Alli, Health Insurance Thought

Alli, oops, hit the wrong button, wanted to respond to your post.

Here's a thought.

Can you think of a small business that you and your daughter to could do? This can be a side business.

With 2 people, being you and your daughter, you could open up a small company, technically a sole proprietorship, partnership or LLC (limited liability company). Through a group insurance plan offered by a broker, you would be eligible for an insurance plan. Most likely there's a chamber of commerce in your area that you could become a member of (a yearly membership fee) that sponsors or can purchase into a larger pool of insurance coverage. This is higher end coverage.

Businesses offer "Chevy" plans, which typically don't meet the needs of a sicker patient. As a business owner, you can pick your plan and all the things that go with it.

Rates are much, much less than individual plans and it opens the door on what options you have. It doesn't cost a whole lot to open a business. Just some time, a little research, and a decent biz attorney. Local colleges too have small biz advisors that can help.

Theoretically, you can run "A's Antiques & Crafts" from your house or open a website. A business in theory, has to make it's debt obligation. Premiums and related costs are tax deductable. Just a thought. CA might be a bit more hazy with the laws, but it should be navigatible. You could make your daughter a partner. As an owner, you take "draws" as needed. It's more complex than it seems.

How it looks coming from the government, is bad news.

Marc, a couple of weeks ago HM called, hinting around that they wanted us to do Anna's meds with "M." I said no, because her co-pays are covered by Medicaid. And her co-pays are pricey. So no mail order. They said they would "note that on her file."

There has been a lot of confusion trying to get Provigil covered for her--it has been in limbo for about six weeks. Another push was made by our clinic to HM to cover it two weeks ago. HM is flat out refusing. Medicaid can cover it, they said. I don't think Medicaid will. They are pretty firm in what they won't cover.

HM covered a med that was $4,000 a month (last year). Anna's neuro said he fought like hell to get them to cover it.

I don't think the sleep doctor here is "fighting like hell" on this one. He shouldn't have to. She is taking meds that are more expensive than this one. She cannot take any other meds in this class because of her life threatening reaction to PPA, the sleep doctor said. It is Provigil, or nothing.

Do we need to put pressure on HM? I have not been in any hurry for her to start this med because the number one side effect is HA.

Cheryl

I think you should hike up the pressure on HM. You can always ask why something was previously covered, why they are not (tell them to put it in writing) now. If they have a history of approving something, then changing you can find out why.

Some of these things honestly are glitches in systems and input error. Sometimes it takes a few calls to sort things out. I had to do that today--I was getting charged against out of network lifetime maxes when there is no such thing at the hospitals I go to. If a hospital and doc takes BC/BS, then they are in network.

Some goofy things pop up. I got stuck with a claim for 98 bucks that should have been paid, but it got stuck in limbo over 6 weeks. I paid it--and with these systems that are not the most well planned, complex stuff gets stuck.

Keep on them.

Thanks. My hubby can talk to his "higher up" person that negotiates things. I've put it on the back burner, but it was annoying to get the call from our clinic last week saying HM was refusing to cover it.

A nurse from HM called today asking about Anna's recovery from surgery. She suggested case management. I told her the case managers we had in the past stated they aren't knowledgeable about Anna's conditions, and they don't even know what to say or suggest. So I haven't gained anything with it. Maybe if they had MD's in case management, I would find it helpful. But the nurses know very little about ICP issues.

I keep reading about more and more Chiari kids who have awful things happening like their brain stems tethering to their spinal cords. It is grim for many families.

Thanks for your help.

Cheryl