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Unread 07-27-2009, 08:00 AM   #51
csdmommy
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Let me break my answers into sections, it makes it easier.

1. My first concern is the status of your employment. As being a contract employee, unfortunately, your employer cannot offer insurance benefits. This is considered a type of independent contractorship. Under this provision, an entity pays a person or business a fee for a person to perform certain duties. A business does this so they can stay out of the catch-all umbrella of fees for worker's compensation, insurance benefits, employee benefits (vacation, paid time off, etc.), 401k, unemployment, etc. If you believe the company is satisfied with your work, then you may try to negotiate a contract for work which will entitle you to benefits. Has this business made any mention of insurance benefits? The reason I ask is because of the information I provided. You would have to take certain measures to protect yourself if they tried to make this arrangement while you are still, essentially, an independent contractor.

2. Waiting periods are usually dictated by the insurance company. There is an open enrollment period, in most cases, which is typically for one month in the fall or early winter (usually October). During this time, employees can switch plans, modify benefits, add/delete benefits, etc. If an open enrollment is not mandatory from the insurance, then the employer will let an employee be added at any time.

3. If open enrollment is not a factor, then there is a form that the employer will have you fill out, called an add/delete form, which they would then have to fax or mail to the insurance company. Once recived, the information is keyed into their system (usually within two weeks) and you would then be added to the plan. You would then receive a package with your cards and benefit guide. You need to ask the business if they have an insurance with a open enrollment period or an insurance which any employee can be added at any time.

I hope this helps out. It was lengthy, but I find details help explain an answer better than just throwing terms out there. After you find out the information from the business, let me know and perhaps I can help you from there. Also, ask if they have a "large group plan". If they do, then the insurance company cannot disqualify anyone for preexisting conditions.

Best of luck.

-Christy
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Unread 07-28-2009, 12:51 AM   #52
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Hi csdmommy, thanks for the speedy reply! I was able to get the contracting agency to re-activate my insurance immediately right away today. It is limited benefits and covered less than 20% of the cost of my prescription, let alone reimbursement for doc visits. I guess I should be lucky they covered anything at all.

Today- I told my actual manager at the company I work for that I require outstanding health insurance- which they have. I cannot say that she was all too surprised. This company is actually very interested in making me a permanent employee. They will soon find out that if they wish to keep me as an employee- they will need to provide benefits asap so that I can meet my "basic needs". Its a rather interesting situation there at work, but I will say that I am rapidly learning that they need which gives me leverage.

Are you familiar with the BC/BS or BC/BS Horizon PPO thingys coverage in this area? I am probably way off LOL... I know little about this, just repeating what I think they have.

Thank you again, I appreciate it!
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Unread 07-28-2009, 01:22 AM   #53
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PS I hope I do not sound spoiled, I am VERY jaded about the healthcare system in this country...

I honestly know that I am truly fortunate and grateful to be alive and have any type of insurance in the first place- even if it dosen't cover everything.

Thanks again!
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Unread 07-28-2009, 08:01 AM   #54
csdmommy
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Hey, icequeen! Which state are you in? That will help me out when I am working on the BCBS Horizon PPO information for you.

Good for you.........having leverage on them to get benefits. When I was in med school, I worked part-time jobs (before I met my husband) and could never get benefits through them (employers). I was still eligible under my father's insurance (I was under 24 and a full-time student), but did not want him to take on that expense. With my medical problems, though, I had to keep coverage under him.

Good for you!

-Christy
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Unread 08-02-2009, 03:15 AM   #55
icequeen
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Hi csdmommy, I am in California, thanks for checking it out, you rock!
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Unread 08-04-2009, 01:42 AM   #56
csdmommy
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I will get all of the detailed information I can for you. It might take me a few days.

-Christy
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Unread 08-09-2009, 01:14 AM   #57
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Hi, thanks for this great post. I've learned so much here. I have United Healthcare through work, and The good Lord was able to help me get into a sub program just 2 days ago. After less than a week of praying for it. Although God is strengthening my faith because I asked him to, I am still so pessimistic, Everything in the past few weeks seemed to good to be true, from finding out about Suboxone, to actually getting on it, and having my insurance cover everything. and I keep expecting the bubble to burst anytime.
I checked and was so surprised that my insurance covered the medication under my plan. I only have to pay $30 a month for pills. Otherwise it was cheaper to stay addicted almost. I broke down and cried when I saw that.
But I keep reading nightmare stories of insurances only covering it for a short period of time, or denying coverage. My own paranoid feelings that they'll be some clause I missed, and that they won't cover it for some reason... and that when I go to get my 1st full month's supply on Monday, they're gonna say it's $2000.
As I said, my faith has a long way to go. Forgive me Lord.
It's just after years of thinking it was hopeless, in the last week my whole life has been handed back to me, After reading about Sub, to calling around, making appointments at the wrong places, and actually getting a call saying to come in right away by a Christian doctor who is in Network. Sorry about the rant, but with all the stigma in the news with insurance companies right now. I've just gotta say that God, using United Healthcare and Suboxone saved my life.
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Unread 08-20-2009, 11:43 PM   #58
MEski-1969
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I just got my first reimbursement check from Aetna for my $150 appointment. It was a whole $18!!! I will be calling them tomarrow and see what the deal is. Maybe they can suggest another sub Dr?? Oh well its better than nothing and my scripts are only costing me $30 so I guess I am fortunate in that aspect.
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Unread 07-21-2010, 06:46 AM   #59
csdmommy
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OK, I'm back!! Any more ?'s for me? Fire away!! I missed you guys.......

-C.

P.S. I am still sober!!
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Unread 07-21-2010, 05:57 PM   #60
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Quote:
Originally Posted by csdmommy View Post
As some of you already know, I know quite a bit about the in's and out's of medical insurance. I am a certified medical coder and insurance biller. I am using this knowledge to help anyone in this forum, as I see that there is a need for this type of assistance. Post any questions you may have and if I don't have any answer for you, then I'm sure someone else can help. I also have contacts at many insurance companies, as well as most of the state and federal programs. These people have always helped me out when I had a question related to my past work in the field and I can glean information from them to help you guys out.

So........any insurance questions are fair game........ask away!!!!
It never ceases to amaze me about the people on this forum. What a wonderful thing that I just read: the above. I"m waiting for a doctor who takes UPMC to call me but they are paying for the medication. And yes, I have Medicaid with the HMO and they have this city wrapped up as tight as my leg (I fell, infected, hospital, etc). There concierges are polite and very helpful, but the city has so many people that want to get onto this treatment that the lists are very very long. I just wanted to put in my personal thank you, it may say senior member, but I'm really still a newbie. Or pehaps it says senior because I AM A GRANDMA!!! Thank you, your special and if I have a problem I will ASK AWAY.


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Unread 08-03-2010, 07:12 PM   #61
jdjk
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csdmommy,

Would it be possible to read all the posts in the thread "Insurance will pay Drs just won't accept it" and add your comments. Any advice that you can offer on how to bill in NY would be appreciated. Thanks.
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Unread 02-21-2012, 09:45 PM   #62
KJ42
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Hey csdmommy,

Are you still around and available to answer ins questions?

Thx,
KJ
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Unread 04-09-2014, 09:09 PM   #63
nolongeraddicted
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Quote:
Originally Posted by marn71 View Post
CSDMOMMY,thankyou for the reply. dont have a plan,open enrollment,for my job isnt open again until,november.Public assistance wont cover opiate assistance.But not giving up so easy.iam am still searching for some coverage. thank you,marn
Just saw today that if you qualify the company that makes suboxone will cover your mess for 1 year.
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Unread 12-17-2014, 09:35 AM   #64
Nalaaaxo
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Quote:
Originally Posted by csdmommy View Post
As some of you already know, I know quite a bit about the in's and out's of medical insurance. I am a certified medical coder and insurance biller. I am using this knowledge to help anyone in this forum, as I see that there is a need for this type of assistance. Post any questions you may have and if I don't have any answer for you, then I'm sure someone else can help. I also have contacts at many insurance companies, as well as most of the state and federal programs. These people have always helped me out when I had a question related to my past work in the field and I can glean information from them to help you guys out.

So........any insurance questions are fair game........ask away!!!!
Hello!
So I'm completely new to ALL of this. I told my parents just a few hours ago that I have an addiction problem to Herion. It took a lot for me to tell them, but after doing so they are very much on my side only because I WANT to get help! I live in New Hampshire an I have Medicare for insurance through the state. I've looked into a few drs that prescribe soboxone. I just need some help as to I've never been in this boat before.. I had a miscarriage about a year ago an got into using every day after that. From the moment I woke up till when I fell asleep. I want to beat this addiction an I know it's possible for me with the sobo an support of my family. Any information would be GREATLY appreciated!!! Thank you
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Unread 12-18-2014, 12:48 AM   #65
MicheleJ
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Here's a question from an overly paranoid person.
I need to go to rehab. Applied for insurance on Marketplace. Chose a top, top widely accepted insurance company--zero deductible-and inpatient substance abuse is "fully covered" at "no charge". I already paid for the first month. I know the rehab I want to go to accepts this insurance company. I called.
Are there any waiting periods? Or should I be able to go to rehab on Jan 1st when my coverage begins? I didn't read anything about a "waiting period", but, just wondering.
Also, are pre-existing conditions-such as substance abuse-prohibited from being excluded under the ACA? I think they are, but just figured I'd ask, anyway.
Thank you for providing help for us.
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Last edited by MicheleJ; 12-18-2014 at 01:00 AM..
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Unread 12-18-2014, 06:58 AM   #66
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Hi Nalaaaxo and Michele, csdmommy hasn't been around in a few years, so I think, unless someone else knows, you might have to call your insurance carriers to get those answers.

Nancy
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Unread 12-18-2014, 03:34 PM   #67
MicheleJ
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Thanks, Nancy.
Frankly, I'm not going to call & even open up that whole can of worms with the insurance company. If someone here had advice- that's one thing. I don't need my insurance plan canceling me because of any questions I may ask!! I also know I didn't read anything about any of that- so I'm just going to put it out of my mind!!
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Unread 01-12-2015, 08:53 AM   #68
MattC42286
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Hi csdmommy. I totally agree with everything you said. Sometimes it is meased up that it has got to be that way. Do whats best and easiest for you and mostimportabtly so what is right. Good luck on everything. Thanks! Matt
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Unread 01-12-2015, 08:57 AM   #69
MattC42286
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Hi MicheleJ. I would definately call my insurance company and ask them as im sure they would have all the answers you need. In my opinion it would be covwred but i am in no way any type of professional in that category. I will be prayong for you as you go on your journey. Thanks!! Matt!
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