<p>Do you buy a regular policy or just the university one in the second state?</p>
<p>We must have had the unicorn of individual insurance policies. Daughter had to go to Johns Hopkins and it was covered. So, I guess since I am looking for similar insurance and my policy was a rare one with all that it covered, I am unlikely to find it. I will say, our policy was quite expensive but still a heck of a lot cheaper than if we paid out of pocket. It seems like I am searching for something that no longer exists.</p>
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A PPO will pay for out-of-network care – at a lesser rate, but they will pay. </p>
<p>There is an ACA patient bill of rights that requires all insurers to pay for emergency care when a person is unable to get care from a network provider (such as when traveling) – and I believe the law also requires insurance companies to pay for out-of-network care for necessary medical expenses when there is no one in-network who can provide the care. </p>
<p>One reason I think you should wait is that this is all very new, and if you call an insurance company now three times and talk to three different agents, you are likely to get three different answers. If you go with whatever is the best at-home plan, you’ve got care covered from January through August. You’ll be able to take a more leisurely look at options down the line when all the hubbub about ACA and exchange enrollment has died down, and you’ll be able to talk with a benefits administrator within the company you choose after the details of where your daughter is attending college are known. Because you will then be a policy holder, it will be possible for someone to give you more definitive answers about your daughter’s specific situation. </p>
<p>It will work out, and it probably will work out in a way that will cost a loss less than what you would have faced if you and your daughter lived in a world without the guaranteed-issue provisions of ACA. (It may seem like more if you only look at your 2013 insurance premium compared to what you end up paying in 2014-- but in a non-ACA universe, your daughter’s condition would have had ramifications in terms of her insurability and cost of insurance that could have lasted a lifetime).</p>
<p>Yeah, I think a wait and see approach is best right now. We’re likely going with that route. We need something for 1 January but we have some time to determine what to do with our daughter once she goes off to college - which might be a moot point if she stays in state. The one PPO offered in our state is Tier 2 in-network for her doctor. So, we’re likely going with that.</p>
<p>Texaspg, I bought the university one. I am not saying people should copy me. I just did what was easiest.</p>
<p>By the way, I really appreciate all of y’all’s advice. I didn’t mean to turn this into a discussion of my own personal issue.</p>
<p>southbel - you are a perfect test subject here and you are why the thread exists. We need more people to ask questions so we can get better at understanding how to work with the law.</p>
<p>dstark - so how did the reimbursements work or did you just pay for two premiums with no claims?</p>
<p>No Southbel. People should talk about whatever concerns them (except for the politics). Others have similar concerns. That is how we learn. Dont worry about sharing your personal story. Thanks for sharing.</p>
<p>“A PPO will pay for out-of-network care – at a lesser rate, but they will pay.”</p>
<p>With all due respect Calmom, this is a very misleading statement. She will get killed if she has to be hospitalized out of network.</p>
<p>Texaspg, that is a good question. There were a few claims and I cant remember.</p>
<p>I think we did use my plans for some claims and my kids plans for other claims usually depending on where they were treated. I have to admit. Things are blurring together.</p>
<p>I did pay for two premiums.</p>
<p>southbel - are you from MD? I think there was a news story posted saying the State prevents ANY hospital from declining any insurance (I wonder if it works for OOS insurance).</p>
<p>So JHU being on your plan may not be a coincidence if you are MD resident.</p>
<p>Out of network scares me because of two things - balance billing and unlimited out of pocket maximum. If I paid out of pocket for her surgeries, they would have run around $300K per. This is not counting the multiple tests and appts in between these surgeries. </p>
<p>That being said, the chances of her getting surgery anywhere but here and/or Johns Hopkins is highly unlikely. Although, she did have one same day emergency surgery because her brain herniated. That’s the scenario that scares me.</p>
<p>We’re what I would classify as upper middle class. She has a trust from her grandparents but it wouldn’t take long to deplete my savings pretty quickly at these kind of prices. We wouldn’t ever think of touching her trusts even if her grandparents signed off on it. With the new policy we’re thinking of taking, the co-insurance is 50% for out of network but then I have that dreaded balance billing issue.</p>
<p>I can only hope this gets worked out as time passes and before she goes to school. The mom in me wants her to stay close to home but the adult in me knows that if the best school for her is out of state, that’s where she should go.</p>
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No, I’m in South Carolina. I recognize I am lucky our policy was taken so many places. Not sure why that was.</p>
<p>We did have to jump through quite a few pre-approval processes to get her care at Johns Hopkins, including having her current doc sign off on it as necessary. Perhaps that’s why it was covered?? I wish I was smarter on insurance.</p>
<p>Southbel, do you have choices in South Carolina for 2014 that will cover your daughter where you want in SC and at Johns Hopkins?</p>
<p>I’m grateful when people ask specific questions here that I don’t know the answers to. Someone else does know the answers, and then I learn something. Thanks, southbel.</p>
<p>Sounds like you had nice insurance if they covered a trip to JHU.</p>
<p>Is your current specialist in state?</p>
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Why do you assume that there is an unlimited out of pocket maximum for out-of-network coverage? My ACA policy has a $9000 out-of-pocket maximum for out-of-network care. </p>
<p>Or are you just referencing the policy you had before.</p>
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Right now, just for in South Carolina. There’s one PPO that will cover her current doctor as Tier 2 in-network. Johns Hopkins would be out of network. Unless something really odd happens, we could likely be okay without JH. They were key in diagnosis for her and determining a treatment plan. Either way, my choices are limited so I really do feel like I am getting less with the insurance options now. Of course, my number one concern was continuing care with the doctor who has been through all of this with her.</p>
<p>My only reason for worrying about her at school is the appts to track her if she has to keep up monthly visits. In thinking about it, even if she had an emergency surgery situation again, she would have to go to somewhere else in all likelihood. Most surgeons wouldn’t touch her case with a ten foot pole and would ship her off to another hospital where they could deal with her situation.</p>
<p>“It will work out, and it probably will work out in a way that will cost a loss less than what you would have faced if you and your daughter lived in a world without the guaranteed-issue provisions of ACA. (It may seem like more if you only look at your 2013 insurance premium compared to what you end up paying in 2014-- but in a non-ACA universe, your daughter’s condition would have had ramifications in terms of her insurability and cost of insurance that could have lasted a lifetime).”</p>
<p>This seems like such a fantasy view of the ACA, I’m not sure what to say. She would have only had a hard time getting insurance prior to the ACA if she was one of the small percentage of people buying an individual plan, not as one of the vast majority of people getting insurance through employers (or their spouses employer). Plus the fact that that some states (mine does) already had a high risk pool established, for people who couldn’t get insurance otherwise.</p>
<p>I am hoping the ACA works better in the future, but it’s just not believable to try to rationalize every negative change for every person. There are some people in this version of the ACA that are getting hurt, sometimes via their health, sometimes via their pocketbooks. It’s impossible to spin that every bad effect on someone personally is actually a good thing.</p>
<p>Current specialist is in state at MUSC. SUPER lucky in that regard. Current choices of ACA policies has no out of pocket limit for out of network. </p>
<p>Right now, according to her current doctor, there are five experienced surgeons in her type of case (I may be slightly off on that number). There may be more but those are the five he knows about and/or are known for this type of surgery. It’s an odd surgery because they have to be experienced in both ENT and Neurosurgery based on the location of her tumor and where it keeps coming back. It’s a benign tumor but it’s just aggressive and keeps returning. It has an enzyme that eats bone and keep eating through areas that are sensitive. In essence, it’s a type of very aggressive cyst.</p>