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Looking for new health insurance...underwriting stuff (Level 4?)


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I e-mailed our insurance agent a couple days ago. I can't take the $6000 in-network high deductible plan anymore. My husband and I are arguing about it. He says for $304 a month and $6000 deductible, it's way cheaper than going to a more expensive "co-pay" plan. I just don't know.

 

Anyhow, our agent gave us some quotes based on my dd having a "Level 4" rating. Level 4 people can't even get life insurance rider! We have not gone through underwriting yet, but she said she put her in as a level 4 just based on her "situation." I thought Level 4 was for life-threating (high liability) people. What about pandas is level 4? Heck, what about "chronic tic disorder" or "post-infectious encephalitis" is level 4??

 

Also, anyone have any advice for filling out questions for underwriting, so we are not giving more info. than we need to?

Thanks!

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Is the $304.00 for just her or all of you? Maybe since PANDAS is considered auto-immune that makes it level 4?

 

We go through our state for our kiddo since due to her other conditions she is considered un-insurable. We use what is called a "Risk Pool" type of insurance. All the un-insurable people of my state become a group. We pay $450.00 a month just for kiddo and have a $1000.00 deductible.

 

Check with your state to see if they have anything like this (google I guess?).

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I don't know anything about insurance underwriting, but my guess would be that some people are rated based on an actual diagnosis, while others can be rated by the level of medical costs incurred during a given calendar year; i.e., if you've been "expensive," they're betting you're going to continue to be "expensive," so you're going to be paying higher premiums. It's my understanding that every insurance company has access to your insurance records, so it's not even a matter of what you do or don't disclose in your application, except to the extent that if you purposefully contradict your history, they'll know about it.

 

I can also say that in recently changing jobs, I had to elect between a similar high-deductible plan and some other plans, and I'm part of a pretty big group so my DS's situation or our family history wasn't part of the picture. Nevertheless, I made myself a little spreadsheet comparing the plans and my out-of-pocket costs based on what our medical expenses have run us over the past few years (prescriptions, therapy, etc. included) and, much to my surprise, the high-deductible plan did wind up being the least costly overall! It's just a pain in the butt at the beginning of the year while you have to front-load everything to meet the deductible. :(

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We went with a high deductible 3000 per person with a 4000 maximum out of pocket per person or 8000 total for the family. It saved us about 500 per month in premiums over a copay type plan. One IVIG for our son and he had reached max so everything else was free. The copay type insurance would have cost us 6000 more per month in premiums and would have cost us more in copays and percentages. So as long as our son is getting IVIG the high deductible plan would save us.

Disclaimer!!!

When we began this plan we did not know our son would need IVIG so our premiums, while rated, where not rated at the highest level. i am scared to see the renewal rate come April.

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Believe it or not, the high deductible plans are usually cheaper. We had a choice between $160 per month, $2400 ded/$5300 out of pocket max or $460 a month, $800 ded/$1200 out of pocket max. I did the math. The monthly premiums alone was more than my total yearly out of pocket is w/ the higher deductible IF I actually hit the OOP. We had IVIG last yr, so yes, we did hit it but we still saved $$.

 

Our costs are based on a family policy, not per person.

 

My advice is to get out your calculator and do the math on it.

Edited by nicklemama
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I know this is totally not part of the conversation- but you are all reminding me to be thankful of my husband's wonderful health insurance plan. I do not have to think about any of this. I would probably be even loonier and more distraught over the monster formerly known as PANDAS. You all have my utmost respect. TRULY.

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Was in a hurry to pick up DS so came back to add a few things. One thing to save money if you choose a high deductible plan is to open a Health Savings Account (HSA). The money you put in goes in before its taxed, so its saves you there. If you don't use all the money w/in the plan year, it rolls over to the next year.

 

Like Nancy said, its a pain in the butt to upfront those med costs until you hit your deductible. The HSA will take some of the sting out of it. Dh works for a major US corp and they payroll deduct for the HSA. The downside is its funded as its taken out of your check. Dh's company puts $500 in the account, up front. I think as an incentive to choose the plan. They also offer the standard BCBS plan I mentioned above, one other even higher deductible plan and an HMO. We had the HMO before DS got sick. I bailed out as soon as I could after he was diagnosed w/ PANDAS. It paid nothing for consults and visits to the PANDAS dr's. I could only get 8 days of azith at a time. That was a pain in the butt.

 

I'm really happy to be back to a BCBS policy. No more getting referrals. Now I'm able to have DS see any doctor. I will get back 60% of the costs if we go out of network. So far, none of DS's doctors are deemed out of network.

 

Back in the old days, we had a great BCBS policy from Dh's employer. $250 ded/ $500 out of pocket and NO premiums. I'd love to have that now. Company did away w/ it about 10yrs ago.

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