Insurance Nightmare at worst possible time!
 

I'm in quite a situation - My employer is changing our health insurance, and ALL 4 choices they are offering all excluded rsd for treatment or exclude chronic pain conditions for treatment!!!

Oddly enough, about 4 months ago they had us do a mandatory survey about our health, confidential of course, asking very specific info about any diagnosis or medication we were on or had received, and other health related info, in order for them to "shop" out some health insurance companies. I'm almost certain that they used this info, and when the prospective insurance carriers saw rsd/crps they told them it would be $$$$$$ for any policy, so they decided to get policies that would exclude any treatments.

I'ts really messed up, I've talked to the Oregon Insurance Commision, and if the policy's were out of Oregon, they'd be illegal because group policy's here can't have those kind of exclusions, but my coprorate office is in CA, and that's where the policies were purchased, and I guess it's legal there. I'm in the process of hiring a lawyer, the first one I called just happened to have a mother who has rsd in her shoulder, so I figured that was a sign. She said because they did the survey first I have a case for discrimination against them as they can't ask you what your medical conditions are and then shop for insurance like that. But in the meantime, my coverage runs out at the end of June. No one is gonna give me an individual policy, at least not one I can afford. My only even semi viable option is a quickie wedding to my fiancee so I can get on his insurance, but he is just recovering from getting out of the hospital from having serveral surgeries himself from compartment syndrome on his leg and almost losing his foot.

I'm not sure I really have a question . . . I guess I'm looking for ideas. I know I won't qualify for any insurance/government options because I have income and a job and am offered group coverage even though it excludes me, but it seems like there has to be something out there, right? I've called everything I can think of . . . . .

WOW!! I would think you would have a good case also, but it is what to do in the mean time right? I don't have any suggestions at all just know that I am on your side. It is so wrong wrong wrong for them to have done that survey & then shop around like that.

Besides you do you know how many other people are being put on the spot like you are??? Are you union by any chance??? If you would care to share who do you work for???

I am sorry this is happening to you.

DebbyV

Just a thought, explore the options on the new insurance for covering a pre-existing condition. I once had this happen to one of my employees and we found out that since she had a pre-existing condition and this insurance was replacing the old coverage, she was still covered for her condition. The new policy had an exclusion for any new cases or diagnoses that came after the employee was enrolled in coverage. Not sure if this would help, but you might look into it. Good Luck!! Lisa

Something doesn't sound right. Group policies don't have pre-existing clauses in California and I've never heard of RSD as an exclusion, to date. Private policies can exclude whatever they want to but I've not heard that of a group policy. I think I'd want to see that in writing, in the policy. Discrimination certainly sounds like an issue too.

You might also want to call the California Insurance Comissioner's office and do a little investigating.

Hi Holly,
First, I am sorry you are going through such a stressful and hard time.. it's great that you have found an attorney that is willing to help you and understands your circumstances!

I would have him contact your employer and suggest that his mandatory survey was an invasion of privacy and he has no legal right (at least, that's what I would assume, but check with your attorney) to demand private information about your health status, meds taken, prevailing conditions...that is ludicrous to ask of employees...was this an anonymous survey?

Maybe your attorney can convince your employer to continue paying for your present insurance policy which runs out in June, so that the coverage can continue until this is all resolved. he might be willing to do that once your employer has a reality check with your attorney!

I know nothing of labor laws, but your employer's strategy sounds manipulative and wrong...and illegal..
Holly, I hope your fiance is feeling better after his surgeries, and I hope the two of you find a workable solution soon!!
Sending hugs,
Hope4thebest :hug:

So, i found out the new insurance doesn't exclude rsd exactly, it just excludes coverage for any chronic pain treatment. So techinically it would cover things like pt, but it wouldn't cover any meds or pain management at all. But I've been told several different things in the last few days, so I'm waiting til I get it in writing . . . . I've been told rsd was specifically excluded (along with fibro. etc), I've been told it's just the pain managment, I've been told it's only chronic pain treatment . . . . I'm sure I've been told some other things too, but I can't remember them now.

I tried to go the preexisiting route, but the said because the new policy excludes the treatments, it didn't matter. I've tried every angle I can think of here :( It's not a union, it's actually an ESOP, and it spans over several states. You'd think since it's employee owned it would be easier or something, but nope :(

In Oregon, group policies can't have these kind of exclusions at all. I talked to the CA Insurance Commision, and they wanted me to send them a copy of the policy, which I'm doing. It does say clear as day in the exclusions "Chronic Pain Treatment", and the HR dept here is working on writing something up for me using some procedure codes I got from my doctors office (just for my normal monthly visits) saying that with the new policy they would not be covered and are specifically excluded. BOLI's office that oversee's benefit packages is also looking into the legality of this one, and I am seriously considering filing a complaint with them. But, I also have to consider the fact that if I want to hire a lawyer and pursue this I will likely lose my job - that's just how my company is. They will find a way or reason to fire me if I pursue this so I will have to tread carefully. I want to make sure my company compensates me for this, but I also want to preserve my job.

As to the survey they had us fill out, I found the email with the link, and it was still up online! So I was able to go back and print it out. And wow!!!! First off, it was not anonymous! It asked your first and last name, birth date, height and weight, as well as any dependants. Then went on to list a bunch of diseases asking if you had them or not, incuding HIV, mental illness, drug addiction, cancer, heart problems, etc. Talk about HIPPA voilation! Then it asks if you were disabled in any way, what meds you were on, how long, why, if you've been told you may need surgery in the future, what you thought your medical costs would be in the next year, and a few other questions. It ended with a paragraph about insurance fraud and about how if you intentionally lied or omitted information it could be used to deny you coverage in the future. All this was done on . . . . . SURVEY MONKEY!!!!! And according to the email, all employees, whether you were on the companies health insurance or not had to take the survey.

On a good note, I think we may have a found a workable solution :) We are considering getting married now, just a quickie in front of a judge thing, and then still have our real wedding later like my mom is planning, that way I can get on his insurance. He is a federal employee, so all his benefit info is online, so I was able to do all the research while he is home recovering and just bring him the info. I found a plan that would still cover everything I need, and be cheaper then what he is paying right now even when he adds me on (thankfully the feds only have individual and family plans, and he has a son, so he was already on fam, adding me on doesn't make a huge jump in price). So I was able to find a cheaper plan that still covers every single one of my meds and doctors, doesn't have a dedcutible, no waiting periods, exclusions, preexisting, decent copay, and will cover all his/his son's needs to, and save him some money. I think he feels good because he gets to be the 'hero' in the situation :) My mom even thinks it's a good idea, which I'm surprised at. But she realizes how important it is that I have health insurance and that if it lapses how hard it's going to be that she can over look the fact that I'll be married a few months before my wedding . . . .

I've talked to a couple other people at my work who were affected negatively by the change in insurance, but not to the extent that I was.

Your need for medication/treatment would be more reflective of an acute exacerbation, not the need for ongoing treatment of a chronic disorder. Might still be covered because of that. All comes down to what "phraseology" your doc uses in his diagnosis.

I'm glad you found a way around this mess hollyk24, congrats! :) And yes, having lived in the DC area my whole life, my brother who works for the fed and his family are well taken care of by their BC/BS ppo. Me, on the other hand, who works in the private sector lost my coverage because the company went chapter 7. All alternatives where too expensive, twice my mortgage amount per month. The new company I work for has no benefits. The system we have in this country is pathetic and looks and feels criminal. Who needs this kind of stress when they fall ill.

Right Jim... This is so wrong..enough already with this employer..he needs a spanking..lets get married..sue due to discrimnation and aggravation of your terribly painful illness...let em fire ya..they were lucky to have you and you are better off without them! I am all for people with pre-existing should be cut slack and to go thru the back door to get your personal information then build it against you is wrong..wrong!! One more person/group punishing us for something that is out of our control...I am so sorry Holly that this is happening to you...and I am sure your stress level is thru the roof...not to mention your fiancee's health issues...I ma sorry for all of that..and I hope he feels better soon...so...

I want to say congratulations on your beautiful marriage...what shall we all wear to the wedding??

Love, Kathy:grouphug:

Dear Holly -

To everything others have said, I would just emphasize that you have the right to see the exact language of the policy. First things first, you should ask to be given that portion of the policy which excludes coverage for any chronic pain treatment, if they are using that as a basis to deny you coverage.

Then we can discuss whether it's lawful.

Mike