Thursday, January 20, 2011

Pre-Existing Conditions, Insurance and Health Care Reform

I have 2 children that are chronically ill.

If you know me or follow HWHAP even occasionally you know that my son, Nate has type1 diabetes and my daughter, Sophie has Crohn's.

In September of 2010 we reached the the end of our COBRA coverage and found ourselves without health insurance.  I worked for months prior to the expiration of our policy trying to find a company that would cover Nate and Sophie but found that with their pre-existing conditions we could not get coverage through a private policy.

In Texas we have the Texas Health Insurance Pool which is basically a state plan through BCBS that charges a premium to cover pre-existing conditions.  The monthly premium is determined by your zip code and which deductible you choose.  If you live in Texas and need to look up the rates you can check them out here.   Expensive!  

There are now different options through the federally run programs including a Pre-Existing Condition Insurance Plan where the rates are 1/2 the price of the State High Risk Pool.  But - - - you knew there was a but --- right?  To qualify for coverage you must have been uninsured for at least the last six months before you apply.  Yes, that rule applies to children too. Still, a very good option to have because many people have gone months and even years without coverage.  If you have a pre-existing condition and have been without insurance --- I encourage you to check this out!

I really don't know enough about the health care reform to preach it here on my blog.  I wish I had time to sit down and go through the plan page by page but you know - - - I haven't had a chance to get that done.  One thing I do know is that beginning in October of 2010 Health Insurance Companies can no longer deny a child with a pre-existing condition from a private policy if they are under the age of 19 and on a policy with a parent.

Sounds amazing right?

Just the answer we were looking for - right?

Once I found out about this part of the health care reform I started researching policies and filling out applications.  We decided to go with the same company we were on with COBRA since we were familiar with them and somewhat knew what they would cover.  We received a quote and I filled out the very lengthy application for the Houston Five and held my breath.  I received a call from a nurse that worked with the due diligence team and my 1st thought was that she would be asking questions and inquiring further about both Sophie and Nate.  I was shocked when she told me all of her questions would be about me and why I had a hysterectomy.  Not a single question or concern about Nate or Sophie.

A few days later I received word that we had been accepted with one small change. Sophie and Nate were indeed offered the opportunity to have private health insurance with one small catch --- their monthly premium would be 300% more expensive than originally quoted.  This put the monthly premium WAY over our budget and my head was only moments away from exploding!!  So, yes with the health care reform bill our children can get the coverage that they deserve but you have to pay a small fortune to get it. Still, at least there is an option.

We have been blessed beyond belief since losing our coverage back in September.  I was able to fill all of our supplies before we lost coverage and it seems like just as we get close to running out of supplies someone from the DOC has been kind enough to send us just the things we need just when we need them.  We've received test strips, lancets, lancing devices, insulin and even pods so that Nate can keep pumping.  I have been blown away by the generosity and kindness of these people that we have never even met (in person).  These people deserve way more than my thanks.  We look forward to paying it forward when we can.

Thank you so much!!!

I love the DOC!!!

So, for some good news . . .

After all of the research, applications, let downs, endless phone calls . . . the list goes on.
We finally have coverage for the children through the TX CHIP program. I will occasionally be chronicling our journey with CHIP here on HWHAP.  It's been interesting so far -- I will post more soon.  Let's just say I'm SO happy to have the supplies from our friends in the DOC because we haven't been approved for test strips, pods or pretty much anything except for insulin and even that was quite a little battle.

Thanks to Penny over at A Sweet Grace  for the suggestion to request a case manager.  We were assigned a case manager today and things are already looking SO MUCH BETTER!!

More soon - I promise.


I feel the same way! Reform sounds amazing but will that eliminate medicaid or chip? Can i afford the premium? Its not a perfect system either way.

Im shocked you havent been approved for strips yet! Please keep us posted on that.

Theres a program in chicago i researched before i got let go and when i thought we were moving was like chip or medicaid. Full coverage. No child denied with a premium depending on your income heres the difference between that and chip though. You could make anywhere from 20 a year to 150 thou! Your premium would just be more if you made alot.

I swear it was amazing. Thats what we need. Ok im rambling i just totally understand.


Penny said...

Thanks for posting this Laura, because people need to know about what health care reform - and the repeal that is happening now as we speak - will do to our kids. I fear that Grace will grow up and become a young woman and not have healthcare coverage and not be able to access any that she can afford. The fact that she could stay on our policy until age 26 right now AND not be denied because she had a pre-existing condition seemed almost too good to be true. I have a feeling the repeal will take away all the good things that healthcare reform has brought to the table for our kids.

I am so thrilled the DOC came through for you and that you have TX CHIP now. In PA I loved our CHIP< it was the only insurance - the government insurance that people rail against - that would take her. They covered it all for her. As of Dec. 1st she was dropped by CHIP to Medicaid and it's been the worst 2 months so far - they cover nothing and everything is a fight. Below Medicaid there is nothing for her, no insurance. And we don't need her to be on Medicaid, we are not poor people. I feel guilt and glad all at the same time.

Good job on the case manager. When we were on CHIP our case mgr helped us out immensely. PLease let me know if you need some more pods and I will be happy to send a few your way. Gotta keep Nate pumping sister!

Good post my friend.

When we first got our diagnosis, I was so happy we were already on insurance. But, I always fear the future and "pre-existing" conditions. I'm glad to hear things are looking up for you. It's too bad that we have to worry about insurance on top of diabetes health in general.

Amy said...

Wow, Laura. I hate to hear of such struffles within our little 'family.' But, it does sound like you are being taken care of and held afloat by some pretty special people. :)

Please continue to express your needs so others can step in and offer their abundances.

I will certainly keep you in our prayers and am so happy you have a case manager to help sail through the system.

:) Tracie said...

Hearing your story makes me realize that I take my health care for granted. Don't misunderstand though, I am so very grateful we're covered, even if our policy is going to a crappier level with higher co-pays and NO durable medical. It's a good thing that Jessi went back to MDI's a year ago, but if she wants to start pumping again...we're screwed.

The DOC are an amazing group!
I'm so glad things are working out for you in that respect and that you are a tenacious woman to get things done reguarding insurance!

alix said...

you have been a busy researching, sitting on hold mama. sorry your family has had to go through this. we had our ins. issues too, as you have read.

glad there is light at the end of the tunnel AND that you have a wonderful doc and staff.....

hang in there

Stephanie said...

Laura, please shoot me an email when you have a chance. I'm assuming that since you are on Omnipod, that you use the Freestyle Lite strips? Since Adam started pumping a few weeks ago, we have switched back to the One Touch strips. I have a few boxes of Freestyles that I'd love to send you.

Something does need to be done about health care. I just wish we, as a nation, could get something done SOON. I fear for when Adam grows up and will have to choose a job not based on what he likes to do, but because of the insurance.

Sarah said...

I can't even fully explain to my friends how difficult this aspect of having a child with diabetes is....they're baffled that the insurance companies wouldn't want to cover them and all their needs based on what the doc orders. I am too. I actually find this to be one of the most taxing aspects. I hope all keeps improving for your family and soon you'll not need CHIP but instead will have great coverage with less hassle. We can dream, right?!

Meri said...

What a journey! I'm so happy you have the things you need right now. We will be here if you find yourself short dear Laura! I hope things start looking up day by day! Love you!

Lora said...

What in the world - are we in the stone ages?! Paying SO much more for a pre-existing condition? Barely covering insulin and nothing else? Who is the mastermind behind this hoo-hah?!

Sorry - that just really gets the blood boiling! You have my e-mail address, right? Let me know what you need. Since both of our boys are about the same age, we might use a lot of the same stuff. I sincerely hope and pray that things will work out in the most positive way for you and your family.

Unknown said...


I'm so thankful you've been able to get what you need to keep moving along...but I'm so FRUSTRATED at the hoops you've had to jump through and the curve balls you've had to dodge...


This oughtta be good...

If it's your first time to purchase an insurance policy, be sure to familiarize yourself with the laws and regulations in your state about individual health insurance.

Sundas said...

I wish I had time to sit down and go through the plan page by page but you know - - - I haven't had a chance to get that done. One thing I do know is that beginning in October of 2010 Health Insurance Companies can no longer deny a child with a pre-existing condition from a private policy if they are under the age of 19 and on a policy with a parent. sexual advise

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Just a Mom

I am NOT a doctor, nor do I play one on this blog.

I AM a wife.
I AM the mom of 3 wonderful children.
I AM my son's pancreas.

The information provided on this blog is from our personal experiences with Type 1 diabetes. Because something works for us does not mean it will work for you.

Please consult your doctor if you have any questions or concerns about your health care options.

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