke almost a month to send them the claims from my surgery and scans. Duke told me they sent them to the insurance company the day after the surgery. Then the insurance company told me they sent them to the wrong address (how would they know?), so I called and had them sent again to the address the company gave me over the phone.

I mean I have decided to just get treatment no matter how much debt I get in so treatment is not depending on the decision. BUT they don't know that so i might try to use that as a leverage.

But what depend on the decision is me being able to apply for aide to get help with treatment. I can't apply for anything without knowing they are definitely going to deny or not.

[veryworriedmom]

We got the same run around from the insurance saying they didn't receive the medical records, pathology report etc. It is not true because when they finally faxed us back something it had the doctors fax number and the date and time stamp from the original transmission. What you need to do is have a copy of all your medical records. everything from the first visit to the last. these are vital not just to deal with insurance but to have for future treatment/providers.
When the insurance said they didn't receive records I faxed them personally and I asked them to confirm receiving them. If they didnt confirm I faxed them again and again until I got a live person to say they had them. when dealing with insurance you must make a note of everyone you speak to and the date and time. They will push you away as much as they can. If you do not have a fax, please find one near you to send and receive information. It may be worth getting a cheap or used one.
When you move to your job in DC you may consider looking for places over the river in Maryland, if the insurance laws are better it might be worth the commute.Rent is cheaper than Dc. VWM