*#&$*@*@^%$#^ More.... it may be that my dd's arthritis will be "preexisting"......

[Joanne]

Since XH did not inform me of the lapse in coverage, and we will have more than 90 days between lapsed coverage and new enrollment, there is a chance that her Juvenile Rheumatoid Arthritis will be "preexisting". I'm not sure for how long; I need DH to found out.

One of her meds is $1500 a month. Yes, a month.

If we enroll her in the Texas State program, they will have to cover it. But, of course, the coverage isn't as good as the school district where DH works.

[Tutor]

Ugh. I am so sorry. I'll be praying that you can find a way to meet all of your dd's needs... and not throttle anyone. :)

[Andie]

Since XH did not inform me of the lapse in coverage, and we will have more than 90 days between lapsed coverage and new enrollment, there is a chance that her Juvenile Rheumatoid Arthritis will be "preexisting". I'm not sure for how long; I need DH to found out.

One of her meds is $1500 a month. Yes, a month.

If we enroll her in the Texas State program, they will have to cover it. But, of course, the coverage isn't as good as the school district where DH works.

Could it be that after a period of time on the state program, she could then go onto dh's policy without a problem?

[Brigitte]

Can you get gap insurance until the new insurance kicks in? What about COBRA? You have 30 days from the end of the previous insurance to sign up for it.

[Joanne]

Can you get gap insurance until the new insurance kicks in? What about COBRA? You have 30 days from the end of the previous insurance to sign up for it.

It's not a matter of new insurance kicking in. We can enroll immediately. It's a matter of a wonky policy in states with health insurance that relates to continuous coverage vs. a lapse. If you lapse in coverage, your new company can exclude previously diagnosed issues from compensation or treatment.

I can't afford the Cobra (and our new insurance is much less, even though it's still a lot!).

The previous insurance terminated Feb. 1. I didn't know until this week.

[Whisperlily]

You can also have double coverage...

I know that if you sign the kids up for Medicaid, they'll cover her condition, therefore it won't be pre-existing when you sign up for your DH's health plan through work.

You can carry insurance and have Medicaid as a secondary coverage. This way, only the co-pays, and your portion are paid by State coverage, and the rest are paid by the other insurance.

I don't know about TX Medicaid coverage, but in some states all prescriptions are covered in full.

[Scarlett]

What kind of man lets the insurance lapse on his child with high medical needs? I hope he was homeless and eating from garbage cans during this time. That's all.

[Laurel T.]

If it does turn out that this is considered pre-existing and the insurance does not cover pre-existing conditions for a period of time, I would enroll dd in the State program. You would probably have to carry the state plan at least until open enrollment for XH employer. It is hard to add someone to a health care plan except at the time they are hired or during open enrollment periods (usually once a year).

If you can get your hands on the health plan document you might want to take a look and see if there is anyway around it. Many plans have waivers on waiting periods for new hires (if that applies to your situation).

Good Luck. I know how frustating things like that are.

Laurel T.

[Ravin]

Since XH did not inform me of the lapse in coverage, and we will have more than 90 days between lapsed coverage and new enrollment, there is a chance that her Juvenile Rheumatoid Arthritis will be "preexisting". I'm not sure for how long; I need DH to found out.

One of her meds is $1500 a month. Yes, a month.

If we enroll her in the Texas State program, they will have to cover it. But, of course, the coverage isn't as good as the school district where DH works.

CHIP in TX can be used as secondary coverage insurance. It'll pick up anything your other insurance doesn't, as long as you're within the income guidelines.

[Rhonda in TX]

I know you are feeling attacked from every side right now. This just stinks.

:grouphug:

This too shall pass. Really.

[Remudamom]

I know how scary this must be for you. My arthritis meds are $2000 a month, and I don't know what we would do if the insurance didn't cover it.

I'll be praying hard for you that it all works out.

[Cathy in TX]

Joanne,

It appears that pre-existing conditions can be excluded for three months by the new insurance. My dh switched jobs, due to a lay-off last October. His benefits from the new job began in February, and as of last week, we were still getting letters from the new insurance asking to prove we had coverage during the time he was out of work. Every letter mentions a three-month exclusion. (Fortunately for us, we did have COBRA coverage, so it is just a matter of the insurance company getting the right document to the right person.) I am guessing this is the time exclusion allowed by TX law...

While we were waiting for our new insurance company to send us our policy info and new insurance cards, my dh needed his monthly shot of Humira for arthritis. His osteo doc gave him a free sample. Perhaps your daughter's doctor would be willing to do the same thing if he were apprised of the situation.

Good luck,

Cathy

[Amy in NH]

Well, shouldn't XH have to cover the extra expense since he's the one who let the coverage lapse?

I'm surprised that Medicaid coverage is not better than a school district insurance policy. Here in NH, Medicaid covers everything including copays for doctors appointments and medications. If you qualify for food stamps, surely you also qualify for your kids to get Medicaid?

[Claire]

It's a matter of a wonky policy in states with health insurance that relates to continuous coverage vs. a lapse.

Interesting. Think about who this policy benefits. Does it benefit citizens of the state, including the state's children? No. Does it benefit insurance companies? Yes.

That tells us a lot about who wields power in government.

[Scarlett]

Interesting. Think about who this policy benefits. Does it benefit citizens of the state, including the state's children? No. Does it benefit insurance companies? Yes.

That tells us a lot about who wields power in government.

Egg-zakly

[True Blue]

I think ex should have to pay for the difference, too. This really makes me angry.

[Denise in IN]

Joanne, it seems like you're getting hit with all kinds right now. I'm sorry you're having to deal with this. No advice or knowledge on the insurance, but prayers and :grouphug: for you and your family!

[LizzyBee]

Interesting. Think about who this policy benefits. Does it benefit citizens of the state, including the state's children? No. Does it benefit insurance companies? Yes.

That tells us a lot about who wields power in government.

Actually, it's way better than it used to be. Until 1996, every time you changed health insurance, you (and your family) could potentially have pre-existing conditions. Under the Health Insurance Portability and Accountability Act of 1996, if you change insurance because you change jobs or your employer changes health insurance carriers, there will not be pre-existing conditions if there has been no lapse in coverage. This is federal law, not state, although there are differences in the way the states interpret and implement it.

Joanne, I'm sorry you're going through this. :grouphug:

[Melinda in VT]

I could swear that when DH switched jobs we had 90 days to decide if we wanted COBRA or not. And we could activate it retroactively.

But that was 8 years ago and I had newborn twins and we had just moved cross-country away from all our family and friends. Suffice it to say my memory of that time is a little fuzzy. :tongue_smilie:

In your situation, I would do the following:


Double, triple check that we couldn't get the kids on COBRA until DH's policy kicks in, so there would be no lapse.
If that's not possible, apply for state insurance or Medicaid and use it in conjunction with DH's insurance, if possible
If that's not possible, apply for state insurance or Medicaid and use it just long enough to be able to transfer to DH's insurance with no lapse in coverage