just got a letter 12/24 telling me my insurance coverage terminates on 12/31/09

2

Comments

  • Nana b
    Nana b Member Posts: 3,030 Member
    AnneCan said:

    Lisa,
    I am sorry for this;

    Lisa,

    I am sorry for this; you don't deserve this! I hope you are able to resove this without too much trouble. I will be thinking of you.

    They should have sent you notice or an open enrollment pkt
    http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html
  • lisa42
    lisa42 Member Posts: 3,625 Member
    ADKer said:

    social security disability
    Lisa -

    I am just wondering whether you are receiving or have considered applying for social security disability. If you have not worked for more than a year, I believe that you are eligible. You also become eligible for Medicare 2 years from the date of disability, which would be the last date that you worked, or the date of diagnosis if you have not worked since diagnosis. My husband's job was eliminated at the end of last year, probably because of my medical bills (he worked for a governmental unit that was self-insured). We have COBRA for 18 months but I will become eligible for medicare before that expires. Insuring the rest of my healthy family should be easier without me.

    Just an idea. Let me know if I can help.

    soc sec disability and Medicare
    I will look into Medicare- someone else mentioned it also. As a teacher, I was not putting into social security. Teachers have a separate retirement system (STRS) that we put into and are not eligible for social security. We DO, however, put into Medicare. I've been receiving disability through my STRS retirement program. My mom actually mentioned to me yesterday that I should look into the Medicare situation. It's been 2-1/2 yrs now since I worked, so I should definitely look into it.
    Thanks for the info!

    Lisa
  • lisa42
    lisa42 Member Posts: 3,625 Member
    Sundanceh said:

    BCBS
    Never heard of these guys, but if its an HMO, that concerns me - they will be able to dictate which doctor you will see, and referrals would probably be needed, and coverage can be limited.

    HMO's put me in the bind I was in many moons ago, and I could not get a referral or determine my treatment - the rest of my story is well known.

    And I think the big thing is will they pay for Dr. Cantrell's treatments because they are an HMO.

    Sounds like a cost saving measure by the school district to move off of PPO and over to HMO.

    I'm sorry that they allowed this to happen to you - someone dropped the ball around the holidays leaving you with limited recourse for action.

    Hopefully, you will still be able to see your doctor and continue with your new treatments - these things should not happen to people in a modern society, but it always centers around $$$.

    I'm glad your Christmas was good anyway - have a safe New Years.

    -Craig

    HMO's
    Hi Craig,

    I actually have already had an HMO. They've really been pretty good so far, actually. Difficult for a couple of months when I was first diagnosed, but really very good since then. According to the former coworker I spoke with, Aetna prices were going way up, so the teacher's union took a vote and decided to pressure the school district to change. Now, the school employees have a choice between Kaiser and Health Net. Kaiser is still provided for the family free of charge so many employees picked that & Health Net has a cost to employees, but not as high as they were having to pay for the Aetna. All the years I worked for Vista school district, I had medical benefits provided for my entire family at no charge. Definitely a wonderful benefit, as most school districts around only covered the employee, not the whole family. My husband's company only pays $150 towards health insurance costs, so I definitely had a good thing going while it lasted.

    Thanks for the support-
    Lisa
  • lisa42
    lisa42 Member Posts: 3,625 Member
    Wow! Thank you everyone!
    Hello everyone,

    I'm overwhelmed by all of your kind and helpful posts about my new insurance dilemma.
    Thank you to the many of you who gave me helpful links and helpful information!!!!
    You guys are the greatest!
    I'll obviously know more tomorrow when I contact Health Net, if they can help me do anything before my school district benefits guy comes back from vacation on Jan. 4th. I was told by a former coworker that I spoke with that Aetna's costs were going up way high and that the teacher's union took a vote and pressured the school district to change insurance companies to keep the cost down for what the employees were needing to pay out. We always have been spoiled in our district by not ever having had to pay for any medical insurance costs at all up until the past year, apparently. I never had to pay anything, which is why my husband and I always used my insurance and not his (his company only contributes $150 & the employee pays the rest, which would now be even more than we're paying for COBRA).
    Anyhow, my school district benefits person really dropped the ball- maybe intentionally- who knows, maybe all of my medical expenses was a major contributing factor to why the cost was going up so much! I can't believe, though, that I'm the only one who had major expenses that were being paid for. I can't believe when I try to add it all up, though, how much was paid out on my behalf in the past 2-1/2 yrs! Even before that- my son was on growth hormone for 13 years, my husband had stents put in his heart, etc. When I think of all that, I really can't complain about insurance costs!

    My oncologist's office had just put in a request to Aetna last week for a retroactive coverage and reimbursement for my Dr.'s visit to Dr. Cantrell. Since they actually did approve paying for the interferon, we thought we'd have a shot at getting some of Cantrell's Dr. visit cost paid for. Of course, now I'll have to start over with Health Net!

    Well, thanks again so much- you guys never fail to come to the rescue to give advice and support!!

    I'll let you know what happens and I definitely appreciate the prayers too.

    Love ya'll-
    Lisa :)
  • qwe
    qwe Member Posts: 124
    lisa42 said:

    Wow! Thank you everyone!
    Hello everyone,

    I'm overwhelmed by all of your kind and helpful posts about my new insurance dilemma.
    Thank you to the many of you who gave me helpful links and helpful information!!!!
    You guys are the greatest!
    I'll obviously know more tomorrow when I contact Health Net, if they can help me do anything before my school district benefits guy comes back from vacation on Jan. 4th. I was told by a former coworker that I spoke with that Aetna's costs were going up way high and that the teacher's union took a vote and pressured the school district to change insurance companies to keep the cost down for what the employees were needing to pay out. We always have been spoiled in our district by not ever having had to pay for any medical insurance costs at all up until the past year, apparently. I never had to pay anything, which is why my husband and I always used my insurance and not his (his company only contributes $150 & the employee pays the rest, which would now be even more than we're paying for COBRA).
    Anyhow, my school district benefits person really dropped the ball- maybe intentionally- who knows, maybe all of my medical expenses was a major contributing factor to why the cost was going up so much! I can't believe, though, that I'm the only one who had major expenses that were being paid for. I can't believe when I try to add it all up, though, how much was paid out on my behalf in the past 2-1/2 yrs! Even before that- my son was on growth hormone for 13 years, my husband had stents put in his heart, etc. When I think of all that, I really can't complain about insurance costs!

    My oncologist's office had just put in a request to Aetna last week for a retroactive coverage and reimbursement for my Dr.'s visit to Dr. Cantrell. Since they actually did approve paying for the interferon, we thought we'd have a shot at getting some of Cantrell's Dr. visit cost paid for. Of course, now I'll have to start over with Health Net!

    Well, thanks again so much- you guys never fail to come to the rescue to give advice and support!!

    I'll let you know what happens and I definitely appreciate the prayers too.

    Love ya'll-
    Lisa :)

    Sorry to hear that my
    Sorry to hear that my prayers are with you.
    We had something similar

    My husband retired from a job were we got medical inc. we just payed the deductible and out of pocket we just got a letter in the mail saying as of Jan 1 20010 we have to pay fore it now or they will terminate us this is unfair cause the medical Inc was part of the retirement package.
  • AceSFO
    AceSFO Member Posts: 229
    Hi, Lisa,
    My mother is

    Hi, Lisa,

    My mother is pretty well versed in this sort of thing and I told her about your situation. Here is her response - hope this helps.

    If the group plan, Aetna, is being terminated December 31, 2009 because the school is going with another carrier, the “other” carrier has to insure the people on COBRA. Her new insurance will be effective January 1, 2010 at 12:01 a.m. I believe the fact that the school is closed until January 4th is totally irrelevant to the insurance coverage. It would have been nice if the School Board had notified both active employees and those on COBRA about the change in benefits. However, the new carrier MUST continue the benefits of the people who are on COBRA. The major problem with the school being closed is that she cannot get answers as to who her new insurance carrier is. She will be on the Health Net plan.



    The other issue at stake is: When does her COBRA run out? Could it be that December 31st is when she loses COBRA benefits? Note that I am referring to the person with the problem as a “she” but it could well be a “he”. Moot issue. He/she should be getting new id cards in the mail momentarily and on Monday, January 4th this person better be on the telephone with the Board of Ed office and get some answers. If the COBRA benefit period does expire on 12-31-09, he/she better buy individual coverage IMMEDIATELY so that he/she doesn’t get hit with a waiting period for preX. However, the fact that Aetna is being termed 12-31-09 is a good indicator that the insurance contract year runs from January 1 and they found a less expensive plan. The Interferon should be covered by Healthnet inasmuch as it was covered by Aetna. Chances are that he/she will have to have the interferon pre-authorized (from the doctor to HealthNet).
  • lisa42
    lisa42 Member Posts: 3,625 Member
    Adrian- thank you!
    Adrian,

    Thank you so much and tell your mother thank you so much for the information! It does give me peace of mind!! As to a couple of your mother's questions... I still qualify for Cobra for another 16 months, so hearing that the new carrier (Health Net) has to also allow me to pay into them is good news! I will definitely be on the phone with them as soon as I can Monday morning.

    Gracias!

    Lisa
  • christinecarl
    christinecarl Member Posts: 543 Member
    I will definitely pray for you
    My job is changing ins coverage next year and its making me nervous, I pray for a positive resolution for you, keep us posted on it.
  • patsy1954
    patsy1954 Member Posts: 85

    I will definitely pray for you
    My job is changing ins coverage next year and its making me nervous, I pray for a positive resolution for you, keep us posted on it.

    Just Said a Prayer
    I just said a prayer for you, I'm sure it will be answered! I am going through a similar issue. Mu company was sold to Dell and I can only sign up for insurance on January 1st. They asure me that I will be covered as of the 1st. I see the interventional radiologist on the 5th, I am scared to death that I won't have coverage. I don't even know what each insurance is offering for coverage and cost. It is either Aetna or Harvard Pilgrim. Sounds like Aetna might be a pain. Any experience with either of these plans would be appreciated.

    Pat
  • lisa42
    lisa42 Member Posts: 3,625 Member
    called the insurance company
    HI All,

    Well, Monday morning now & I just got off the phone calling Health Net. They checked and my former employer Vista Unified School District never gave them any of my information and they can't add me until they get something in writing from the school district. Problem is they're closed until Jan. 4th.
    I then called the Cobra dept at Aetna and was told the same thing. The woman there was very sweet and sympathetic and said that by law Health Net has to accept me and there won't be an official lapse in coverage because they'll backdate it to Jan. 1st when they process it. That made me feel a lot better. Someone here had already told me that by law Health Net has to accept me since I still have 16 months of qualifying under COBRA laws.
    I guess I better go call and see if Aetna will still send me my prescriptions even if it's a bit early & contact all my Dr.'s office of the impending change.

    Thanks again, everyone, for the replies, support, and information!
    Happy New Year!
    Lisa
  • dianetavegia
    dianetavegia Member Posts: 1,942 Member
    lisa42 said:

    called the insurance company
    HI All,

    Well, Monday morning now & I just got off the phone calling Health Net. They checked and my former employer Vista Unified School District never gave them any of my information and they can't add me until they get something in writing from the school district. Problem is they're closed until Jan. 4th.
    I then called the Cobra dept at Aetna and was told the same thing. The woman there was very sweet and sympathetic and said that by law Health Net has to accept me and there won't be an official lapse in coverage because they'll backdate it to Jan. 1st when they process it. That made me feel a lot better. Someone here had already told me that by law Health Net has to accept me since I still have 16 months of qualifying under COBRA laws.
    I guess I better go call and see if Aetna will still send me my prescriptions even if it's a bit early & contact all my Dr.'s office of the impending change.

    Thanks again, everyone, for the replies, support, and information!
    Happy New Year!
    Lisa

    Whew....
    Glad that you got some answers.

    We live in such a small area that if something like that happened to us, I could call Suzanne R. at home and she could log on and fix it. Everybody either knows everybody or is kin.

    Glad this worked out, Lisa. God is in control even when the adversary tried to mess things up.

    Diane
  • lisa42
    lisa42 Member Posts: 3,625 Member
    patsy1954 said:

    Just Said a Prayer
    I just said a prayer for you, I'm sure it will be answered! I am going through a similar issue. Mu company was sold to Dell and I can only sign up for insurance on January 1st. They asure me that I will be covered as of the 1st. I see the interventional radiologist on the 5th, I am scared to death that I won't have coverage. I don't even know what each insurance is offering for coverage and cost. It is either Aetna or Harvard Pilgrim. Sounds like Aetna might be a pain. Any experience with either of these plans would be appreciated.

    Pat

    to Pat
    Hi Pat,

    I'm sure you will get added on Jan. 1st like they said will happen. Actually, Aetna has not been a pain. This problem of mine isn't Aetna's fault- it's the fault of my former employer who never notified me of the change and never gave any of my information to Health Net, who will be the new insurance carrier. I've heard a few people slam Aetna, especially the Aetna HMO, but I've really done pretty well under them. They allowed me to have my liver surgery out of network by the surgeon I wanted and it was 100% covered. The only time I ever had troubles w/ them was the first month I was diagnosed and then I was given the run around a bit, but after everything was in order they've been great. My first oncologist used to order CT or PET scans for me every 6 weeks when I first was doing Folfox chemo & the insurance covered it without any problems. They even recently covered my interferon that I'm getting from Dr. Cantrell, which is not on the "approved drug" list for colon cancer. So, if you end up w/ Aetna, don't despair- they've done me pretty well. I'm relaxing now, as I believe it will fall into place for me with Health Net too.

    Take care and Happy New Year!
    Lisa
  • KathiM
    KathiM Member Posts: 8,028 Member
    lisa42 said:

    called the insurance company
    HI All,

    Well, Monday morning now & I just got off the phone calling Health Net. They checked and my former employer Vista Unified School District never gave them any of my information and they can't add me until they get something in writing from the school district. Problem is they're closed until Jan. 4th.
    I then called the Cobra dept at Aetna and was told the same thing. The woman there was very sweet and sympathetic and said that by law Health Net has to accept me and there won't be an official lapse in coverage because they'll backdate it to Jan. 1st when they process it. That made me feel a lot better. Someone here had already told me that by law Health Net has to accept me since I still have 16 months of qualifying under COBRA laws.
    I guess I better go call and see if Aetna will still send me my prescriptions even if it's a bit early & contact all my Dr.'s office of the impending change.

    Thanks again, everyone, for the replies, support, and information!
    Happy New Year!
    Lisa

    Keep on 'em, girl!!!!
    I'm breathing again, I was so worried for you!!!!

    Please keep us posted after the 4th...

    Hugs, Kathi
  • Annabelle41415
    Annabelle41415 Member Posts: 6,742 Member
    Wow
    I am so sorry that this has happened. I am hoping that you can straighten everything out. I don't understand how a school district can just change insurance companies and then have dropped you. I am praying that all this gets resolved. Let us know what you find out today. Doesn't seem like they gave you enough time to do anything about this situation either, just doesn't seem fair.

    Kim
  • luv3jay
    luv3jay Member Posts: 533 Member
    Well it sounds like the
    Well it sounds like the school district is just switching companies, right? If that's the case, won't you be covered by the new company? i hope it's seamless and you weren't required to fill out any new documents. Either way, I think you should call Aetna to make sure and to see who the new company is and give them a call.

    -Sheri
  • lisa42
    lisa42 Member Posts: 3,625 Member
    to Diane, Kathi, Kim, and Sheri & also my CEA news
    Hi Kim, Sheri, and everyone else,

    I did make all of my pharmacy calls & Aetna is sending me my next month's shipment of interferon tomorrow, even though it's not due to be sent again until Jan. 9th. They made an exception for me and approved it to be shipped early. I was also able to take care of all the rest of my family's meds from our local pharmacy and the mail order pharmacy. The only thing that might not be able to happen is my Dr. appt. that I have on Monday morning, Jan.4th. It's not really an urgent appt, though, so I'm going to call them right now to see if there's a way I can get in before 12/31 or, if not, to put it off another week then.

    By the way, I just found out from my onc's office that my CEA # from 12/21 was 28.6. It was 28.7 on 11/30. So, it either went up and came down again after I started on Dr. Cantrell's treatment, or it never went up during that time. It had jumped up 10 points in one week a couple of weeks prior to my last test, so I'll never know if it stayed the same or went up and came down again, but I'm definitely pleased to find out where it's at. Dr. Cantrell had told me not to be alarmed if my CEA initially went up when I first started on the treatment, and that it normally takes about 4 weeks of being on the treatment before it really "kicks in". I had only been on the treatment for 2-1/2 weeks on 12/21. I'm thrilled to know my CEA hasn't skyrocketed while waiting for the treatment to kick in.

    Take care everyone-
    Lisa
  • KATE58
    KATE58 Member Posts: 299
    lisa42 said:

    to Diane, Kathi, Kim, and Sheri & also my CEA news
    Hi Kim, Sheri, and everyone else,

    I did make all of my pharmacy calls & Aetna is sending me my next month's shipment of interferon tomorrow, even though it's not due to be sent again until Jan. 9th. They made an exception for me and approved it to be shipped early. I was also able to take care of all the rest of my family's meds from our local pharmacy and the mail order pharmacy. The only thing that might not be able to happen is my Dr. appt. that I have on Monday morning, Jan.4th. It's not really an urgent appt, though, so I'm going to call them right now to see if there's a way I can get in before 12/31 or, if not, to put it off another week then.

    By the way, I just found out from my onc's office that my CEA # from 12/21 was 28.6. It was 28.7 on 11/30. So, it either went up and came down again after I started on Dr. Cantrell's treatment, or it never went up during that time. It had jumped up 10 points in one week a couple of weeks prior to my last test, so I'll never know if it stayed the same or went up and came down again, but I'm definitely pleased to find out where it's at. Dr. Cantrell had told me not to be alarmed if my CEA initially went up when I first started on the treatment, and that it normally takes about 4 weeks of being on the treatment before it really "kicks in". I had only been on the treatment for 2-1/2 weeks on 12/21. I'm thrilled to know my CEA hasn't skyrocketed while waiting for the treatment to kick in.

    Take care everyone-
    Lisa

    aetna did the same thing to
    aetna did the same thing to me!
    they said I had exceeded my 'LIFETIME BENEFIT AMOUNT'
    (in 6 months)
    They are notorious for that.
    good luck and i will pray for you.


    Craig,I had an hmo for 25 yrs,never had a problem
    never paid a dime out of pocket even when a serious injury
    kept me in physical therepy and specialists appts for a year.
    kATE
  • lisa42
    lisa42 Member Posts: 3,625 Member
    KATE58 said:

    aetna did the same thing to
    aetna did the same thing to me!
    they said I had exceeded my 'LIFETIME BENEFIT AMOUNT'
    (in 6 months)
    They are notorious for that.
    good luck and i will pray for you.


    Craig,I had an hmo for 25 yrs,never had a problem
    never paid a dime out of pocket even when a serious injury
    kept me in physical therepy and specialists appts for a year.
    kATE

    to Kate
    Hi Kate,

    Wow- that's amazing and maddening that Aetna told you after 6 months that you had reached your "lifetime benefit amount"! I guess some other people have also had problems with them. My Aetna HMO has actually been very good to me. My problem wasn't being caused by Aetna- it was the fault of my former employer. They switched from using Aetna to Health Net and "forgot" to include me, a paying customer on COBRA status. Apparently, all the regular employees already have their new Health Net ID cards & I was just overlooked. I don't work there and don't talk to my former coworkers as often as I used to. Even so, I spoke to a couple recently, but it never occured to them to bring up the insurance.
    It probably was not intentional, because by law I have to be covered under the new insurance carrier they're picking up (Health Net)& I'm sure they know that. Since November 1st, I've been paying the insurance company directly and no longer my former employer, so I guess "out of sight, out of mind" or something like that. It will get taken care of in another week, retro to Jan 1st.
  • dorookie
    dorookie Member Posts: 1,731 Member
    lisa42 said:

    to Kate
    Hi Kate,

    Wow- that's amazing and maddening that Aetna told you after 6 months that you had reached your "lifetime benefit amount"! I guess some other people have also had problems with them. My Aetna HMO has actually been very good to me. My problem wasn't being caused by Aetna- it was the fault of my former employer. They switched from using Aetna to Health Net and "forgot" to include me, a paying customer on COBRA status. Apparently, all the regular employees already have their new Health Net ID cards & I was just overlooked. I don't work there and don't talk to my former coworkers as often as I used to. Even so, I spoke to a couple recently, but it never occured to them to bring up the insurance.
    It probably was not intentional, because by law I have to be covered under the new insurance carrier they're picking up (Health Net)& I'm sure they know that. Since November 1st, I've been paying the insurance company directly and no longer my former employer, so I guess "out of sight, out of mind" or something like that. It will get taken care of in another week, retro to Jan 1st.

    Glad to hear it
    I am so glad you got some answers and especially that AETNA helped you out with your prescriptions. I really like AETNA, have had them for over 4 years now and all through the cancer stuff they approved everything and I had no problems. I hope you have good luck with your new insurance.

    Sure hope you are feeling okay with the treatments, you are in my thoughts and prayers...

    God Bless
    Beth
  • KathiM
    KathiM Member Posts: 8,028 Member
    lisa42 said:

    to Kate
    Hi Kate,

    Wow- that's amazing and maddening that Aetna told you after 6 months that you had reached your "lifetime benefit amount"! I guess some other people have also had problems with them. My Aetna HMO has actually been very good to me. My problem wasn't being caused by Aetna- it was the fault of my former employer. They switched from using Aetna to Health Net and "forgot" to include me, a paying customer on COBRA status. Apparently, all the regular employees already have their new Health Net ID cards & I was just overlooked. I don't work there and don't talk to my former coworkers as often as I used to. Even so, I spoke to a couple recently, but it never occured to them to bring up the insurance.
    It probably was not intentional, because by law I have to be covered under the new insurance carrier they're picking up (Health Net)& I'm sure they know that. Since November 1st, I've been paying the insurance company directly and no longer my former employer, so I guess "out of sight, out of mind" or something like that. It will get taken care of in another week, retro to Jan 1st.

    HealthNet is big.....but I had all covered....
    I am on an 'individual HMO' plan with them. The umbrella company has always been very helpful and sympathetic, I just once got mixed up with a group that was not very good. But, because I did my homework, I was able to set everything to right, and they even have a 'wellness nurse' that contacted me every so often to make sure I was doing well.

    The 'bad' group was horrible with paying, and drove my medical team to distraction....my onc got so mad that she said 'Kathi, I can't give you your infusion because they haven't paid on anything'. Now, I called them, and they said my onc hadn't billed, typical run around...one pointing at the other...but I called my onc back and said "I know my rights, you are contracted with my carrier, it's not my fault they are slow paying. I WILL be there for my infusion as scheduled!!!!!" (I had also told the group administration that I would be very appreciative if they called my onc and made a payment). Sigh...

    I'm so relieved that you are getting it straightened out, but I am also mad that you have to do this when you are battling for your health!!!!

    BTW, have you heard from our mutual friend?

    Hugs, Kathi