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Insurance Coverage Issue

I had a liver and kidney transplant in February 2012 after 13 months of being horribly sick, on Dialysis and in and out of ICU's. I have an employer based, excellent insurance plan and Medicare due to the dialysis. I am at the $1,000,000 lifetime cap on the insurance and Medicare will not be the primary payer for 30 months post transplant. (Medicare waiting period).I think the Affordable Care Act is going to kick in and prohibit lifetime maximums for existing plans...does anyone have any experience with this or know anything more?
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  • chris in rereading this I thought ur med waiting period was waived because u were on dialysis prior to tx.pls chk. gl, susie

  • Thanks Susie and everyone. I appreciate your taking the time to write. The $1,000,000 was well spent since I am now doing great! Even back to work part time and having fun times with friends and family. But obviously, the costs will contine for meds, labs, Drs, and with no coverage that will add up VERY quickly. That's my fear. I need continuing coverage now and when the 36 month post transplant Medicare eligibility expires.
  • It's terrific that you're thinking ahead. In most cities there is a listing for health care adviser's in the yellow pages or on-line.  Select one that IS NOT affiliated with just one insurance company.  It would be best to find one that is totally independent.  For a relatively small fee (compared to what it could cost to make a big mistake in your selection) they will evaluate your options and discuss them with you thoroughly, along with providing a written analysis.  It could be the best money you ever spent! 

       Don't believe all the chattering your read.  Most of us in the medical profession DON'T know the implications of the new health care plans, but for sure pre-existing conditions have been hit by a huge rock from David's sling and hopefully that Goliath nicknamed "preexisting conditions" which has doomed so many, will fall down dead and no longer be a criteria for the right to health care. 

     And as for care allocation and issues around cost vs. length of life, what Obama's medical committee's of professionals who have proven their success at treatment efficiency (which were in place during the Bush administration but without any real in-put) aim to do is evaluate actual provider's outcome and quality of care and steer/create outcome criteria competition to those organizations who understand that our medical/financial resources are NOT unlimited (health care cost is now 18.7% of our GNP) and need discernment and wisdom in using the financial and medical resources available. But these stories about doctor's terminating lives is balderdash -- in the sense that selective termination has been occuring in intensive care units for patients who have no chance of returning to any life quality since Hospice came to America from Great Britain almost 25 years ago. The unfortunate thing is that technology ramped up on our society so quickly we began to assume that eternal life was just around the corner, and death became an enemy.  We never processed what all this technology was going to do to us ethically, morally, religiously or legally -- let alone it's impact on our social system.  We fell under the spell that bigger and better technology translated into longer and better quality of life.  So we have hit not only a financial wall but for many of us an internal wall that prompts us to determine for ourselves, our family and our social environment what life is worth, why are we so afraid of death, and are the resources currently spent on medical care to prolong what is in all probability a very miserable quality of life for perhaps six additional months of "existing", worth the cost if it is robbing our children and grandchildren of a secure financial future (and medical technology is doing exactly that.) 

       In my mind I think I have come to a quasi-Darwinian position (and no, I don't believe we evolved from apes) -- that we should cautiously intervene in costly medical events that are unable to provide the individual a life with a quality awareness of self and relationships.  This is spoken by a spouse of someone who used approximately $5,000,000 to gain 14 years of life.  Every penny was worth it and savored.  But the $1,000,000 spent in the last 17 weeks of life, when there was no chance of healing, health or life to be had, because his body was "all used up" by the effects of transplantation medications was not a morally sound choice.  However, I had his medical power of attorney and was keeping my commitment to follow his wishes  His death at the age of 49  was caused by his volunteering to serve as a Marine in VietNam where he was seriously wounded and given Hep C in a transfusion, and his Harvard living well requested that everything be done until there was nothing left to do, and so I kept my word as his last remaining voice, and although I was conflicted at the continuation of a "nothingness" I could not justify, my word had already been given to a man who never once complained that his life was over only because he believed in serving his country. 

      You have an easy question that can be empirically answered -- what is the best option to protect my future for quality health care, but I think all of us have a bigger question within  --  at what point is too much, just that, too much. And at what point is living with grace, freedom from pain, and awareness of those who love me, more life-giving then a technology/medicine/procedure that at most will buy a few months, likely at extraordinary expense and will in all probability lead to an awareness of physical misery more consuming than death.  All of us need to engage in this dialogue -- our finances can never outpace the development of medical technology because our quest for immortality has become a universal obsession, and just as there are allocation for organs there is going to need to be an allocation of medical resources.  May we come together and not take positions as Republicans, Democrats or members of the Tea Party, but as citizens of this country born from the search for freedom, that we corporately need to protect.and honor with discernment and wisdom the fact of it's limited medical and financial resources.

  • Hi Chris.  Last year my husbands company (we are retired) turned our vested insurance plan over to Extend Health. They helped us chose the best insurance plans for us.  I was not asked about my health condition and the insurance company that I get my meds through has already notified me that I will be insured by them again this year. They did raise my insurance $4.00 but I can live with that - all my meds have been covered.  Also, we received a card from our health carrier that we would still be insured by them - don't know though how much our costs will go up.  My understanding is that the insurance companies cannot ask question you about a previous condition. You might look into Extend Health and see if they can help you decided what to do.

  •  Hey Chris,   Well I think we all are wondering the same question about Obama care,  I have not read anything long term with the A C A , I have asked my tx cntr bout it as well  thinking they may have an idea,  but they dont,  they feel same way I do ,  the frist year the white house is going to brag how good this act is ,  I think its going to fail miserably .. I truely hope they have look long and deep to transplant costs and the bigger cost of medications after tx,   it still amazes me  that they seem to think we need a third goverment health program { medicade,medicare and now obama care }   I agree that all people need a good quality and affordable heath care,  but why couldnt they just fix medicade or medicare ?  and save tax payers a horrible amount of money and grief of all of this  ...    I agree ,   if you can hang onto your employers insurance for at least through 2014 and see how Obama care  turns out ,  

  • not sure, is it feasible to change insurace provider for 2014 via your employer?
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Looking for My Kidney Hero

My dear Friend Susy - a double lung transplant survivor is in need of a Kidney Angel (O positive blood type).  If you can be Susy's Hero- contact her at susygar@aol.com Thank You So Much!