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neardc wrote :
I suppose that other things to consider are how critical it is to have the surgery, and how expensive it is (and with that, what are her mother's financial resources). It makes a difference if we're talking about $5,000 vs. $150,000.

Are they any options for insurance coverage through school that would get her at least some basic coverage (even with a high deductible) and not require an extended delay to deal with pre-existing conditions? Or, can she be added to one of her parents' insurance (that may depend on the laws of the state she lives in, but in some areas students can be on their parents' policy past the age of 21).

And, has anyone approached her dad to ask for his help on this?

There are important lessons here about how important it is to have health insurance even when you are young and to make paying those premiums a high priority. You really do never know what sort of unexpected health issue could come up... For her, her lapse was just really, really bad timing...
She is insured and has been for five months or so. There was a month between graduation and this job she wasn't insured. Since the injury was from back in high school and has progressively got worse it is preexisting. Because of the lapse she won't be covered for another 8 months just for this injury.

There are few ways this can be fixed but all require telling her dad. Neither her mom or her want to. I told her this may be that time you want to suck it up.
- October 30th, 2009, 01:01 pm
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Can_I_just_be_Jo wrote :
She is insured and has been for five months or so. There was a month between graduation and this job she wasn't insured. Since the injury was from back in high school and has progressively got worse it is preexisting. Because of the lapse she won't be covered for another 8 months just for this injury.

There are few ways this can be fixed but all require telling her dad. Neither her mom or her want to. I told her this may be that time you want to suck it up.
The whole issue of pre-existing conditions is for another discussion, I suppose, but as your friend's situation illustrates it's a major flaw in our healthcare system that causes needless delays in healthcare (or prevents people from getting desperately needed care). It's crazy what little things can sometimes be considered pre-existing, too...

Tell the dad. Even if he's a jerk, this may be the kind of situation that he's good for (and where he would genuinely want to help).

Also, has she triple-checked with her health insurance company? Talked with several different people? There may be some parts of her care that are covered. She should also try to negotiate a fee with the doctor. Or, seek another physician who is more amenable to working with her in this situation (even if just being willing to take the fee that insurance would have covered instead of the higher rate that uninsured folks always seem to have to pay...).

I have a friend (in her 50s) who stupidly went without health insurance because of the cost and then found out that she had to have hip replacement surgery. She managed to negotiate lower rates with the physician, anethsesiologist, and hospital. But then she applied for insurance with Kaiser (the HMO) and it was all covered. I was shocked that Kaiser would take her at that point and not charge her an arm and a leg for premiums because of her pre-existing condition, but they did. I don't know if there is any possibility of checking into that option but it might be worth checking out...
- October 30th, 2009, 01:31 pm
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librarybabe wrote :
Tell her she has the choice of robbing her mother of a some money or an irreplaceable daughter. Either way her mother loses something. Her mother has already told her which she values more.

If it hurts her pride, you might remind her that in the current health care situation, it is likely that she will need to return the favor someday to her mom. It is just a loan.
This is good advice.
- October 30th, 2009, 01:35 pm
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neardc wrote :
The whole issue of pre-existing conditions is for another discussion, I suppose, but as your friend's situation illustrates it's a major flaw in our healthcare system that causes needless delays in healthcare (or prevents people from getting desperately needed care). It's crazy what little things can sometimes be considered pre-existing, too...

Tell the dad. Even if he's a jerk, this may be the kind of situation that he's good for (and where he would genuinely want to help).

Also, has she triple-checked with her health insurance company? Talked with several different people? There may be some parts of her care that are covered. She should also try to negotiate a fee with the doctor. Or, seek another physician who is more amenable to working with her in this situation (even if just being willing to take the fee that insurance would have covered instead of the higher rate that uninsured folks always seem to have to pay...).

I have a friend (in her 50s) who stupidly went without health insurance because of the cost and then found out that she had to have hip replacement surgery. She managed to negotiate lower rates with the physician, anethsesiologist, and hospital. But then she applied for insurance with Kaiser (the HMO) and it was all covered. I was shocked that Kaiser would take her at that point and not charge her an arm and a leg for premiums because of her pre-existing condition, but they did. I don't know if there is any possibility of checking into that option but it might be worth checking out...
Everything comes down to let her mother help her or going to her dad. She was supposed to still be on his insurance during the lapse. Probing that issue may force payment. The other is her dad has more than enough money to pay for it.

Her father is just like my ex and she is the same age as my older kids. I think that is why we are such good friends. I tell her how her mother feels even when her mom can't say it and she tells me what all my daughters swearing means.

Since it seems no one will go to the dad I am trying to get her to understand her mom is doing this for herself as well. No one wants to see their kid in pain.
- October 30th, 2009, 01:42 pm
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I'd double check on the health insurance too...I know for my insurance the pre-existing condition block-out period only kicked in if you'd been off of insurance for more than two months, so if her insurance had only lapsed for 30 days or so she may still be covered.
- October 30th, 2009, 01:50 pm
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cardguy wrote :
I'd double check on the health insurance too...I know for my insurance the pre-existing condition block-out period only kicked in if you'd been off of insurance for more than two months, so if her insurance had only lapsed for 30 days or so she may still be covered.
I know all it takes is a call from her dad to his insurance company. What it was is he forgot to call at the beginning of the year with her school schedule. Once he does that she is covered till six month after she graduates. Heck that would actually make her insured through his plan for the surgery. I am going to email the stubborn child. God she is just like my kids.
- October 30th, 2009, 01:57 pm
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You are being a good friend. When you are in the middle of a situation like this, it can be difficult to think straight or get a clear view of your options... I'm sure it is a help to have you there for support and to "translate" the situation for her.
- October 30th, 2009, 02:04 pm
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So, technically her dad was at fault for the lapse? If that is the case, somehow (and I wish I knew how) persuade her (or maybe her mum) to contact him to make that call. Then she gets the surgery she needs and won't feel guilty about the cost to her mum. It seems such a little step for such a big outcome.

Good luck, Jo. She has a good friend in you.
- October 30th, 2009, 05:30 pm
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Not sure if anyone will read this. I work for doctors so I asked our billers. They said Blue Cross is know for kicking claims like this. They said all she needs is the doctor to send a letter stating it is not pre existing. He did, she's covered!!!!!
- November 4th, 2009, 08:33 am
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