View Full Version : Insurance question

07-25-2009, 12:59 AM
Hi all. Is anyone else out there worrying that the insurance co. will drop you? My pcp laid some disturbing advice on me last week and I'm feeling concerned. The situation is, I need to see an immunologist to verify some things for me and my pcp that only an experienced immunologist can do. But those will be expensive tests. It's been a little over a year of many different expensive tests ran by rheumatology, hematology, etc...now. My pcp tells me that if I absolutely need to, to just go ahead and make an appt with the immunologist, but if I can wait, it may be a good idea to do so. She told me about people getting dropped from their insurance because of things like this and she's concerned it could happen to me.

I have heard of that happening to patients once they were dxed, but not in the process of finding one. So I'm wondering how worried should I be about it? I'd like to get a dx of this rare complement deficiency type disease they think I have if indeed I have it...there are treatments specific for it and if it's causing my problem swallowing and other symptoms, I'd love to take something that will get rid of these problems. Nothing we've tried so far has helped really.

I hope that came out clear...I'm having trouble getting my thoughts out properly and being clear. If I don't have the deficiency, then great...but if so, and it's causing this pain, I'd love to try the specific treatments for it. From what I understand, an immunologist that has treated patients with this is the only qualified specialist there is for dxing and treatment. The docs are surprised the rheumy found it to start with...but aren't sure that's definitely it. My pcp strongly suspects I have Lupus and Sjogren's but wonders, if there is a deficiency, then it could be creating the lupus/sjogren's or vise versa. She also wonders if this is Lupus and the deficiency. ugh...it's so mind twisting. One way or the other, we've got to find out if this deficiency does indeed exist.

I don't know what to do. I was all excited about setting up an appt with such a specialist and maybe solving mysteries and getting treatment...but now, I'm of course worried my ins. will drop me. I have an appt with a neuro next week and a GI doc in september... adding the immunologist makes me worry that will topple things over with the ins. company. I'm already worrying about the appts I have scheduled. Thoughts, ideas, advice?

07-25-2009, 08:03 AM
Is your insurance through an employer of you or your husband or are you privately insured?

Private...they can't...may/can. By law a health insurer can't drop you, provided you pay your premiums in a timely fashion but...They will find a legal way to do it. Is there a clause in the fine print?

Employer sponsored....no. Don't quote me on it..things are changing.


07-25-2009, 08:15 AM

Im sorry I dont have any info about how that works, with the insurance and you being dropped, is your insurance through your employer or.... I didnt know you could be dropped. Im sorry I hope things work out for you. I wish I knew more.


07-27-2009, 12:41 PM
I'm sorry...I forgot to mention it's group insurance... through my hubby's employer.

Yeah, Oluwa...that's what I'm wondering about...how things are changing. I don't pay attention to the news much lately, but my pcp said it's been on the news and it's something the president is supposed to be working on fixing.

07-27-2009, 09:01 PM
I would advise that your husband get in touch with his HR rep to get the name of the insurance rep who sold the plan to his company. The rep would know what your insurance company's policies are and could help you find out how much of your test is covered. We sell health insurance in my office and I am going to double check on this tomorrow with one of the reps and will be back with his answer.

07-28-2009, 10:23 PM
Thank you very much Sandy.

Hubby won't be happy to hear the suggestion, but he'll do it. Lol...he always hates to have to ask them for anything. He says they can't stand to see anyone coming with questions and don't try to hide it. We'll see what happens. I'd call but they don't allow that...only employees.

08-06-2009, 09:14 AM

I don't know how, but hubby got someone in HR to help him. She called the insurance co. herself and directly asked. There's no way they would drop me over that... the only way they would is if I got supplemental insurance right now. So I called the immunologist's office and they fit me in an appointment later this month...that fast! that's the fastest i've ever been able to see a specialist.

So maybe we can finally lay some things to rest or diagnose something.

Thanks Sandy, Chriss, and Oluwa.

08-07-2009, 07:25 PM
that's great news! I am sorry I didn't get back to you, but that was the same answer I got. I was going to ask you which company you were insured through, but that was even better that he got the answer.