Evaluating doctors

[MontanaMom]

I'd like some advice on how to evaluate doctors. Our daughter has been seen at Shriner's Spokane, and it looks as if surgery is definitely in the future.'
While I like the doctor she has seen (he explains everything very well), I have
not met the surgeon yet.

Shriner's is in many ways the best choice for us. Closest to our Montana home. Financially best, because our insurance will determine this is a pre-existing condition and not pay. But how do I know if this is best medically for our daughter. Living in a relatively remote area, our other options would be significantly farther than what is already a 4.5 hour drive.

Is it safe to assume the surgical treatment at Shriner's Spokane will be excellent?

Elaine
MontanaMom

[LindaRacine]

Hi Elaine...

and, welcome.

I don't have a good answer for you, but hopefully you can link up with at least a few other families who have used the same surgeon. If you don't hear from anyone here, try asking Shriner's for the contact information for a few other families who have been through the same surgery recently.

Good luck!

Regards,
Linda

[mariaf]

Financially best, because our insurance will determine this is a pre-existing condition and not pay.

There was a discussion on another forum about this recently.

While insurance companies look for all sorts of reasons not to pay, I thought it was now law in all 50 states that insurance companies are not allowed to refuse to pay for conditions they deem pre-existing. I could be wrong, but that is what someone posted and I thought it rang a bell.

Anyway, please check to be sure they would deny payment. Since my son's diagnosis in 2000, we have probably had 3 or 4 different insurers and none ever even brought up the fact of my son's scoliosis being pre-existing when we submitted bills for payment.

Best of luck to you - I'm going to see if I can find/pull the post from the other forum, but I'd be interested to hear if anyone knows definitively if, by law, insurance companies can deny payment on those grounds.

[MontanaMom]

An insurance company can deny coverage for pre-existing conditions. Ours has a policy of no coverage of pre-existing conditions for a year. They refused to pay for my daughter's follow-up visit to Shriners which happened within months of our taking out this plan. They also refused to pay for another daughter's treatment for a congenital anemia. After a year, these conditions will be covered, and hopefully we won't need to do surgery for scoliosis until it is covered.

We have never been without insurance. But as small business owners who try to provide insurance for our employees, we've found that our premiums have gone up drastically each year. Thirty per cent increases are typical. So my husband has switched coverage to get something more affordable. Then the next year premiums jump again, and he will have to switch policies.

An interesting thing we learned about health insurance. When you take out a new policy your local insurance agent makes a profit of 50% of the first year's premium. If you keep your policy for more than one year, he gets something like 12 or 15% of the premium. Your agent has a financial interest in your switching policies. Not that OUR agent would be influenced by that, of course, but he has always suggested a new, more "affordable" policy to my husband whenever my husband has been upset by the huge jump in premiums we've faced.

I am a little ticked by having two bills just rejected this year for routine check ups on our girls with pre-existing conditions. Daughter #2 had the flu, and she needed her hemoglobin checked several times in one week because it had dropped significantly and our doctor thought a transfusion might be called for. Since she has a diagnosis of a congenital anemia (alpha thalassemia hemoblogin H disease).......that's a pre-existing condition and won't be covered until we've had our insurance longer. Too bad my 14 year old didn't plan her flu better. We can probably plan the scoliosis surgery better, unless my husband is forced to change providers to avoid another 30% increase in premiums. Given what we're dealing with trying to keep a small business afloat during a recession, we face the reality that we may have to drop our insurance coverage for our employees if we can't control health care expenses.

Elaine in Montana

[hdugger]

I believe that's true if you change jobs (and thus insurers), and if you've had continuous coverage without any long breaks. We've had this several times recently, and the new insurer has always accepted pre-existing conditions.

But, if you buy insurance on your own, or if you've had a break in coverage, then they can refuse to pay for pre-existing conditions. (Hence, the push for healtcare reform in this area.)

There was a discussion on another forum about this recently.

While insurance companies look for all sorts of reasons not to pay, I thought it was now law in all 50 states that insurance companies are not allowed to refuse to pay for conditions they deem pre-existing. I could be wrong, but that is what someone posted and I thought it rang a bell.

Anyway, please check to be sure they would deny payment. Since my son's diagnosis in 2000, we have probably had 3 or 4 different insurers and none ever even brought up the fact of my son's scoliosis being pre-existing when we submitted bills for payment.

Best of luck to you - I'm going to see if I can find/pull the post from the other forum, but I'd be interested to hear if anyone knows definitively if, by law, insurance companies can deny payment on those grounds.

[mariaf]

Hdugger,

I believe you are absolutely correct. I went back and found the post which read, in part:

"It is against the law to deny pre-exisitng laws everywhere in the US. Bill Clinton passed a law right before he left office so that people could not be denied based on health conditions....."

BUT, someone pointed out that is when the coverage has been "continuous" so that may be the issue.

In any event, I think what MontanaMom has had to deal with regarding insurance is horrible and unacceptable - and let's hope one day (soon) the insurance companies are held accountable and made to pay for treatment, not just collect premiums.

I know that even our insurance has gotten to point that sometimes I feel that we pay more than our insurance carrier. For example, on a recent MRI, our portion was nearly $900 which wasn't covered. Often, the "uncovered" portions and rising copays can really add up, especially with 2 or 3 kids.