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Avatar universal

still confused

I don't mean to seem brain foggy but here goes. I received my paperwork form ltd. I am going to go down and apply for ssd on monday,offices closed due to snow..I will also contact unemployment. Do I have health insurance now? I am confused as the paperwork they sent me states I need to decide if I want ltd to pay until ssd picks up? I am really confused. I am on week 48/72 yes I am doing it and feel okay. This paperwork stuff is making me nuts!! thanks for any help:)shelly
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Avatar universal
sorry haven't posted in awhile but I was part of that mess on the interstate..I live off 81 north and travel to dr.s on 81 south once a month...I have been snowbound for days....I had to get a ride to the doctors (local) have a double ear infection,sinus infection,upper resp. on augmenten for 14 days ugh...haven't received mail,finally garbage picked up yesterday!!!! my car is still buried...but on a lighter note? week 49/72 and wake up in morning and can't move my fingers..feels tight and really weird..can hardly type. new side? otherwise all is same sx's are there but just ignore as much as possible. I haven't been able to get to the ss office it has been closed due to inclement weather. I am going to call or try to again!! to speak with an information officer. I am calling unemployment or trying to!!!busy all the time!!! to let them know of my new situation. I have to call about insurance ie health coverage to my ltd carrier , from the paperwork I believe that when ssd is approved you are elig for medi part a and b..and they retroactive it? I have no idea. I have been paying cash for everything and still confused. I can't afford cobra @ 1091. a month..cheaper to pay cash. I will keep you updated. I was out on std initially, 6 months then denied ltd. I had to appeal. I appealed and it took from july 06 until last week for the appeal decision. Meanwhile, I was terminated from my job in december and had to wait until end of jan. until they approved unemploymet. They had to render a decision which boiled down to are you able to work?? In which the adjucation person for unemployment stated can you answer a phone for an hour a day?? yes, so I am able to work...so now they deducted my unemployment received so far from my retrocative ltd check that I am to recieve soon, and I will be  paid ltd monthly...this is all very confusing but i am going to call an information officer and set up an appointment...keep you posted...shelly
Helpful - 0
Avatar universal
you said:

"Too expensive, too congested, too many lawyers"

you mean there is still a place in the US that does not have this problem?? LOL


Good luck with the move. I moved a few years back after 25 years in one house. Heavens to Merkitroid, what a lot of junk I managed to collect in those years!

Im STILL unpacking!

Where do you plan to move to? Here we have those same issues, too many lawyers, too congested and too EXPENSIVE! But we do have great summer beach days in the dead of winter!

Good luck with the paper chase with disability and Cobra.
Try not to let it stress you out too much, that is their intent!




Helpful - 0
173975 tn?1216257775
"Normally your health ins. co will send you a form saying your health ins. is ending and give you the option of continueing on Cobra. Since this is NOT a work injury, I am not sure how LTD will help pay for your health coverage? Mine disablitly ins. pays for my disability and that is all. Did you buy a special disability plan that would continue your coverage in case of any type of illness? I know as teachers we aren't covered by SS, so you may have done this. I tried but they turned me down when they found out I had Hep C."

My LTD provides "financial protection by paying a portion of income while undergoing a long period of disability."

So I have cash coming in to pay bills while I'm not working.

And now, I guess my questions is, since my job still has me under insurance until April 15, what happens after that?  Who pays for the meds, the injections, the doctor visits?  

Why didn't I THINK about this before I started tx?

I'm gonna try to call my state sponsored health benefits program on Tuesday.

I'm beginning to think I may have to just go back to work, which means going off tx.

What do you mean, as teachers we aren't covered by SS?
I feel so ignorant.  :(
Helpful - 0
131817 tn?1209529311
Normally your health ins. co will send you a form saying your health ins. is ending and give you the option of continueing on Cobra. Since this is NOT a work injury, I am not sure how LTD will help pay for your health coverage? Mine disablitly ins. pays for my disability and that is all. Did you buy a special disability plan that would continue your coverage in case of any type of illness? I know as teachers we aren't covered by SS, so you may have done this. I tried but they turned me down when they found out I had Hep C.
Helpful - 0
173975 tn?1216257775
All I can say is it's a good thing for me I found this forum.

I am so clueless.

Researching now and came up with this;
'For loss of coverage due to termination of employment, reduction of hours, or leave of absence, the employee and/or dependents are entitled to 18 months of COBRA coverage. Time on leave of absence just before enrollment in COBRA, unless under the federal and/or State Family Leave Act, counts toward the 18-month period and will be subtracted from the 18 months. Time a member spends on federal or State leave will not count as part of the COBRA eligibility period."

It's dawning on me that the disability coverage has nothing whatsoever to do with my health benefits coverage.  (duhhhhhhh)

And that if I want to have tx paid for after FLMA expires on April 15, I gotta enroll in COBRA?  Found the premium page and seems like single coverage is about $335 per month.  (Deducting that from the LTD benefit doesn't leave a whole lot to live on but what choice is there?)

I wouldn't have a clue about any of this if I hadn't found threads and info on forum.

So sorry if I've bored any of you with this prosaic insurance stuff but I really need help, so thanks again.
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173975 tn?1216257775
Thank you thank you thank you.

I have no confidence in my ability to figure this insurance stuff out by myself.  I find it incredibly intimidating.  (Guess that's the plan huh?)

So now I'm gonna make it a point to stay on top of the COBRA issue.

I've read in some of your posts about your situation and how 'physically' devastating the tx has been (and for many others, as well, nygirl, for ex and sf girl come to mind.)

I think it's really hard for strong (pre-TX) physically active people to handle the debility, let alone the mountain of paperwork one has to sift through in order to buy the time to treat the virus.

And I'm the worst patient!  Good thing only my flock have to put up with me, and me them.  (When they get on my nerves, I stick 'em back in their cages.  They probably wish they could do the same to me, hahahah)

Not to insult anyone, but though I live in NJ (Totally by mistake) I'm not a fan of the state and am trying to get out.  Too expensive, too congested, too many lawyers (hahah).

IMHO, you're NOT missing a thing.  
Helpful - 0
Avatar universal
I think the answer to that question is YES. I do know when your health ins. ( not related to your disability) runs out, you have 63 days to connect with Cobra, file and get the ball rolling. Who knows why they picked 63 days, but like all things disability it makes no sense.

Im such a wuss, there is no way I could manage with under 30 temps! I don't know how you guys do it, I'd never leave the house and fireplace!

I was in Montana once visiting my sister and it was 20 below, I walked outside and passed out. LOL
I have never been so cold in my life!

You should receive papers telling you its running out (I think)that should come with instructions on how to proceed. They too have a website that I found helpful.

One of my favorite places I used to fisit often is Cape May. I was born and raised here in Santa Barbara, but I dearly love the east coast. Spent quite a bit of time in and around Philly area too, so pretty.
New Jersey really is a gem, many people see Newark and dont realize how pretty New Jersey really is! I've driven all over NJ and it's lovely.


Stay warm!
Helpful - 0
173975 tn?1216257775
Hey, K?  What's insensitive about the beach?  :)

PL - I'm on NJ/NY border.  Yeah, it's been frigid.  temps are supposed to be in the balmy 40's next week.

personally, I like the cold weather, though I'm glad I wasn't in that 30 mile long traffic jam on 78 the other day that stranded thousands of motorists for 20 hours!

Now, that looked like a real disaster.

Ok, to paraphrase so dummy me makes sure she understands, I should apply for cobra before 3 month end of FLMA to cover all other health problems/emergencies, etc., not realted to hep-c TX, neutopenis, etc?

I'm Reeeeeeaaaaaaallllllll slow at this.

Maybe i'm in denial.

Helpful - 0
137539 tn?1344379928
Don't know where you are but your weather sounds like ours has been....  High of 15 and one morning it was 3 but because of the windchill it was -24 I am on the pa /ny border and I'll bet you we haven't seen 30 in at least 3-4 weeks

When I got my LTD I was ok till my FMLA ran out with the job and they had to let me go.  Then I had to pay cobra to keep ins. But with a work related disability it is different as you are covered for that injury as Kalio said. But you may have to add in to it to cover any other medical problems
Helpful - 0
96938 tn?1189799858
Before you go there on Monday, make sure the office is open - it may be a holiday.  Presidents' Day.
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Avatar universal
Sorry I didnt respond sooner, went to the beach.

the answer is YES. Your health costs that are related to your disability will be covered by them. But only those costs related to your disability, so that is why you still need Cobra, for any other health related issues.

I'd give you the same advice, see if you can find the "infromation officer" because they are independents paid by the state to help you find your way through the morass. Its hard to get ahold of them, but you can make an appt. to speak to them in person or on the phone, have all your questions listed and go through them one by one.
Hopefully someone here more versed in this as it relates to HCV will weigh in on it.
You can also speak to your caseworker. If you happen to have a nice one, they can often help you through and answer questions. Just keep in mind they work for the insurance company, so when it comes to the money part, speak to others about your rights but the worker should be able to answer your questions and help you too.
Also, they have a website that has lots of info that might be beneficial.
Helpful - 0
173975 tn?1216257775
Just found this statement in my DB Plan manual.

No contributions are required for your coverage after you are disabled for 3 months.

Does that mean my health benefits are taken care of?
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173975 tn?1216257775
The Beach!!!!!

Wow, it's 15 degrees here.

Thanks for the info.  I desperately need all the help i can get to understand this stuff. :)
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Avatar universal
We had President's Day last week didn't we?

I could swear it just passed. Not that we have a big Prez day celebration around here ... we put a black scarf on the GW voo doo doll. ;)

Hope you are doing ok, another week down!


wyn

That was insensitive of me! Sorry about that. Holy cow I can not imagine that temp!






Helpful - 0
173975 tn?1216257775
I'm trying to read through the COBRA info and I'm even more confused.

You and SFgirl sound like such experts in this area.

I don't understand the qualifying events.  My situation doesn't meet any of the criteria.  I (may) lose health coverage coz of not being able to return to work coz of SX but I don't even know the answer to that, yet.  

If I purchased and paid into LTD, won't they continue my health benefits?

Sorry to sound like such a ditz.  I don't get it.

I just don't wanna be left in the dark holding the bag on april 15 when the FLMA runs out.

I did just get approval of my LTD and they said they would review my case every three months.

I'm trying to read and understand their manual but, again, insurance and bureaucratic stuff are not my forte.  

Thanks much for any advice.
Helpful - 0
173975 tn?1216257775
Rant on!

What a nightmare you've been through.
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Avatar universal
Hey I read that book! It is so true, and this changing of the case workers is designed for confusion too. It makes no business sense to have the case worker work a case for six months, then pass all cases onto someone new and get all new cases and start all over again learning new cases, but that is what they do.

I broke several discs in my back lifting a box at work and have had to deal with them since 03. It is an incredible mess.
I really feel for anyone who is depending on that money to survive. I was so fortunate that I didn't have to and if I had needed them to survive, I would have starved first it took them so long to process things.

Insurance companies bail on you when you become ill and the protections you tried to put in place by paying into disability fail too. It's a nightmare. And depressing to say the least, my heart goes out to Shelly and all of the people facing that whole mess.

What they should do is be better at distinguishing the real disabled people from the fakers and thieves instead of abusing every person who has to enter the system like they do. You dont know how many times I have been waiting to see the Neurologist with a room full of other patients who are sitting there discussing how they will fake their symptoms, makes you just want to throttle them. What LOSERS. They will sit in the waiting room talking about it! Geez! And her eI am struggling to just be able to walk unassisted. Really burns my ass. I told the doc " those two guys in the waiting room are sitting there discussing how to fake their symtoms and what works best" He didnt seem all that shocked by it..

There was hard core evidence of my condition, MRIs showing this horrible broken mess in my spine, yet workers treated me like I was faking. Sort of hard to fake broken discs! Of course, later I learned they had gotten tht idea from notes made by one case worker whom I had NEVER SEEN.
I mean, COME ON.
That case worker obviously assumed EVERY person was faking. So suddenly one day they just stopped the checks and wouldn't even tell me why nor did they notify me. I just realized after a few months they hadn't been coming. They are so small, took me awhile to notice.
I just ignored them, I was so fed up with the whole thing. So this case worker whom I had never laid eyes on ordered up some detective "investigation" ( I found out later) and had people FOLLOWING ME around apparently and taking pictures of me limping around. This went on for over a YEAR and god knows what that cost the state. I found out later he had called all these people, including a local news reporter who had done a story that I was quoted in.
He did all this KNOWING I had plenty of hard evidence showing I needed what the neurosurgeon calls a
"spinal replacement" surgery, an operation I did not want to have until it became impossible for me to walk at all because the failure rate was so high and the risk of being in a wheelchair great. I figured if I have to get it at some point, I will wait until I have no other chance of being mobile. 3 years later I get this big check in the mail covering the missing payments and saying the "investigation" was not valid.
Im sure all that detective work cost MORE than the measly amount of money they expect people to survive on.They had the MRI evidence I was injured right in the file the whole time but apparently that same caseworker had "lost" all my pertinent medical records! Yeah right, "lost" them, he probably toosed them in the trash or something in his effort to "catch" me.
It is even harder on women because we earn less per hour than men so of course our benefit amounts are much smaller.
This subject just gets me going!

Hope you are hanging in there and getting through the weeks left OK.
sorry for the rant!

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173975 tn?1216257775
Thanks both.

I'm gonna pore over your responses a little later and copy 'em to my DT.

This info is INVALUABLE.  To tell the truth, so far the hardest part of TX is the insurance.

kalio, I agree that it's an 'unspoken' policy, to make things that much harder for the claimants..

Like in "Grisham's "The Rainmaker".  Whne the kid dies from leukemia and the insurance guys get on the witness stand and admit they train the adjustors to 'deny all claims for one year' in the hopes folks will give up, go away and leave them alone.

How obscene.  :(
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131817 tn?1209529311
Yes, I read an old paper that say I can extend 36 months too. It's called Cal Cobra, I think. It's an extention of Cobra. What bothers me is it says to send in this postcard 63 days AFTER you are discontinued. What does this mean? I have no coverage for 3 months? How would that work. We lost our "card", so I am working on finding out about it. Does your husband know?  Mine is up this next month. I sure don't want to chance losing it.
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Avatar universal
I've bene meaning to tell you that after my Cobra extension of 18 months was ending, my husband was able to extend it again ( not sure how but I will find out) and the new papers say we can continue like this on Cobra for another 3 years.
What happens then, who knows.
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131817 tn?1209529311
I went out on disability over 18 months ago. Your work health ins. will only cover you for about 3 months, then you need to apply for cobra and pay the premiums for cobra to extend your ins. for up to 18 months. After that they can extend it again for up to 36 mos. So you will have your same coverage, but you have to pay. I have to pay over a thousand a month for my family. It covers dental and vision and very low co pays, so it is worth it. Especially on tx! Talk to your ins. co's about Cobra. I believe it is a federal program.
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Avatar universal
All states have an information line you can call for assistance. It takes some endurance to work your way through the system to get to actually speak to a live person and ask your questions but call and make an appt. to speak to the "information officer" to answer all your questions.

They also have booklets you can have sent to you, Im suprised you didn't receive one with all your other paperwork. Somewhere in those papers there should be phone # you can call for assistance.
It is an incredibly draconian system, it takes persistence and stamina to wind your way through. I know how hard all that is to do especially when faced with illness but keep in mind all people on those benefit plans have some form of illness they are dealing with along with the paperchase of disability so you are not alone.
My feeling is it is intended to be difficult on people in the hopes you will just give up and find some other way to get by. It sure seems that way to me.
Another thing they do ( at least in my state) is they CHANGE your worker out of the blue, so you finally have a worker who understands your case only to call the next time and find out some new worker who knows nothing about the case is now your worker. It just makes it that much harder on the claimant. They are supposed to make notes on your case paperwork but it seems they never do, so you end up telling your story over and over to different people.
It isn't you, Shelly, it's the system. Feeling confused and unsure of what is going on seems to be the cornerstone of the disability system.
I'd try to utilize the information officer, they are there to guide you through the miasma.
Helpful - 0
173975 tn?1216257775
"Do I have health insurance now? I am confused as the paperwork they sent me states I need to decide if I want ltd to pay until ssd picks up?"

I know what you mean.  I'm gonna be facing a similar issue in a couple of months.  While I'm covered by my job insurance right now coz I took FLMA, and I was granted LTD by my carrier, I don't understand what happens at the end of the 3 month FLMA.

I want to assume the ltd continues my health ins but you know what to ASSUME anything means.  

Any info you find out, please post it on community and I'll do the same.

My dilemma is who pays for the meds and doctors visits when I don't return to work April 15?

Is it my LTD carrier?

I feel really dumb but I never did understnad insurance, maybe coz I've never had to use it.

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