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Thanks again! Yeah, we have some time at least before we worry about this. She may choose in state schools and the issue is moot.</p>
<p>I hear you on mritis! Plus, every tiny thing is treated as possible recurrence. She’s had five surgeries now but this latest one has lasted about eight months now so hopefully we’re over the hump so to speak. Her doctor and her text each other - that’s how well he knows her now!</p>
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Ideally, no. However, we’re super committed to allowing her as much freedom as possible. Right now, she has monthly or more checkups. That may change if things stabilize (fingers crossed). No matter what, our desire to allow her a normal life will be complicated but we’re willing to try and make it work.</p>
<p>I dont know if I could go thru 5 surgeries without cracking. Hoping it is one and done. </p>
<p>Southbel, how is your daughter handling her situation?</p>
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Why do you assume that the home policy won’t cover routine checkups in the college state? Wouldn’t it make more sense to check with the insurance company? Also, what do the routine checkups and monitoring cost? Have you considered the possible benefits of an HSA plan – for example, you get the policy in your home state, fund the HSA, and use money from the HSA to pay for your daughter’s checkups in the other state? (Little known fact: a person can use their HSA funds to pay for medical expenses of a dependent, even if the dependent is not on their insurance plan – I paid for my daughter’s vaccinations before she traveled to India that way. My daughter was on a totally different plan, but still a dependent).</p>
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Extremely well. She’s got my husband’s laid back nature. She used to have facial paralysis but they’ve since been able to correct that. Her reaction to that? Everyday was ‘Talk like a Pirate Day’. I am blessed with this child.</p>
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The plans that are now available in our state - it’s fairly limited - have already been researched by my husband and myself. If she chooses out of state, there are no network doctors for her in the college locations she is looking.</p>
<p>We’ve discussed this as an option as well - the HSA or just paying out of pocket. At this point, I am just trying to be risk adverse and cover contingencies. Perhaps it is a lot of worrying for nothing and that is my sincerest hope.</p>
<p>“Extremely well. She’s got my husband’s laid back nature. She used to have facial paralysis but they’ve since been able to correct that. Her reaction to that? Everyday was ‘Talk like a Pirate Day’. I am blessed with this child.”</p>
<p>Awesome!!!</p>
<p>The multi-state plans in Maryland cover out of network doctors, but at a higher co-insurance rate. Check those out in your state.</p>
<p>You are an amazing mother, southbel. And what a brave child.</p>
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There’s one in our state that is multi-state. It’s an HMO and I would honestly rather not deal with an HMO. If I absolutely must, I guess I could but my preference is a PPO like I have now (or used to have?)</p>
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<p>She can’t get subsidies as a dependent, as you already seem to know. Down the line, asset verification is irrelevant – it has nothing to do with subsidies, and would be relevant only for medicaid in non-expansion states – and given what you have said about your own financial situation and your daughter’s medical needs, I have the sense that you probably don’t want medicaid.</p>
<p>Keep in mind that if your daughter’s condition is so complicated or rare that there are only 5 qualified specialists in the US, then just about any insurance plan will have to pay for those specialists – assuming that is a fact and not just your opinion about the quality of other facilities. </p>
<p>I understand your concern but I really do think that it is premature for you to be worrying about this until you have a sense of where your daughter will be going to school. Some university insurance plans are terrible, but others are pretty good – so if she is headed off to an urban university near a major teaching hospital, you may find that you like the university plan.</p>
<p>I don’t know what you have been paying for the plan you have now, but again – it may be less for whatever you get down the line, because your daughter’s premiums can’t be tied to her medical condition. (It might not be less than what you have been paying on an older policy where your daughter was included as a child – but it probably is considerably less than what you would have paid to insure your daughter after age 18, assuming that you could have even found a policy to accept her, in a universe where medical underwriting still applied.) </p>
<p>The individual rates for young people are pretty low- so perhaps it would be worth it for you to double insure. But again: you will be able to make that choice any time in the future. What you have with ACA is a degree of flexibility that you never would have had with pre-existing law, simply because your daughter now has a guaranteed right to buy insurance in any state, from any company.</p>
<p>I recognize I am a worrier and likely worrying too much. While my husband and daughter are laid back - NO ONE would describe me as such! I think it boils down to I really did like our current plan and am just dismayed at losing it and now having to find something else.</p>
<p>I always wondered how that worked. If there are only literally a handful of doctors that can treat a condition, then does in-network and out of network become a moot point? I guess some doctors could treat her condition but honestly, we want someone that has at least some experience in her condition versus those that have only seen it in textbooks.</p>
<p>Quality of care does not show up in the data. This is a problem.</p>
<p>It is ALWAYS o.k. to buy as many insurance policies as you want for anything, assuming that you are willing and able to pay the premiums. But most forms of insurance won’t pay more than your actual “loss” or out-of-pocket costs, and sometimes too much insurance can make things complicated as to which company is actually on the hook for payment. You can have a situation where Company A tell you to submit the claim to Company B first- and Company B insists that you first submit to Company A. So its not always a particularly good idea – but certainly it can make sense in some circumstances – usually where there are different benefits offered by each plan, although there may also be overlapping coverage.</p>
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<p>I understand. The multi-state plans here are not HMO’s. The good news it that your daughter and my daughter will not be uninsurable since they cannot be denied insurance now because of their conditions. I really worried about that prior to the ACA.</p>
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<p>True, but even in New Jersey, far more students attend college in-state than out-of-state. The figures vary a bit over time, but typically 35-40% of New Jersey residents attending college do so OOS. And New Jersey lies at one extreme of the student-exporting scale. Nationally, less than 20% of college-going students attend college OOS, and the figure is much lower in many states, especially those with strong in-state public higher education systems where in many cases only about 10% of the state’s residents attending college go OOS.</p>
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That’s the part I always appreciated and wanted fixed. My daughter is the very definition of pre-existing and high risk!</p>
<p>“So its not always a particularly good idea – but certainly it can make sense in some circumstances – usually where there are different benefits offered by each plan, although there may also be overlapping coverage.”</p>
<p>I guess when a kid lives in two states, two policies can make sense.</p>
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Pretty much. Out-of-network might still cost more because those doctors can “balance bill” – but it’s not as if there is a lot of shopping around that you can do. </p>
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It would be up to the insurance company to make the decision as to whether or not the specialist you want to see is necessary. I’d be proactive: that is, don’t wait until after she has already seen the out-of-network doctor to submit the claim – instead, once you are enrolled in a given policy, if the specialist your daughter sees is not in-network, take steps right away to get that doctor approved.</p>
<p>This really is a new process for insurance companies, at least on the individual market. In the past they wouldn’t have been accepting new enrollments from families like yours – now they will probably have quite a few coming in who already have very specific and highly specialized care needs. So step #1 will be to enroll in a policy, whereas step #2 would be to find out what the process would be to approve out-of-network care if needed.</p>
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<p>But again, I’m a little puzzled as to why people believe that the ACA makes this necessary – as opposed to simply working with the primary insurance company. Health insurance has never been sold across state lines – the policy I bought for my kids from Blue Shield of California was never effective in any other state, but there was a procedure in place that I followed to insure that my kids were covered when they attended colleges in New York. I know for a fact that there were multiple insurance claims filed for my daughter while in NY, many from out-of-network providers-- each was rejected because they were below the $5000 deductible, but none was ever rejected because the provider was in New York or out-of-network. I did have dual coverage because of the college plan - but I could have opted to structure things differently (lower deductible at home, to start). </p>
<p>I understand that some networks are narrowing and some insurers are going to EPO’s rather than PPO’s… but I don’t know that any companies are writing plans that prevent people from seeking health care when they are traveling or living temporarily out of state. So I just don’t understand the kerfuffle… in my view, it’s the same now as it was 5 years ago, only there are more options now.</p>
<p>Well…Calmom, like I said, I have been buying policies in two states. Been doing that for 9 years so… I wont blame ACA. :)</p>