The Mystery of NY Health Insurance

[LoriAnn]

Ok this may seem like a strange posting, but I am desperate and I thought there may be some people out there that could give me good advice. I have had chronic IC and Vulvodynia since I was thirteen. My parents had WONDERFUL health insurance! And I pretty much saw the best doctors I could, including Dr Whitmore, Dr Ledger, Dr Kaufman… I could receive physical therapy and just pay the copayment. Well now I am in the position that after 3 yrs of cobraing my parents plan, I am being booted and I am absolutely TERRIFIED! I couldn’t imagine not being able to get the proper help when I get a bad flare up. I remember how it was before I knew about my various doctors and the only way I can describe it is pure HELL!

I work for a small business that is actually letting me pick our health insurance policy. God bless them! However, since there will be only two of us covered, they can’t afford the ppo policy I got from my parents.
The business I work for is located in NYC, so I was wondering if any fellow IC patients out there could recommend affordable policies I can look into? I looked into Blue cross Blue Shield, but right now the only policy we can afford is the DirectHMO, which I believe will exclude getting coverage in other states? I tried looking into Aetna but they won’t let you talk to anyone they have to call ya back. I know this seems like a silly posting but I am freaking out and I have less than a week to make this decision. I know I am blessed because I get to pick the health insurance, but I really don’t want to screw myself out of seeing the doctors I need to see. Thank you for any and all advice.

Lori
NYC

[RAS6]

Hi Lori,
I am in western NY (Buffalo area). I had Blue Cross Blue Shield through family health plus for a year. It covered all my IC meds except proced (which I believe is off the market now anyways) It also covered numerous bladder installments and my csto/hydro under general anesthesia. The issues I ran into were that it was an HMO and I was limited to the Buffalo area. I needed to see an IC specialist and the only one on this side of the state is in Rochester, so I couldn't see him. Also, some small tests including lab work done at doctor's offices and bladder scans were not covered (usually only cost me $10 to $12 each though) I just had to be sure to get refferals and check before any scheduled tests, procedures to make sure they were covered. Because this was government insurance, I had very low copays and no premiums or deductables. If you get alot of in office treatments (DSMO, rescue treatments, Pelvic therapy, etc. I would check your co-payments and make sure it is something you can afford. My new insurance is United Health and while I can go virtually anywhere to see a doctor, Elmiron is not covered as well as many bladder instllments. Plus I had to get a termination letter from my old insurer befor UH would cover any Urology visits. They had a pre-existing conditions clause. You may want to look into that too. Also, I now have to pay deducables (mine are low) but some can be very high. I don't know anything about Aetna.
Hope that helps!

[Lishypaz]

Rachel--

I live in Jamestown and I see Dr. White at Jamestown Area Urology. He has been great and we've been through many hydros together, pelvic floor rehabilitation, and trial and error with meds. He has referred me now to Dr. Mayer at Strong Memorial Hospital in Rochester because we have exhausted all options here. Both docs are wonderful and both docs accept your insurance. I have gone through 3 insurance changes in the last two years and it has been difficult finding which covers what. I am currently on Independent Health which is very big in Buffalo, but not very big in Jamestown. It does, however, cover all of the meds and most of them are first tier. Elmiron is 2nd tier, but with all of my other insurances it was 3rd tier. When you mix your instill cocktails at home, it works out to be way cheaper--my doc orders enough for me to do it every day if necessary and I can sterilize my needles, syringes, catheters, and bottles myself so I cut down on the cost there. My husband is losing his job in 3 weeks and although I can carry the insurance we are scared to death about how we will make it. We are hoping we qualify for Healthy NY or Family Health Plus and that they continue to cover my specialists. My newest thing is I need to see a pelvic floor rehabilitation specialist--not one that deals wtih electronic stimulation but one that deals with massage. This scares me to death!

good luck with you insurance woes.

[RAS6]

Hi again Lish!
I did answer your response to me on a different thread, but I thought I should respond to this one too. I know family health plus uses many different insurance providers. When you apply you should be able to see what your options are. It just depends on what county you live in. For my little tiny county we only had one choice (Blue cross/Blue shield) but I believe most other counties have more than one option. I recently applied for my duaghter's insurance through child health plus and the list was there online. Also, Dr. Mayer's medical billing specialist let me know that many insurance companies will let you see a specialist not in your network (that was my issue, I could only see Doctor's in certain areas) as long as your reffering physician puts alittle pressure on them. She said usually a phone call or letter from the primary physician was enough. Just so you know, Elmiron is available at reduced cost through Johnson and Johnson if you are income eligible. There are links here to the website. I was going to apply, but I went off of the Elmiron so I didn't need to. My insurance no longer covered Elmiron at all and it was over $200 a month. With me working so little right now it wasn't even an option. Plus I had no relief from it and prettty nasty side affects (nausea, some hair loss).
Good luck with you situation and keep in touch. It's nice to find someone who sees the same Doctor and lives somewhat nearby!

[shell]

I'm not sure how things work in NYC. Is there a chamber of commerce or similar association that small businesses can join? If so, maybe you could check with that association or other small businesses to find out what they use for insurance. It they've been using a particular health insurance company for any length of time they should have a sense of whether it's decent coverage and what any terms are with pre-existing conditions.