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Barbara In the last few sentences of your message, you asked about
changing employers and pre-exisiting limitations. Three years ago I was
laid off, and I was really worried about insurance coverage from a new
employer. I didn't have myelitis then, but did have breast cancer a few
years before. When I interviewed with my current employer (Octel
Communications) I asked the HR person about pre-existing limitations.
This company does not have any such limitation, which was a great
relief. My husband's last job also did not have the limitation. We are
both in the computer industry, and work in Silicon Valley. Right now
the economy here is booming, and companies are in fierce competition for
the employees with the right background. Having really good benefits is
one way they attract new employees.
Just an aside - the company you work for has control of what kind of
insurance coverage you get. All the big insurance carriers carry a
range of coverages. If you are leaving a company to be self-employed,
COBRA is probably the best bet.......
>----------
>From: comm97[SMTP:comm97(AT)cris.com]
>Sent: Thursday, June 05, 1997 5:24 AM
>To: tmic-list(AT)eskimo.com
>Subject: Re: Insurance info
>
>
>
> ----
> From: JHarper33(AT)aol.com
> To: tmic-list(AT)eskimo.com
> Date: Wednesday, June 04, 1997 4:51 PM
> Subject: Re: Insurance info
>
> In a message dated 97-06-04 09:43:53 EDT, you write:
>
> > The situation regarding insurance in America is not good. As a
>Registered
> > Nurse and a pt with a myleopathy, there is no way out of the current
> > situation regarding the need for a national health plan. The question
>that
>
> > needs to be addressed is will this social order care for people who
>they
> can
> > no longer exploit in the job market ? The question is clear, if one
>views
> it
> > from an unemotional perspective. Michael
> >
>
> ---------------------------------------------------------------------
>----
> > ---
> >
> > From: CaseyNotes(AT)aol.com
> > To: tmic-list(AT)eskimo.com
> > Date: Wednesday, June 04, 1997 8:50 AM
> > Subject: Re: Insurance info
> >
> > I would like to hear about people's experience with insurance
>overall.
>
> > My
> > husband has TM and wants to leave his job this August, but we are
> > worried
> > about insurance. We want to be self-employed. Any advice out
>there?
> > Since TM nearly always is a one-episode event has anyone been able
>to
> > get a
> > doc to write a letter stating that for insurance purposes??
> > Thanks.
> > Carolyn Casey
>
>
> I don't want to start an argument, but I'd like to pass along these
> thoughts: the government can't give anything without taking first. Also,
>the
> government is not known for its efficiency in anything it does. I really
> don't know if I want it managing my health care. What is going to
>happen to the delivery of care with $115 billion slashed from the Medicare
>budget? The closure of hospitals and the move to managed for profit care .
>The question of "who decides" what level of care is determined by the battle
>itself to transform this system . A national health plan will never occure
>under the context of this current system. We need a VISION of what type of
>society we want . This vision must obviously include not only healthcare,
>but providing for those unable or not needed for work, quality of life issues
>in the community, education etc. Given the technological level the productive
>process is at in this country, all these things and more are possible.With
>regards to "self employed" mantra being discussed. The goal of insurance
>is to make profit. This happens by collecting $ from the 'not sick' and
>eliminating the 'sick' from the role. The environment of managed care, which
>essentially translates to non care, means no in patient therapy, no PT in the
>home beyond some abstract point, co pay for service etc etc etc.But I guess
>both points
>could be made about insurance companies, also. At this point I don't have any
>better ideas. We have several on the list from other countries: how is your
>health care system, especially in regards to your TM?
>
> We only had two problems with our insurance. One was that they would
>not cover the drs. recommendation that I go into the rehab unit of the
>hospital for 10 days. I didn't want to do that, anyway; I wanted to go home.
>But I didn't feel they had the right to determine what my treatment would be.
>I did have physical therapy through home health care three times a week for
>three months and was very pleased with it. The insurance did cover that,
>after some talking (first they wanted me to go to a place an hour away. I
>couldn't drive, my husband needed to work, we don't have any family here to
>help with things like that. etc. It would've been a mess.) I don't
>know if there may have been a difference in quality between PT at home or in
>a hospital. I felt the therapist I had did great with helping me to adjust to
>the environment I was actually in, rather than an artificial one.
>
> The second problem was getting the insurance to pay everything it was
>supposed to. We kept getting notices from them and from the hospital and my
>husband had to make multitudes of phone calls, but everything finally was
>taken care of.
>
> I just remembered a third problem. When I first went to the ER of our
>small town hospital (with no neurologist on staff), they made an appt. for me
>with a neurologist's office without checking first to see whether that dr.
>worked with our insurance. We got there and found out he didn't. We called
>out insurance co. from his office, explained that we had followed their
>rules, and this was a referral made from one of their drs. at one of their
>hospitals and we felt they should cover this out-of-network dr. under the
>circumstances. The insurance guy was unmoved and uncaring. We ended up having
>to go to the ER of another hospital 45 minutes away. Ironically, the dr. who
>saw me there was from that same practice, and the insurance did cover her
>under those circumstances because she was the neurologist on call for the
>night.
>
> Other than that, they've been great. They've covered the different
>medications I've tried with no arguments at all.
>
> Has anyone had trouble getting coverage after changing companies with a
>TM diagnosis as a "pre-existing" condition? I am concerned about that if my
>husband ever changes jobs.
>
>Barbara
>
>
>
>
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----
From: JHarper33(AT)aol.com
To: tmic-list(AT)eskimo.com
Date: Wednesday, June 04, 1997 4:51 PM
Subject: Re: Insurance info
In a message dated 97-06-04 09:43:53 EDT, you write:
> The situation regarding insurance in America is not good. As a Registered
> Nurse and a pt with a myleopathy, there is no way out of the current
> situation regarding the need for a national health plan. The question that
> needs to be addressed is will this social order care for people who they
can
> no longer exploit in the job market ? The question is clear, if one views
it
> from an unemotional perspective. Michael
>
-------------------------------------------------------------------------
> ---
>
> From: CaseyNotes(AT)aol.com
> To: tmic-list(AT)eskimo.com
> Date: Wednesday, June 04, 1997 8:50 AM
> Subject: Re: Insurance info
>
> I would like to hear about people's experience with insurance overall.
> My
> husband has TM and wants to leave his job this August, but we are
> worried
> about insurance. We want to be self-employed. Any advice out there?
> Since TM nearly always is a one-episode event has anyone been able to
> get a
> doc to write a letter stating that for insurance purposes??
> Thanks.
> Carolyn Casey
I don't want to start an argument, but I'd like to pass along these
thoughts: the government can't give anything without taking first. Also, the
government is not known for its efficiency in anything it does. I really
don't know if I want it managing my health care.
What is going to happen to the delivery of care with $115 billion slashed from the Medicare budget? The closure of hospitals and the move to managed for profit care . The question of "who decides" what level of care is determined by the battle itself to transform this system . A national health plan will never occure under the context of this current system. We need a VISION of what type of society we want . This vision must obviously include not only healthcare, but providing for those unable or not needed for work, quality of life issues in the community, education etc. Given the technological level the productive process is at in this country, all these things and more are possible.
With regards to "self employed" mantra being discussed. The goal of insurance is to make profit. This happens by collecting $ from the 'not sick' and eliminating the 'sick' from the role. The environment of managed care, which essentially translates to non care, means no in patient therapy, no PT in the home beyond some abstract point, co pay for service etc etc etc.
But I guess both points
could be made about insurance companies, also. At this point I don't have
any
better ideas. We have several on the list from other countries: how is your
health care system, especially in regards to your TM?
We only had two problems with our insurance. One
was that they would
not cover the drs. recommendation that I go into the rehab unit of the
hospital for 10 days. I didn't want to do that, anyway; I wanted to go home.
But I didn't feel they had the right to determine what my treatment would
be.
I did have physical therapy through home health care three times a week for
three months and was very pleased with it. The insurance did cover that,
after some talking (first they wanted me to go to a place an hour away. I
couldn't drive, my husband needed to work, we don't have any family here to
help with things like that. etc. It would've been a mess.) I don't
know if there may have been a difference in quality between PT at home or in
a hospital. I felt the therapist I had did great with helping me to adjust
to
the environment I was actually in, rather than an artificial one.
The second problem was getting the insurance to pay
everything it was
supposed to. We kept getting notices from them and from the hospital and my
husband had to make multitudes of phone calls, but everything finally was
taken care of.
I just remembered a third problem. When I first went to
the ER of our
small town hospital (with no neurologist on staff), they made an appt. for
me
with a neurologist's office without checking first to see whether that dr.
worked with our insurance. We got there and found out he didn't. We called
out insurance co. from his office, explained that we had followed their
rules, and this was a referral made from one of their drs. at one of their
hospitals and we felt they should cover this out-of-network dr. under the
circumstances. The insurance guy was unmoved and uncaring. We ended up
having
to go to the ER of another hospital 45 minutes away. Ironically, the dr. who
saw me there was from that same practice, and the insurance did cover her
under those circumstances because she was the neurologist on call for the
night.
Other than that, they've been great. They've covered
the different
medications I've tried with no arguments at all.
Has anyone had trouble getting coverage after changing
companies with a
TM diagnosis as a "pre-existing" condition? I am concerned about that
if my
husband ever changes jobs.
Barbara