Question:
Insurance experts - help needed
My son, who is 6 weeks post-op, has been on disability and receiving welfare benefits, including medical. This insurance paid for his WLS. The benefits are set to end Sept. 10, but if his doctor signs off that he is still disabled, he may be able to continue the medical benefits until March 2004, but that is the longest he could possibly keep them. (In our state, you can only be on welfare for 2 years.) The catch here is that he would like to start looking for work. If he cannot find work that will pay for benefits, then he will lose all benefits, and be without coverage of any kind. He and his fiancee are getting married July 26, and she is a part-time employee who has medical benefits, but the company's policy will not allow him to be put on benefits as long as she is part-time, even if he would pay the entire premium.<p>I am concerned that as a post-op, he needs to keep some type of benefits. Do you think he would be able to purchase private insurance? Or do you think no one would cover him because of the WLS? This is a very scary issue. He has been doing very well, with no complications, but you just never know. Also, does anyone know if he could keep the benefits he has now, under the COBRA laws? Or does that not apply to state-funded benefits? If he were able to pay for them himself, that would be the ideal solution, as this insurance has been great for him.<p>Thank you everyone. I have asked other insurance questions here before, and you guys have been great with your answers. — Carlita (posted on June 27, 2003)
June 27, 2003
Well let me start by saying that if your son applies for an individual plan
on his own then he may be denied. It's up to the discretion of the ins.
co. that he applies for. On the other hand, if he gets a job that offers
benefits, then he cannot be denied due to pre-existing conditions. Also
COBRA coverage is benefits you had through a previous employer, it does not
apply to medi-cal. If your son does not find a job that offers benefits,
then he should try and stay on medi-cal until March 2004. Also if his new
wife goes full time then he will be able to get coverage at her job, even
if he has to pay for it. My suggestion is for him to stay away from
individual plans because they can and will deny coverage due to his weight.
I have been denied before by Pacificare when I applied for an individual
plan due to my weight. Hope this info helps.
— Audra P.
June 27, 2003
He should contact the welfare office or his state's government web page
about low-cost insurance options. In Washington state there is a program
for people who make too much for welfare, but can't afford a private
policy. It is on a sliding scale based on income. There can be
pre-existing rules if there is a gap in coverage, but if no gap or not
pre-existing (like if he got hurt or ill not related to the surgery) then
the coverage is pretty good. The catch is that there is usually a long
waiting list to get on the program.
There are ways to obtain free medicine from the pharmaceutical companies,
there are some medical groups that will help with a sliding fee discount.
Finally, should there be a real crisis, lets say he has an emergency and
needs surgery, some welfare programs will cover it because by incurring the
bill you have become eligible after a cost share portion. The best thing
would be to go to a county hospital or at least a major one, because they
all have programs to help people on low income that can't qualify for
welfare - you just have to ask and probably jump through some paperwork
hoops.
— bethybb
June 27, 2003
Please e-mail me for help. My e-mail address is [email protected]. I
would be delighted in supplying you with information. This would take so
long to type. It would not do you any justice to try and type all the
information that I could help you with. I have helped many people get
approved for wls surgerys and coverages that some insurance companys would
not touch. After you e-mail me directly I will give you my phone number.
Take care and good luck.
— Georgia Girl
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