any health insurance experts

[OceanCityGirl]

my son broke his hand pretty badly, three weeks ago. At the time I had very good coverage thru my husband's union. He's currently working for a non-union company which offers crappy coverage for $100. per week. He will be back in a union position shortly. The union coverage is up on the first of Jan. I have 45 days to opt into cobra for $1000. per month. Coverage will be retroactive.
Union coverage is a ppo, work is an hmo.
I just found out today that my son's injury requires surgery. It's possible that it may need a bone graft. If treatment for an injury is begun while under insurance is the insurance company obligated to finish treatment even if you cancel the insurance.
If not it's most likely that my out of pocket expenses thru the current employer's insurance will be greater then the $1000. needed to continue the other policy thru cobra. Plus I know there would be no questions asked about which dr's to see. I could end up having to pay this cobra for 3 months in order to keep it active though. That's alot of money.Thanks if you can help.

[iuparrothead]

If treatment for an injury is begun while under insurance is the insurance company obligated to finish treatment even if you cancel the insurance?

Nope. Any and every insurance company with do anything they can and go to great lengths to avoid paying for the surgery... especially if it's a pre-existing condition. Even if it appears they should be obligated, they will make sure to let you know they aren't. They will send denial after denial after denial until you're forced to just pay out of pocket. That's their game in a nutshell.

[Quiet and Shy]

If treatment for an injury is begun while under insurance is the insurance company obligated to finish treatment even if you cancel the insurance?

Nope. Any and every insurance company with do anything they can and go to great lengths to avoid paying for the surgery... especially if it's a pre-existing condition. Even if it appears they should be obligated, they will make sure to let you know they aren't. They will send denial after denial after denial until you're forced to just pay out of pocket. That's their game in a nutshell.

Not sure about that...my understanding is that if there are no gaps in coverage, a new insurer is by law obligated to take on pre-existing conditions. It may take a bit more leg work to get additional opinions, etc. though. Good luck! And for your (((son))).

[iuparrothead]

If treatment for an injury is begun while under insurance is the insurance company obligated to finish treatment even if you cancel the insurance?

Nope. Any and every insurance company with do anything they can and go to great lengths to avoid paying for the surgery... especially if it's a pre-existing condition. Even if it appears they should be obligated, they will make sure to let you know they aren't. They will send denial after denial after denial until you're forced to just pay out of pocket. That's their game in a nutshell.

Not sure about that...my understanding is that if there are no gaps in coverage, a new insurer is by law obligated to take on pre-existing conditions. It may take a bit more leg work to get additional opinions, etc. though. Good luck! And for your (((son))).

I think what's going to make this really sticky is the cobra factor. I'm not saying you're not right, but the insurance companies will make it an unbelieveable headache in the case there is even a minor little loophole that I would almost expect paying out of pocket before they cough up payment.

[nomad]

my son broke his hand pretty badly, three weeks ago. At the time I had very good coverage thru my husband's union. He's currently working for a non-union company which offers crappy coverage for $100. per week. He will be back in a union position shortly. The union coverage is up on the first of Jan. I have 45 days to opt into cobra for $1000. per month. Coverage will be retroactive.
Union coverage is a ppo, work is an hmo.
I just found out today that my son's injury requires surgery. It's possible that it may need a bone graft. If treatment for an injury is begun while under insurance is the insurance company obligated to finish treatment even if you cancel the insurance.
If not it's most likely that my out of pocket expenses thru the current employer's insurance will be greater then the $1000. needed to continue the other policy thru cobra. Plus I know there would be no questions asked about which dr's to see. I could end up having to pay this cobra for 3 months in order to keep it active though. That's alot of money.Thanks if you can help.

I'm licensed in Maryland to sell health insurance so I know a little about it. From what I recall the old insurance company is not responsible for any healthcare after coverage is terminated, regardless of when the incident that caused it occured. Since COBRA is retroactive you can always actually see if paying it out of pocket is more, or not. In Maryland you can submit bills you have already paid for reimbursement.

I would call anyways, the rules are different in each state.

[Bob Roberts]

Try this healthcare provider for laughs................

http://video.greatestjournal.com/files/ ... _penis.wmv

[OceanCityGirl]

The cobra payment will be $1000. I feel pretty sure it will be less then out of the pocket expenses. The MRI we're getting tomorrow is pretty likely to be more then half of that.
I'm going to have to get the cobra money together. Trying to start this whole thing all over again with a new insurance co. esp an hmo will be a nightmare and delay the surgery more. Son is still hoping to salvage spring track season and if the surgery is done quickly he'll have a really good chance of doing that. In fact the recovery for the surgery is alot less then the time in the cast was going to be.

[davesnik]

I can't offer any advice but I can definitely feel for your situation. I am helping my boss deal with some issues with his health insurance involving cobra and it's a pain in the a**. Nothing is simple anymore....

[carey24]

I've been doing medical billing for many years. I will tell you this, ANY insurance (Cobra or not) will do ANYTHING to GET OUT OF PAYING. I know personally of insurance companies that pay their employees bonuses for NOT paying claims. If they can find one character on a claim that is wrong, they will deny.

That aside, my advice is this. Call the doctor that is recommending surgery and ask to speak to his billing manager. Explain your situation. Ask what your current bill is with them now. Figure out if the dates of service already billed are covered by your previous insurance (it sounds like they are). If they are not, (if your son was seen after termination of the insurance) ask if they have a self pay policy for patients without insurance. Doctors take a hit every time they get paid from an insurance company. ie: they charge $600, insurance pays $250, you pay $20, they lose $330. Many doctors do not charge self pay patients the full amount, since they aren't going to see the full amount from an insuarance company anyway. And most doctors will set up a monthly payment plan.

After you figure out what you currently owe, find out exactly what surgery needs to be performed. Contact the surgeon's office. they will be able to give you an estimate for the surgery. Inquire about their self pay policy also. Keep in mind, when your son has surgery, you will be billed from the surgeon, the facility, and the anesthesiologist.

Please email me with any questions. I am glad to help any way I can.

[honeysucklevine]

My company is a third party Cobra adminstrator and I would definitely see how much it would be out of pocket. Like it was mentioned earlier, it is a pain in the a** to deal with, and is not the cheapest thing in the world. Sorry about your son's hand....

[iuparrothead]

I've been doing medical billing for many years. I will tell you this, ANY insurance (Cobra or not) will do ANYTHING to GET OUT OF PAYING. I know personally of insurance companies that pay their employees bonuses for NOT paying claims. If they can find one character on a claim that is wrong, they will deny.

That aside, my advice is this. Call the doctor that is recommending surgery and ask to speak to his billing manager. Explain your situation. Ask what your current bill is with them now. Figure out if the dates of service already billed are covered by your previous insurance (it sounds like they are). If they are not, (if your son was seen after termination of the insurance) ask if they have a self pay policy for patients without insurance. Doctors take a hit every time they get paid from an insurance company. ie: they charge $600, insurance pays $250, you pay $20, they lose $330. Many doctors do not charge self pay patients the full amount, since they aren't going to see the full amount from an insuarance company anyway. And most doctors will set up a monthly payment plan.

After you figure out what you currently owe, find out exactly what surgery needs to be performed. Contact the surgeon's office. they will be able to give you an estimate for the surgery. Inquire about their self pay policy also. Keep in mind, when your son has surgery, you will be billed from the surgeon, the facility, and the anesthesiologist.

Please email me with any questions. I am glad to help any way I can.

Right on. I echo Carey's statements...