Who offers the best insurance coverage/approval?

[momto2pandas]

We have a very expensive, but fairly useless, insurance policy through my employer, with Aetna. Between my immune issues and the kids' PANDAS, we are laying out thousands of dollars per month right now, and we seem to have no in-network specialists (even close) available to oversee the kids' treatment. The kids have been doing pretty well with "as needed" courses of standard-dose antibiotics from their pediatrician so far ("as needed" being most of the time since my @#$% sinus infections got going last fall), but I believe that we need a more consistent approach at this point. It's also looking like I will need IVIG for immune deficiency, and my understanding (from the primary immune boards) is that Aetna gives people a very hard time with coverage for that. I get constant sinus infections, strep throat, etc., but nothing "serious" yet (apparently just my "good luck", according to my immunologist; ha ha), so I anticipate having an impossible time getting Aetna to fork over the dough for expensive treatments.

 

So, we are looking at having the company that my husband owns provide insurance for us, which it has never done before. We will then have to pay for the coverage, but paying for more comprehensive coverage will involve less overall outlay and more security for us at this point. The biggest upside is that we will now get to choose our provider.

 

So... looking forward to the possibility of needing IVIG/PEX or something like that for the kids in the future, which insurance companies have people had the most luck with, as far as getting coverage? Which ones should we stay away from? Do any of the "big cheese" specialists participate in any insurance plan? Any advice would be much appreciated!

[thereishope]

My husband works for a small company. Our insurance is expensive, but in the long run if someone should get really sick it eventually works to our advantage. We have UHC (United Health Care). The policy we have (and the only one the company offers) is that we pay for everything out of pocket until we reach a $3000 deductible per person for in network. But after that, we are covered 100%. Well checks are always covered 100%. I don't know what the out of network deductible is.

 

One of the things I don't like is my son has a speech disorder and UHC doesn't cover services for speech. Also, with the plan I have, they don't offer much for mental health. So if you want to see a psych for therapy, that may get pricey.

 

From what I understand UHC is one of the insuarnce that may cover IVIG. Not sure on that.

[MomWithOCDSon]

My husband works for a small company. Our insurance is expensive, but in the long run if someone should get really sick it eventually works to our advantage. We have UHC (United Health Care). The policy we have (and the only one the company offers) is that we pay for everything out of pocket until we reach a $2500 deductible per person for in network. But after that, we are covered 100%. Well checks are always covered 100%. I don't know what the out of network deductible is.

 

One of the things I don't like is my son has a speech disorder and UHC doesn't cover services for speech. Also, with the plan I have, they don't offer much for mental health. So if you want to see a psych for therapy, that may get pricey.

 

From what I understand UHC is one of the insuarnce that may cover IVIG. Not sure on that.

 

We have a "boutique" PPO policy through my small firm with Blue Cross Blue Shield. And like yours, the "mental health" care coverage has historically been about 1/2 what the regular medical is, though the regular medical isn't anything to cheer about, either, in my opinion. Too many procedures are classified as "routine" but "elective;" translation, we recognize them as standard tests/treatments for various ages and/or conditions, but you don't HAVE to partake of them, therefore, we won't cover them.

 

That being said, however, I was told by my HR person at work that there's been a change in the law and, as of January 1, there is no difference between physical and mental health coverage! I know there was a "mental health parity" bill languishing in congress almost 2 years ago, so I'm wondering if that finally got passed?! I guess it's time for a little more research on my part.

[thereishope]

I forgot about that! That they have to treat mental and health the same starting this year.

 

I had the article saved....

 

http://www.nytimes.com/2008/10/06/washingt...&ref=health

[memom]

Gee, if that is true, I wonder if it has any influence on getting IVIG for OCD Pandas.

Probably not.

 

I don't yet know about our BCBS PPO and PEX or IVIG. Sorry.

 

Ellie

[momto2pandas]

Wow, I had almost forgotten about that parity act - it's been out there so long. It's about time, though it doesn't actually do anything for us since we aren't currently using any services with that classification (who knows about the future). I wonder if it just means that insurance companies will raise their premiums across the board or make it harder to get coverage in the first place, since certainly this will mean more expenses for them. Our policy is already more than $1800/month and it's essentially a complete giveaway - they have paid out next to nothing for us.

 

My husband works for a small company. Our insurance is expensive, but in the long run if someone should get really sick it eventually works to our advantage. We have UHC (United Health Care). The policy we have (and the only one the company offers) is that we pay for everything out of pocket until we reach a $2500 deductible per person for in network. But after that, we are covered 100%. Well checks are always covered 100%. I don't know what the out of network deductible is.

 

One of the things I don't like is my son has a speech disorder and UHC doesn't cover services for speech. Also, with the plan I have, they don't offer much for mental health. So if you want to see a psych for therapy, that may get pricey.

 

From what I understand UHC is one of the insuarnce that may cover IVIG. Not sure on that.

 

We have a "boutique" PPO policy through my small firm with Blue Cross Blue Shield. And like yours, the "mental health" care coverage has historically been about 1/2 what the regular medical is, though the regular medical isn't anything to cheer about, either, in my opinion. Too many procedures are classified as "routine" but "elective;" translation, we recognize them as standard tests/treatments for various ages and/or conditions, but you don't HAVE to partake of them, therefore, we won't cover them.

 

That being said, however, I was told by my HR person at work that there's been a change in the law and, as of January 1, there is no difference between physical and mental health coverage! I know there was a "mental health parity" bill languishing in congress almost 2 years ago, so I'm wondering if that finally got passed?! I guess it's time for a little more research on my part.

[thereishope]

Last year, my son would have been only able to receive 10 sessions with a therapist under our mental health coverage. I'm thinking under this new law they cannot put caps like that on a person. I know in the past some people who have been hopsitalized in the psych floor at a hospital and were eventually discharged too soon because mental health benfits ran out. It was very sad. One of those people was a teen who attempted suicide. They discharged her too soon because of money and she attempted it again w/in a week of being let out.

 

Also, some insurances had mental health under a whole separate umbrella with its own deductible.

[fuelforall]

Last year, my son would have been only able to receive 10 sessions with a therapist under our mental health coverage. I'm thinking under this new law they cannot put caps like that on a person. I know in the past some people who have been hopsitalized in the psych floor at a hospital and were eventually discharged too soon because mental health benfits ran out. It was very sad. One of those people was a teen who attempted suicide. They discharged her too soon because of money and she attempted it again w/in a week of being let out.

 

Also, some insurances had mental health under a whole separate umbrella with its own deductible.

 

 

No one is throwing my son out of the hospital. I wondered why. This bill must be part of the reason.

[MomWithOCDSon]

I forgot about that! That they have to treat mental and health the same starting this year.

 

I had the article saved....

 

http://www.nytimes.com/2008/10/06/washingt...&ref=health

 

Awesome! Thanks!