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Thread: After surgery can my daughter get insurance?

  1. #1
    Join Date
    Mar 2008
    Posts
    2

    After surgery can my daughter get insurance?

    It was a very serious health issue when my daughter was 19. Her curve continued to progress past critical points and she felt that her life was at risk. She had breathing and heart issues that seemed to be related.
    Now 5 years later she's not perfect, but she seems ok (or I fear she won't talk about much of her current issues with the rods and hardware). Now she is trying to get out on her own, but finding an insurer because of her surgical history is difficult. I'm sure many here have confronted this problem. What are the realistic approaches. She will be ineligable very soon(days) for my corp. insurance because of age(25). Cobra is next. Then I'm not sure where to try in Texas.

  2. #2
    Join Date
    Nov 2007
    Location
    Houston, TX
    Posts
    1,757
    Quote Originally Posted by Patientsfather1
    Now 5 years later she's not perfect, but she seems ok (or I fear she won't talk about much of her current issues with the rods and hardware). Now she is trying to get out on her own, but finding an insurer because of her surgical history is difficult. I'm sure many here have confronted this problem. What are the realistic approaches. She will be ineligable very soon(days) for my corp. insurance because of age(25). Cobra is next. Then I'm not sure where to try in Texas.
    Is she unable to work?

    If she is able to work, that's her best insurability option. Larger employers who offer a group insurance plan rarely stick to a pre-existing clause (if at all) of more 1 year. And it's going to be a WHOLE lot cheaper than any other option for someone who *can* work (COBRA, private plan, etc.).

    When was the last time she sought treatment for her scoliosis? That's really what insurers technically *ask* when they determine whether a condition is pre-existing.

    If she's *unable* to work, she could be eligible for Medicaid.

    Texas doesn't really have a reasonable state health insurance plan, but they do have something called the Texas Health Insurance Risk Pool (even that has a pre-existing clause - which varies ... you have to REALLY study the eligibility requirements too ... it's quite convoluted). And from what I understand it's pricey ... as in WAY pricey. That might be an option.

    Has she tried to get insurance and been denied?

    Regards,
    Pam
    Fusion is NOT the end of the world.
    AIDS Walk Houston 2008 5K @ 33 days post op!


    41, dx'd JIS & Boston braced @ 10
    Pre-op 53, Post-op < 20
    Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


    VIEW MY X-RAYS
    EMAIL ME

  3. #3
    Join Date
    Sep 2003
    Location
    NJ
    Posts
    1,291
    What causes some problems is insurance interruptions---meaning letting a group plan lapse and not taking COBRA. Once insurance lapses, for any reason, the companies start looking at pre-existing conditions. There is usually no problem when going from one group plan, without interruption, into another. The best bet is always group plans tied to employment or even a professional, union and possibly school plans.
    Original scoliosis surgery 1956 T-4 to L-2 ~100 degree thoracic (triple)curves at age 14. NO hardware-lost correction.
    Anterior/posterior revision T-4 to Sacrum in 2002, age 60, by Dr. Boachie-Adjei @Hospital for Special Surgery, NY = 50% correction

  4. #4
    Join Date
    Mar 2008
    Posts
    2

    Te problem is that at age 25 she wiil not be eligable ..

    She becomes ineligable dependent at the end of the month(tomorrow?)...waiting for Cobra applications now. But when she starts into the work force she will have physical restrictions with two rods and hardware, even after 5 years. She is uncomfortable in standing jobs(i.e. no or little 'sitting' available), so I assume there is a level of legal disability (?), but she doesn't want to make this public because the reality is that corporations will indirectly discriminate, and even educational programs, if she cannot provide proof of insurance or if she has a disability. So..we hide her disability? Most folks do have and hide specific disabilities, even several are likely in most individuals, but just not this documentented level.
    Yes her health is much better. But still there is a reality of certain levels of disability and the reality that employer discrimination (to avoid and minimize potential insurance liabilities, or cost factors). We all know this exists.
    So any other solutions? This is going to make life very challenging for someone trying to get started on their own. I always feared this would be a potentially devastating limitation to her future. So, I'm looking for a solution or even a plan of action to correct this. I suppose this is another argument for self-insurance (at least a $100,000. invested in stable mostly secure growth). Big job!

  5. #5
    Join Date
    Nov 2007
    Location
    Houston, TX
    Posts
    1,757
    Quote Originally Posted by Patientsfather1
    She becomes ineligable dependent at the end of the month(tomorrow?)...waiting for Cobra applications now. But when she starts into the work force she will have physical restrictions with two rods and hardware, even after 5 years. She is uncomfortable in standing jobs(i.e. no or little 'sitting' available), so I assume there is a level of legal disability (?), but she doesn't want to make this public because the reality is that corporations will indirectly discriminate, and even educational programs, if she cannot provide proof of insurance or if she has a disability. So..we hide her disability? Most folks do have and hide specific disabilities, even several are likely in most individuals, but just not this documentented level.
    Yes her health is much better. But still there is a reality of certain levels of disability and the reality that employer discrimination (to avoid and minimize potential insurance liabilities, or cost factors). We all know this exists.
    So any other solutions? This is going to make life very challenging for someone trying to get started on their own. I always feared this would be a potentially devastating limitation to her future. So, I'm looking for a solution or even a plan of action to correct this. I suppose this is another argument for self-insurance (at least a $100,000. invested in stable mostly secure growth). Big job!
    While I understand what you're saying, y'all are going to have to decide "is she disabled or not?". What kind of work can she do? What are her skills?

    Most definitely, she needs to get to a Texas Workforce Commission, do the required testing, possibly receive job training - and so she can apply for jobs through them. You haven't said what kind of job she can perform or her skill level.

    (and, BTW, Karen, unfortunately most - if not all - school districts in Texas are self insured ... and simply have a plan administrator (HAS is the most common one). I was married to a teacher for several years, and school plans are *awful*. Unions aren't nearly as big here as other states, either ... unless she aspires to be a teacher, a machinist or a meat cutter. And silly thing is, the teacher's union doesn't address insurance at all ... it's mainly legal defense.)

    Again, Patientsfather, when was the last time she sought care for her scoli? She *technically* does not have to mention it if it's not been within the pre-existing period.

    On the other hand, if she isn't up front with an employer for fear of discrimination - and can't perform the job she's hired to do without a documented disability - she has NO protection whatsoever. Texas is an "at will" state anyway, and she can't expect to hide a disability simply to get "a foot in the door" (for lack of a better description) without repercussions later.

    You know you have 60 days to retroactively elect COBRA, right? Although there can't be more than a 30 day gap in coverage (for insurance portability and waiver of pre-existing conditions), you could feasibly wait for a while to see if you need to shell out the ridiculous premiums for COBRA. If she finds a job in 2 weeks, there'd be no need for it.

    If you'd like to PM me privately - or better (no 1000 character limit), email me (it's in my sig) - I can give you tons of resources for job hunting in Texas.

    Again, without knowing what she wants to do - and what type of job she's qualified to perform (and can physically perform) - it's difficult to advise on possible avenues for her.

    Regards,
    Pam
    Fusion is NOT the end of the world.
    AIDS Walk Houston 2008 5K @ 33 days post op!


    41, dx'd JIS & Boston braced @ 10
    Pre-op 53, Post-op < 20
    Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


    VIEW MY X-RAYS
    EMAIL ME

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