Medical care at schools

[milara]

So I've come to the realization that several of the schools from which I've received offers have student health plans that are not good enough to meet my needs. It really sucks to have to choose a school based on something like medical care. Has anyone else run into this situation? What did you do?

The other schools have much better health plans, but apparently the insurance company has to approve one of my meds before they'll pay for it. Anyone know anything about that process, and how likely it is to get approved if the doctor recommends it wholeheartedly?

I've tried to get answers out of the insurance companies, but they can't tell me until I'm a plan member actually making a claim. Which sucks a lot.

[Eigen]

I'm a fan of getting your own insurance independent of the school.

Our student health plan isn't bad, per se, but I much prefer having my own. It gave me a lot more options shopping around, and I was able to find one that really met my needs instead of the "all in one" plans that are generally offered to students.

[milara]

I'm a fan of getting your own insurance independent of the school.

Our student health plan isn't bad, per se, but I much prefer having my own. It gave me a lot more options shopping around, and I was able to find one that really met my needs instead of the "all in one" plans that are generally offered to students.

Aren't there problems with pre-existing conditions in those cases? I mean, in my case I imagine they'll take one look at the list of my medical conditions and medications, and turn me down.

[Eigen]

Not sure. But if you have pre-existing conditions, all the more reason to have your own health insurrance. Once you're insured, you don't usually have to undergo another physical (at least I haven't in the last 10 years). But if you go from school healthcare to employer healthcare, if you're ever not employed and want to get your own, you'll have a harder time if you're in worse shape (pre-existing conditions or otherwise).

[joefc]

i think youre fine with the whole pre-existing condition thing as long as there is no break in your insurance coverage, no? it better be, otherwise im f#cked!

but this is my understanding

this could help...

http://www.dol.gov/e...umer_hipaa.html

i wonder if prescription drugs count as 'treatment?' i guess so? then again when i switched from my family's (blue cross) to the one at my job (united), they paid for the medication which I require daily. i had surgery under the old insurance a month before switching over. 4 months later i needed to do a test while with the new insurance, and it was completely covered, as have been all blood tests and prescription drugs which were within the 6 month 'pre-existing' condition clause. once the 6 months are up either way, you should be good, if you can make it that long.

have a long talk with each program asap, and ask to speak about benefits options and that it IS* going to affect your decision. that should get their attention, just dont be rude.

...life would be much easier if they were transparent and clear about this stuff...

just checked this out, know this doesnt have much to do with it, but in my 'claims summary' there is a huge gulf between prices billed, and the amount actually paid by the insurance, the negotiated rate.

if you have to slog it through the 6 month pre-existing condition clause, you can always ask for a discount from whoever you may owe. its my understanding that doctor's offices usually work with you on that as they normally bill incredibly high amounts (some definitely dont though). good luck.

Edited April 3, 2012 by joefc

[wine in coffee cups]

The other schools have much better health plans, but apparently the insurance company has to approve one of my meds before they'll pay for it. Anyone know anything about that process, and how likely it is to get approved if the doctor recommends it wholeheartedly?

Are you referring to prior authorization? Usually that's in place because a drug is expensive with cheaper alternatives the plan wants you to try first or you are outside the demographic that uses the drug for its FDA-approved conditions. (Here's a decent primer on it.) The process involves your physician filling out forms justifying your need, basically, but generally plans will approve PA requests once the documentation is there. You should really figure out why your treatment needs prior auth, though -- if the plan is looking for evidence that you've tried and failed on a less expensive therapeutic equivalent, well, you're going to need to have actually done that, doesn't matter how wholeheartedly the doc recommends the drug! Some Googling ([generic name] "prior authorization") should help you out -- typically the big insurers like Blue Cross, Aetna, state Medicaid programs, etc. will have information targeted towards medical professionals that should clue you in to why the medication has a prior auth restriction and what documentation they need.

[TropicalCharlie]

Not sure. But if you have pre-existing conditions, all the more reason to have your own health insurrance. Once you're insured, you don't usually have to undergo another physical (at least I haven't in the last 10 years). But if you go from school healthcare to employer healthcare, if you're ever not employed and want to get your own, you'll have a harder time if you're in worse shape (pre-existing conditions or otherwise).

From my experience, obtaining individual health insurance with pre-existing conditions is like asking insurance companies to slap you in the face, then point and laugh. I've had one insurance company tell me that having rhinitis was a risk factor and that they would accept me but at a higher premium. Needless to say I didn't go with them. I've been denied by two other major insurers for pre-existing conditions. I don't have asthma, diabetes, cancer, or anything horrible. My conditions are benign in comparison to the aforementioned and rarely require dr visits or prescribed medications. But to insurance companies, as soon as they see these conditions on the application, they just put a big fat DENIED stamp on it.

When I lived in Ca, I even called the state insurance commissioner's office to ask about such rejections and was told that no one can force insurers to insure people. And that I would have to learn to get by on my own. The state offers its own plan to people deemed uninsurable, which in my mind was the furthest thing from my case. But their plan has a wait list and is not affordable. My previous employer didn't offer health benefits, and after being denied twice, I resorted to omitting certain information on my health insurance application in order get on a plan. I don't advise anyone doing so unless you are left with no other options. I had no problems with the plan but was under constant fear of being caught and dropped.

If you have pre-existing conditions, I wouldn't say that it's hopeless to get an individual plan. Some insurance companies will take you but charge a high premium, while others will simply deny your application. There is one good clause in Obamacare which would protect people with pre-existing conditions, but who knows where that will end up.

Edited April 4, 2012 by TropicalCharlie

[Spore]

I am pretty sure if you enroll into a group plan as a graduate student your preexisting condition will be covered. It is very wise to call and ask prior to accepting an offer.

I am sorry that health insurance has become a big factor in your decision of where to attend graduate school.