<p>Maybe it is better if your daughter end up going to school in a state where one of those 5 surgeons works. Then she can be covered in SC and hopefully the other state.</p>
<p>I am not a fan of USC since I went to the other school there but I am glad MUSC has such great talent. :p</p>
<p>Southbel – how far away is the out-of-state college she is looking at? If she needs monthly checkups, would it be possible just to fly her home for the medical appointment once a month?</p>
<p>
The mom in me wants this. Then there’s the idea that I am limiting her based on a medical condition. What if the specialist was not here in Charleston? We would have to travel. Her doctor is the surgeon that can operate on it but there are other doctors that could follow her care. So, really the only reason to force her to stay here would be if she needed additional surgery. There’s only been one case where she required emergency surgery. Now that her case if followed closely, we’ve not had to deal with emergency surgery since. All of her other surgeries gave us a few weeks notice first.</p>
<p>I am perhaps making it out to be more than it is. Yes, it’s a medical issue but her everyday life is pretty darn normal. Just has to keep an eye on things and get surgery if it comes back. So, let me correct myself, there are only about five surgeons who can operate on this tumor. There ARE plenty of other doctors who could follow her care (e.g. appointments, etc). I think I forgot that very important detail - the five doctors are surgeons and that’s why there are so few.</p>
<p>
She’s looking at schools as OOS in NC, GA, TN, and PA. One school is Vanderbilt but it’s a super reach. BUT if she got in there, their medical university is super top notch. She would be in good hands there, I am sure. But honestly, her junior year was a disaster so Vanderbilt is almost 100% a reject for her. Other schools are UNC, UGA, Gettysburg, Dickinson. She can’t decide between a LAC and a large state university. We’re hoping as she spends more time at each, that will be narrowed down.</p>
<p>Southbel, I understood you were talking about surgeons. This is a big deal. </p>
<p>Hopefully, everything is going to be perfect going forward.</p>
<p>Were the surgeons able to remove all the visible tumor?</p>
<p>
They can not guarantee (don’t they always say that) but feel pretty good about the margins. It’s irregular in shape and the questionable area was where it wrapped around her facial nerve - hence the facial paralysis she previously had. However, the paralysis resolved with the last surgery so we feel pretty good this time. Normally, if it comes back, it comes back fast. It’s been eight months since the last. The petrous apex (sp?) was involved and I guess this is a sensitive area. </p>
<p>It’s a slightly oddball thing because it’s a skull base tumor versus a brain tumor but has involved her brain in previous growth (e.g. breaking through dura and brain herniation). Of course it couldn’t be clear cut, right?</p>
<p>ETA: I’ve never actually talked about this with anyone so it feels a bit weird to talk about it so much here. I do hope I’m not monopolizing the thread. We’re just kind of private people so generally do not talk about our woes since people aren’t generally too keen on that stuff.</p>
<p>". Of course it couldn’t be clear cut, right?"</p>
<p>No. Lol.’</p>
<p>But things sound great. It hasnt come back. That is great. You can be done with this crap. Your daughter can be done with this crap. 
</p>
<p>Edit: You are not monopolizing this thread. There are 4000 posts here. :)</p>
<p>Good luck to your daughter.</p>
<p>Southbel is correct that the real problem of going out of network is the balance billing, which is never credited to the deductible or the out of pocket maximum. Do any of the Blue’s have the the Blue Card program in South Carolina? Blue Shield of Ca. is keeping the program, which allows you to go to any Blue Cross/Blue Shield provider for in network coverage anywhere outside your state.</p>
<p>
BCBS was my policy that got cancelled. Now they have nothing but EPOs and they seem limited to SC. I need to double check on that though. This was just based on a search of their online database. When I have a lot of patience and time, I’ll call them up. I liked BCBS PPO but the only PPO offered in my state right now for 2014 individual is CoventryOne. </p>
<p>I have no experience with them. They have two tiers of in-network and then out of network. The two tier thing is new to me but basically it means that the really low out of pocket (co-pays, deductibles, etc) is through Tier 1. Tier 2 is about double costs for those but still has max out of pocket. Finally, there is out of network which has high deductibles, only co-insurance of 50% (Tier 1 is 20% coinsurance), and unlimited max out of pocket. They allow balance billing for out of network. This policy at a gold level will cost my family around $1100 per month.</p>
<p>Crossing my fingers that your daughter is completely finished with tumors, southbel. Gone, over, finished, done, kaput.</p>
<p>Me too! We’re ready to start college with no more surgeries and be able to FINALLY cut down on doctor appointments.</p>
<p>Off to bed for me. We have a college visit tomorrow!</p>
<p>Southbel, I would go with the Tier 1 policy. Although it would have been nice if it had an out-of pocket maximum, at least it will cover 80% of the allowable expense. As for the balance billing amount, the hospital might work with you to reduce this amount. If you ask them before admission if they would accept the in network rate, they might be willing reduce the amount. As a matter of fact, I would call Johns Hopkins now and tell them your circumstances and see if there is some flexibility regarding the balance billing.</p>
<p>Good grief this thread us hard to keep up with if you miss a few days.</p>
<p>First, I just skimmed, but several pages ago caters asked this and not sure f it was answered:
</p>
<p>Cartera – I had asked about the BCBS multistate plan, thinking it was literally, MULTI state. The BCBS agent I spoke with clarified that “multistate” meant it covered vision and dental. He said ANY of the PPO plans had in-network providers throughout every state, so multistate did not denote that…PPO did.</p>
<p>TexasPG…re your question a zillion pages ago 
in our case, we have a very small studio with four people, two of whom are on the same plan. One of my employees is a single earner for a family of four with health challenges (wife in a serious accident several years ago.) My goal was to have the lowest possible deductible and OOP limit for him without raising his premiums, of which he pays 30%. We have paid 70% of his entire family cost historically.</p>
<p>Under SHOP, the 50% subsidy is only narrowly available (based on earnings and owners premiums are ineligible) and prorated accordingly, and even if the small business still qualifies on earnings for a portion, the pro-rated credit sunsets in two years.</p>
<p>But if we were to continue to offer our group plan, this particular employee would not be eligible on the exchange, where in his circumstances, he’d have a dramatically lower deductible and OOP and a better split. So it makes more sense to adjust his wages by the difference and buy individually, even though it means an after-tax $1236/mo for H & I that was formerly a pretax benefit. Mch and I would not have been subsidized in either case, through shop or individually, so after adjusting for taxes, its a wash, and we have the ability to fund an HSA.</p>
<p>My agent said that for many very small, eg 4-10 employees groups this is often proving to be how the analysis goes – but it really depends on unique circumstances. Eg. If our employee was single, he’d be on the “cliff.” In that case, the group plan would be more beneficial in theory…but in adjusting his wage upward, he’s still receiving the same value as before, so its not like it would be taking anything away were his circumstances different.</p>
<p>
Aargh… that is NOT what “multistate” means. “Multistate” means that the insurer has promised to provide exchange plans in all 50 states over the next several years, starting with ~30 or so in 2014. It has nothing to do with provider networks, but it stands to reason that a company that plans to operate in all 50 states will also have to develop networks in all 50.</p>
<p>Many of us parents who raised our children to go to college and expected that they would find jobs that have health insurance or be married to someone who has health insurance by age 26 or 28, have been disappointed. I personally am in the situation where my son is going to be off our policy soon and he has neither of such prospects. Throw in some preexisting conditions, and getting private health care for that young adult is prohibitively expensive for many. I have one child who would have been in that situation. I know many parents who were struggling with this issue. That getting affordable health care was so intertwined with getting a job that offered it was a big problem. THere may not be many in the whole scope of things who are young with pre exists, but those are often the most vulnerable in their generation medically, and need that health care the most. With the prices way up there, thos who don’t need the health care go without, and that drives those prices up even further–the cat chases its tail in these scenarios.</p>
<p>So this way, young people who are off their parents’ insurance and out of COBRA options and don’t have that job that offers health insurance and/or do not get much pay, are more able to get insuracne. Those with preexists will likely get some parental help in paying those supplement premiums too. This oftnen makes it doable. With the very high rates that were in the picture, it jsust isn’t affordable for more families. I can tell you I was dreading the transistion when I saw the numbers for COBRA coverage for my son, and the private options were no less expensive. No way he would have paid for it. He would have gone without. No doubt about that. So we would have had to have paid. We are very, very lucky, as he is, that it is possible for us to do so, but the cost was something that was going to impact us at that level. And mind you, that was not going ot be the end of it, if he did need health care as deductibles and copays would come into play for more costs. Now he can just about afford his own premiums, and if there is a medical crisis, what we would be paying in premiums alone for him could be used to pay the deductible and other uncovered costs. This was a big deal thing for us, and this is as a family that CAN may the amounts. We are up there in income What about those who are not and have children in this situation? They simply cannot pay, and these young adults go uninsured is what happens. </p>
<p>Those high costs, by the way, were for my son who has no preexists. I don’t know what the costs would be for my son who does, as he’s still on our plan as a dependent, and also has his own employer provided insurance as he is one of the lucky young people who found such a job that provides that kind of benefit.</p>
<p>I read this on another board. Assuming the numbers are accurate you can see why the premiums in ACA would increase for many people. If you are one of the families with someone that is one of the unlucky 10% you can see why something like ACA is needed.</p>
<p>Following is not my post but from someone on another board that worked in the insurance industry several years ago</p>
<p>"I posted a while back that a few years ago the costs for the top 10% of the sickliest in the US were $18,500 per year. In the same year the costs for the other 90% of the population is $2327 per year or about $10,000 for a family of 4. Understanding the distribution of wealth and income in this country I would argue that most of the public can’t afford $10,000 for healthcare but I am going to ignore that fact for a moment. I absolutely know that there are very few families in this country that can afford $2327 for the first 3 in the family and $18,500 for the next. We need a solution for the top 10% of the sick people!!! That is what this is all about. We have 3 choices, solve it, ignore it and we all pay (current plan) or let the sick die a slow death.</p>
<p>10% of the 300 million people in the US is 30 million. 30 million times $18,500 is $600 Billion a year"</p>
<p>^ it seems plausible but without some serious sourced analysis to back it up, it is just someone’s opinion.</p>
<p>thanks for explanation kmcmom. I am not sure I understand all the intricacies but it sounds like you can’t go to SHOP and use tax credits to your advantage because the money disappears in a couple of years?</p>
<p>Would you advise a non-profit with 10 people to take the tax credit or will it be the same issue, i.e. - no money in two years?</p>
<p>Calmom, I was relying on an OPM article that said the following about the mult-state plans. </p>
<p>
</p>
<p>Perhaps “may” is the most important word in the sentence. </p>
<p>[OPM</a> Multi-State Plan Program Fact Sheet](<a href=“http://www.opm.gov/healthcare-insurance/multi-state-plan-program/opm-multi-state-plan-program-fact-sheet/]OPM”>http://www.opm.gov/healthcare-insurance/multi-state-plan-program/opm-multi-state-plan-program-fact-sheet/)</p>