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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by tabitha on June 24, 2004, at 1:08:53
So my therapist has been billing my insurance, and due to some fluke of my plan and my state's mental health parity legislation, it's been paying a huge amount, like 50%, with no limit on the number of sessions billed per year. My prior insurance only paid like $1000 per year tops, then it got reduced to $500/year. My T asked me whether I wanted her to bill under my bipolar II diagnosis, which is a parity coverage diagnosis (under state law), rather than the less severe one (dysthymia?) she had been using, and I said sure why not! Milk those b***tards for all you can! She also asked whether I wanted her to bill group sessions along with individual, and I again said why not, so there was a while when she was billing 2-3 sessions per week for me. It's not like she's making it up-- I got the bipolar II diagnosis from a psychiatrist.
So, now I'm self-employed and getting insurance under COBRA. That runs out in 6 months, but I thought, oh, no big deal, I'll just buy insurance myself after that. Well little did I know, the insurance companies can just refuse to sell you a policy if you have health problems. I knew about pre-existing condition, but that's only for 6 months, so it's not horrible. I can pay for 6 months if I have to. But I talked to BlueCross today, actually thinking of just buying it now, since my COBRA plan provider changed to BlueShield, and my therapist isn't in their network. The agent sounded quite discouraging-- I couldn't discuss my health details since I was at work, but she made it sound like you can get refused pretty easily if you have any health problems at all. She strongly recommended I maintain my COBRA policy while applying.
I also noticed the individual plan doesn't appear to cover mental health care at all-- which I don't understand how they can do that, due to the parity laws in my state-- but it didn't look too good.
So now I'm kinda freaking that I won't be able to buy insurance from anyone when my COBRA runs out, due to all the therapy billing. After all, my monthly therapy bill has been way more than my insurance premium-- so if they have a choice and they really evaluate you on an individual basis, I don't see why any company would sell me a policy.
I don't know if reducing the therapy billing, or having her change the Dx code would even matter now, since it will still be in my insurance records forever.
I'm mainly concerned about being totally without insurance-- if worse came to worse I can pay for therapy myself, as long as I'm working.
Does anyone know anything about this stuff?
Posted by ghost on June 24, 2004, at 7:51:32
In reply to I think I've messed up my health insurance., posted by tabitha on June 24, 2004, at 1:08:53
as far as i know, as long as your COBRA doesn't *lapse* before you get new insurance, they can't refuse your treatment under a preexisting condition. It's only when you've been without insurance for any period of time can you be refused coverage. (shoot. that means i'm in a similar situation myself right now. damn.)
i would try to get your insurance squared away before the COBRA runs out and try to keep yourself insured without any lapses. as far as your T and whatnot being out of network with the new BCBS, maybe your T's practice can join the network? I'm not real sure about how easy that is though.
Posted by fallsfall on June 24, 2004, at 11:46:04
In reply to Re: I think I've messed up my health insurance. » tabitha, posted by ghost on June 24, 2004, at 7:51:32
The continuous part only works if the new insurance company HAS to accept you - like if they accept all people employed by a particular company. If it is individual coverage, I believe (but I have been known to be wrong) that they can refuse to cover you.
Do you fall under any groups who would HAVE to insure you? Sometimes you can get insurance through a group (like a professional association? or a social group? or something like AAA - they have prescription benefits, but I don't think AAA has health insurance). Are you married - if your spouse has insurance they probably have to cover you. Are you under 25 and a student? Does your parent's insurance have a rider for children who are disabled? Can you get insurance (from a company who has to insure you) from the Small business assocation?
I don't think that you would be in a different position if you were still reporting Disthymia (but I could be wrong about that, too).
I'm going to ask my company if I can continue to COBRA after my time expires. I don't really think they will say yes, but I'm going to ask anyway.
Posted by tabitha on June 24, 2004, at 12:59:24
In reply to Re: I think I've messed up my health insurance. » tabitha, posted by ghost on June 24, 2004, at 7:51:32
That could be right, but it's not what the agent told me. I currently have insurance with BlueCross under COBRA, yet they said I still needed to go through the complete application process, with doctor's record checks and everything, and she said it could take 2 weeks to process, and I could be refused coverage.
I'm confused. I also had someone tell me that they can't use pre-existing condition exclusion in my state, but their website talks all about it, and it's for my state specifically.
I'd better call them back at a time when I have privacy to ask about all the mental health issues. I wonder if the sales agents really even understand the laws and the processes very well.
Posted by tabitha on June 24, 2004, at 13:05:17
In reply to Re: I think I've messed up my health insurance., posted by fallsfall on June 24, 2004, at 11:46:04
I don't have any fallbacks like that. Maybe I can join some self-employment organization where there's a group plan. There are private companies that do that, but they typically take a percent of your earnings. As a last resort I could go back to a regular hire job instead of self-employment.
I have a while to keep looking though.
Man, there really ought to be some kind of national health insurance thing, or some plan where people who don't fall under anyplace else can get insurance. What's the point of private companies selling it, if they only sell it to perfectly healthy people?
Posted by tterees on June 24, 2004, at 14:02:17
In reply to Re: I think I've messed up my health insurance. » fallsfall, posted by tabitha on June 24, 2004, at 13:05:17
When I was laid off, and I went under COBRA, it was like nothing changed except I was paying $xxx amount per month instead of $xx a month. Before COBRA ran out (18 months in my state), I made arrangements to go on an individual plan with the same Insurance Company (HMO in my case). Again, it was like nothing changed except now I am paying $XXX a month. When I say nothing changed -- same meds, same therapist, same psychopharma guy. I think if you stay with the same Insurance company without a lapse and keep the same coverage nothing changes except the $$$$$. (and that is a BIG change)
Posted by woolav on June 24, 2004, at 15:29:39
In reply to Re: I think I've messed up my health insurance., posted by tterees on June 24, 2004, at 14:02:17
My cobra just exp and I cant get insurance now because i'm considered "high risk" bc I take anti-depressants. I just got married and found the only option is to be added to his plan. This really sucks.
This is the end of the thread.
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