Originally Posted by Jimking

The whole system is rigged to trap and expel those who have pre-existing conditions. One can find themselves in a tight spot in a hurry and its rigged that way on purpose, written by attorneys who are employed by insurance companies. COBRA was passed by congress in 1996 to help those bridge the gap, to avoid the lapse in coverage, in which insurance companies invented. But, what many don't realize if you work for an employer with less than 22 employees and or the company goes chapter 7 there is and never was COBRA to begin with. Just wait and see what loop holes there's going to be with the new health insurance laws. My prediction is not only will insurance companies make a bundle of cash they will, or already have, figured out ways to dump human beings with health issues.

Originally Posted by hollyk24

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.

Originally Posted by hollyk24

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 . . . . .

Originally Posted by hollyk24

I thought it was wrong to, but that was straight from several people at oregons insurance commision's department - they said since the company's corporate office is in CA, and the policy was out of CA, CA laws applied I know in most all other situations it would he the opposite case, but they told me it's where the policy is purchased that determines what laws govern it. I'm still not totally SOL on it, because BOLI (Bureau of Labor and Industries) is looking into the policy, they have a division that regulates companies benefit packages and I've talked to them and mailed them all the policy info and all the documentation and other information I have about the whole situation, so it's possible something could come out of that. The lawyer I'm considering hiring recommended I try that route first, if BOLI finds merit in my complaint they could require the company to rectify the situation or compensate me, but if I go that route I'll likely lose my job, so that's something I have to take into consideration too. While totally wrong and illegal for them to fire me in retaliation for filing a complaint, the fact of the matter is my company is directly related to the housing industry and could easily 'lay me off' instead of fire me if they wanted to get rid of me.