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Avatar universal

Switch Health Insurance?

I have had a Blue Cross Blue Shield policy for quite some time but the policy just keeps going up and up and up; it's like a mortgage payment.  : (

I'm thinking of switching to what *looks* like a better policy but one that may come in at half the price.  Sounds good right?  Well...... but as of now I am covered for HCV related issues, but were I to switch I may be faced with "pre-existing condition" exclusions, in which case, that could exclude me from insurance and therefore not be a prudent move at all.

There are a couple scenarios I can think of;

1)  Keep BC/BS but go with a higher deductible

2)  Go with this new company, go thru the application process and if I get rejected or have an alternate higher rate quoted and then decide what to do.

3) Be up front with the insurance agent (whom I really don't know) and tell him that I have HCV and then ask for his expertise, either in coaching me in how to manage the issue or in helping me find a company that has no HCV testing, or different LFT/ blood panel differences?

4) There are several people in this forum who seem to have lowered their LFTs using alternatives.  Might it be prudent to try this route first, lower the LFT's (if indeed that is possible), which in turn could make the difference in my being accepted or having a different rate quoted?

5)  (this is kind of a subheading) but I am also wondering how to best manage the system.  Some companies just won't pay out for pre-existing conditions for lets say 2 years, but if you have no issues for a certain time you may have coverage.  I also wonder if changing my deductible could end up having that same issue; after all one shouldn't be able to switch it up and down as one needs medical help and therefore play the system.

In general, I'm thinking that the agent may be my best resource, but I'm afraid of disclosing to him could somehow taint our relationship.  He may see me more as a potential liability.

Background info; stage 1 in 2010 ishak score, very minimal HCV related conditions, although I am certainly either feeling more like my age or more symptomatic lately.  I am hoping to treat in the next few years (I hope) in a trial.

Also just wondering if I should pay and pay and not risk upsetting this applecart knowing that there could be expenses coming soon, either TX related or some HCV related issue or post TX related expenses.

I'm a little bogged down with all of the options ....and therefore are doing nothing.... but if anybody has any advice or info I (and perhaps others) might be interested.

thanks,
Willy
24 Responses
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Avatar universal
Shouldn't this be on the social side?
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Avatar universal
Willy,

If it is a private policy, they will apply the pre-existing clause and the length of time depends on who is issuing the policy. Your premiums will be higher.  If you do not list  HCV on your application and they find out which most likely they will, they can terminate the policy.  Also, with private coverage, they still have the right to refuse you.

If it is group coverage, you must tell them about the HCV but the pre-existing clause does not apply and they can't deny you coverage or raise your premiums as long as there was no break in coverage.  Usual requirements are one year of coverage with no break.  

That has been my experience and it may differ from state to state with regard to private policy but is across the board with group coverage.

Trinity
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Avatar universal
I'd stay where you are and increase your deductible. You don't need to be insulated from any and all costs - you need to protect yourself from financial ruin.
Mike
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96938 tn?1189799858
I think I'd go with #1 also.  Sit down and do some calculations with cost savings due to high deductible over a protracted period of time compare to the low deductibale, may be a few years.  

In all situations, I suggest against sharing personal information espcially when it comes to betting against your health and getting the advice of the bookie who is carrying the bet.
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Avatar universal
careful that increase of deductible doesn't amount to a decrease in your prescription coverage..Big difference in copays when you are talking 3 tier $5 $30 $50 vs 20% 40% 60% especially at the price they get for peg,riba & the helpers..
pro
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Avatar universal
Thank you very much!!

JD, I *thought* that I had posted it on the community/social side.  Clearly I did not.  It was my intention; I blew that one.  ; )

In my first few months of exposure to a board I heard a guy explain that before he used a board, not only did he not know the answer, he didn't even know the question.  

That pretty much sums it up with me on many issues, especially so far as insurance goes.

You all bring up very pertinent and important issues and so for the moment it looks as if I will roll up my sleeves and try to understand what all this is before I make any changes.

I'm thinking of visiting a local clinic and getting a larger work up than the routine just to see where I am.  If the coast is clear I may downgrade and raise up the deductible.  

Before I raise the deductible I may also need to know how long that may lock me in at the rate and the terms which may apply to it.

I am hopeful that I may be able to do a trial in the next year or two and if so I *could* have more need for insurance; either for care or for drugs.  Whereas I'm not anticipating the need some rescue drugs are prohibitive.  Plan B, if I can't get into a trial that I like I may end up going the route of regular treatment (which in 2 years *could* include Telaprevir).  Any attempt to save in costs today could really break me in a few years if I were to switch plans and lose premium coverage.

Thank you for giving me some ideas.  I rather doubt that I am alone in this situation.  Seems like every 2 years my insurance goes up 20%.

I will see whatever other ideas come in.  For the time being I guess I won't fess up with my agent while I continue to research what to do.

Thanks again,
Willy
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1117750 tn?1307386569
is this thread really relevent, who cares about your insurance? i dont wish to be rude,
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96938 tn?1189799858
People who still have a modicum of choice in the matter may care. The exercise can be applicable to others.
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Avatar universal
All righty then Willy… hold out your hand… knuckles or palm?

Agree, some may be in the same predestinate.

jep  
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Avatar universal
"is this thread really relevent" I'd say, when treatment costs can run in excess of $100K, and you know down the road you will need treatment, yes it's pretty ******* relevent!
Helpful - 0
476246 tn?1418870914
Sorry I cannot help with your question Willy, but I hope you will be able to find the best solution.

I think that some of us living in European countries sometimes forget how fortunate we are. Or are not aware that you have to pay for everything yourself in the US.

In Denmark, even though some of us pay exuberant taxes, no one has to pay for doctor's and hospital bills. We have full coverage. And for a reasonable private insurance, I even have all my meds fully covered.

Hep C treatment drugs are directly supplied by the hospital's treating team. The whole treatment, check-ups., lab, etc. is free.
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1117750 tn?1307386569
i pay for my tx, i still don think its relevent
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Avatar universal
In my opinion, I would stick with what you have.  With what you have, at least you have a long history with them and whenever you do decide to do treatment, you'll be far more likely to get them to cover any costs whereas, a new copy would not be so much interested in footing the bill for a bunch of extra costs (as being on treatment totally racks up alot of medical costs), since you'd just be coming on board with them.  When you go on a treatment, there's not just the cost of the drugs, there's the doctor's visits, the lab fees, and any additional meds you may need like rescue drugs, pain meds, Anti-D's, etc., etc.   If, you didn't get into a good trial, all of these things would come into play.  I have had some experience with insurance companies prior to my going on Medicare disability and it got to be extremely expensive.  My husband had coverage on me through his company and then, the company went belly-up.  The new company wanted to drag it's feet on covering me and decided to charge us (for the 2 of us, since I had the Hep), $2,000.00 a month.   He was getting further and further behind on keeping up with all of our bills and missed a payment and they canceled us without any notice or anything.  From 1 missed payment!  Then, I couldn't get any coverage with any other company because all of them wouldn't cover the Hep C.    I wish you the best of luck.  Susan400
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Avatar universal
marcia: yeah, you and Trish may laugh and think this is all pretty weird but you have no idea all the fun you're missing out on! Arguing with  dr's assistants about who bills whom, with hospitals about what's  been paid,  with the insurance companies about what's covered, with your employer about which insurance company to switch to  (not to mention arguing with everyone else about how to stop arguing about this). It's kinda like curling,a national sport hard for outsiders to understand.

willy: as a stage 1 Ishak you've got all the time in the world. Still , from the presentations at HepDart'09 it seemed the specialists expected costs for the initial 2 PIs to be high - there's a lot of us on the wait list at this point . Also  that ins co would be looking at ways to cut costs (eg denying PIs to RVRs).
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Avatar universal
willing:  "marcia: yeah, you and Trish may laugh and think this is all pretty weird but you have no idea all the fun you're missing out on! Arguing with  dr's assistants about who bills whom, with hospitals about what's  been paid,  with the insurance companies about what's covered, with your employer about which insurance company to switch to  (not to mention arguing with everyone else about how to stop arguing about this). It's kinda like curling,a national sport hard for outsiders to understand."

willing, I know that comment was tongue-in-cheek however I feel compelled to say I don't find much amusement in this. I find it pretty horrific, frankly.  I've read enough of the insurance woes on this forum to say I find it pretty horrific, frankly. We aren't totally immune to this.  Drugs aren't covered here so there's some dancing about with that. That's a pretty signficant treatment cost so we do have those concerns. We get the tests and the treatment the government says we can have so we hope they're current and on the ball, we wait in line for our turn and sometimes that's a lengthy wait.  Those that can, go out of the country for the extras or differences.  Those that can't...well, they can't.  However...to have to deal with insurance companies as the agents of my health and my family's health...gives me nightmares just thinking about it.

jusjames, you can be such a twit sometimes. You would be the only one who doesn't find this relevant. Part of planning for treatment is planning how to pay for it.  What insurance you have in the U.S. directly impacts that and many people on this board have had various experiences with different insurance companies that directly impact their ability to manage their treatment-related costs and have valuable information to share with each other on that.   Damn right it's relevant .. or as Proactive put it .. pretty ******* relevant.
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Avatar universal
Nothing against you, jusjames, but I certainly agree that it's very relevant to those of us who can't afford the treatment prescribed...    Susan400
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Avatar universal
First off...I feel this topic is absolutely relevant.  Health insurance is a concern to all and I think we all can benefit from the ideas brought out from this thread.  HCV treatment costs (whether treating with meds or not) are horrendous and can financially ruin anyone without the right insurance coverage.

Ok...Willy:  

My opinion is that I would stay with what you have and carefully tweek the deductible if you have to.  In today's health insurance market is would be a huge risk to try to switch.  I assume you are talking about a private policy here and that's even a bigger reason to stay put.  I also would not trust an agent to tell you what's best for YOU in this situation because they are going to make a sale.  I really don't see any way for a new insurer not to find out about your HCV and trying to hide it would just cause you more grief.

I have BC/BS through group insurance and it has been a wonderful policy but the premiums have gone sky high again this year.  My employer is looking around for a cheaper policy so I might be kissing the benefits of BC/BS bye bye without any choice.  Luckily I have my HCV treatment costs behind me and I pray it stays that way.
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Avatar universal
Hey, I am really glad that I posted this thread.  I think that there have been many excellent responses.  While I have been chagrined at the increases in my rates I'm afraid that I'm compelled to stay where I am, at least for the time being.  Yes, the savings look good on the front end, but the there exists a good chance that these savings could be meager indeed should I treat and find that I am not covered, or less covered.  For me, I KNOW that it is coming.

By the way, I would also recommend that anybody having interest in this subject also read the links which often follow threads.  There are many related issues with insurance.  Some people may even be denied insurance post SVR since the insurance companies consider us more of a risk.  If I recall however, one of our past members, mikeg fought and won a dispute in such a case, providing documentation which the insurance company accepted; he got his policy.  This is something which could depend on companies at present, or could change in the future.

Segue into whether this thread is of some purpose?  I think that you have all answered that question already sufficiently.  I agree, or I wouldn't have posted the question, but as mentioned, I would have posted it on the social side.  It certainly pertains to having HCV.  Having or not having insurance will also impact on whether one may be able to treat, or re-treat, or be able to afford rescue drugs etc.  It can be a life or death issue for some.

Now that the thread is here I intend to delve into the two policies and look them over closely.  It is not fun reading and I'm going to for the moment, stay the course.  It is probably every bit as important as learning about TX or learning to live with HCV.

One other important thing to possibly mention; IF you have a policy that you want to keep, KEEP IT!!!!  Even a late payment could cause one to get bumped from a policy.  There may not be another decent policy that one can easily pick up or at the same rate or coverage as one that one earlier had, even from the same company.

Thank you all for the feedback and support and I hope that others in this forum benefit from it.

best,
Willy

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476246 tn?1418870914
You must be out of your mind to accuse me of laughing and not understanding. Next time you really need to think, before you write something like that.

I would NEVER laugh about this. I don't know how, why and where you would get this idea from. I would be a heartless bizznitch.

I understand all to well. I lived in Indonesia for 20 years. I don't think you can even get a decent health insurance there. EVERYTHING is out of the pocket. You gotta pay right there on the spot. No insurance at all.





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Avatar universal
Marcia, in all fairness to willing, I think there was a healthy dose of sarcasm in his comment and we were props in his actual goal of highlighting some of the issues with the current system.
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476246 tn?1418870914
Oh, .... then I got it all wrong!

Ouch... sorry Willing, didn't mean to eat you up alive .... :-)
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Avatar universal
I would stick with BC/BS. I have that insurance and tx only cost me 80$ a month for 6 months. I didn't think that was bad at all. They were also very helpful
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Avatar universal
sheesh! one heavy-handed attempt at sarcasm and look what happens... sorry, no offense meant Marcia. As Trish noted I was just picking on the two of you as innocent bystanders to our national health circus, which must indeed look pretty strange from the outside ( and yes, it's anything but funny if you're on the wrong side of it, as many posts here point out).

Distribution of the 1st gen PIs will be an interesting test case. As I see it Vertex and Schering have about a  2 year window in which they'll have near monopoly control *and* a large backlog of pent-up demand - both of which suggest they'll be able to charge a lot. How EU national health plans, and in this country, HMOs and PPOs will negotiate access will be interesting. Maybe RVRs won't  be the only ones steered towards soc.
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476246 tn?1418870914
my apologies again... I reread what you had written and somehow had omitted the 'missing out on all the fun' part.

I really need a new brain after tx
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