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Special needs baby, health insurance questions

721 Views 13 Replies 13 Participants Last post by  Sierra, 
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I don't know for sure but I do believe that company insurance will cover you depending on what your benefits are. Every company pays for different benefits so you want to pull out the benefits book (or call and ask for one) to find out. Our HMO covers basically 100% and I've switched insurance midway as well (stayed with the same company but our company offers more than one plan) and noone batted an eye.

Private insurance can refuse you though (not Cobra but if you needed to get a plan outside of cobra or private insurance). BTW, Cobra is plan that is often offered to employees that are laid off. You pay a huge amount for a certain period of time (usually about a year) and you keep your insurance for that time.

As for Downs, some children with Down's do not have any health problems. My sister who is 18 years old does not have any health problems related to her syndrome.
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I may be wrong on this but I believe that if you currently have coverage and do not allow that coverage to lapse in between employers that all pre existing conditions will be covered. My daughter spent 116 days in the NICU for a cost of about $400,000 and thankfully my insurance policy was a HMO and covered the entire cost. A month after she came home, we moved over to my husband's insurance and they had a pre existing condition clause. When I first read about it, I was scared that my daughter's medical expenses would not be covered. Later I learned that all we needed to do was have our old insurance company send our new insurance company a letter stating when our coverage started and when it ended. This satisfied them.

Hope that helps,
Michele
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V
I do not know, but I have heard that it is acompany policy at Kaiser that once you are in the system, they never kcik you out for a medical condition. Which means even with a lapse you can still be a "member" and be "self-pay" and when your insurance kicks in again they can't discriminate. I'm not completely sure about this though.

I also think that the above poster may be correct too. The best thing to do is probably call up your current insurance company and ask them all these questions. During the time that your dh is out of work you guys can do COBRA which is where you pay your own premiums but your insurance doesn't really change. Or at least that's the way I understand it. HTH Basically I've said nothing, lol, but maybe my ideas are helpful.
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Also, there are many public funds (grants) out there for special needs children. Some times you have to ask and dig but it is there.

Look into "Frist Step" program. Call your local school district, even for a new born!
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K
A child born with Downs syndrome would qualify for Medi-Cal through a waiver program in most states (meaning even if you aren't income eligible), and should never have to worry about health insurance coverage, even though you will probably always have it.
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I didn't post earlier b/c I have no experience with this, though I do have a child with Down syndrome. We have never been denied coverage, though I should add that my ds is the healthiest of my kids (ds#1 had a broken leg, ds#2 needed a surgery for an umbilical hernia, but ds#3 with Down syndrome has had nothing more than a diaper rash.) So maybe this is a message of hope--that while all the things that may come with Down syndrome can be overwhelming, there is also the chance you will have a healthy, happy baby in all other respects.
Blessings to you and your child,
Jennifer
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Summertime Mommy
You might want to try to get SSI. If you can get even $1 from them for the baby, then he/she will automatically qualify for medicaid.
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Quote:
I may be wrong on this but I believe that if you currently have coverage and do not allow that coverage to lapse in between employers that all pre existing conditions will be covered.
I agree with this. Two of our kids have pre-existing conditions (daughter=pelvic kidney, son=aortic stenosis), and as long as coverage doesnt lapse, there is no problem with pre existing conditions.

In the past, we would have to wait 6 months without incident for us to be covered, now that isnt a problem. Thankfully.

Good luck with your new babe.
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I agree with the other posters - if he does have such a disability, income should not be a factor in getting Medicare to cover his health expenses. Make sure to apply for SSI if he does have Down S. They take into account that a child with a disability is going to automatically cost families more money than a child without and therefore all families with children with disabilities are going to need some help.

My former student had autism and no health problems. He received an SSI check (or rather, his mother did for him) for $500 a month and got Medicare to cover all health and dental procedures.
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K
Yes the waivers are NOT based on income. Loko up the Katie Beckett Medi-Care waiver- it's also called other things in other states. They are specifically for people with disabilities, and waived the income requirements.
And yes, you coudl get SSI as well- which is income dependant, but it's cutoff is fairly high.
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I would apply for SSI as soon as you find out if your ds has downs. It takes about 6 months to get through all the red tape and get everything in motion. My ds is on SSI and will have coverage for as long as he qualifies for at least $1 of money. Each state should also have some kind of SN grants or alternative insurances reguardless of income. In Wisconsin we have Katie Beckett insurance. Hope that helps some.
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Congratulations on the good news! I'll keep sending good thoughts your way!

Tara
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Sierra
Quote:

Originally Posted by sweetbaby3
I agree with this. Two of our kids have pre-existing conditions (daughter=pelvic kidney, son=aortic stenosis), and as long as coverage doesnt lapse, there is no problem with pre existing conditions.
Yes, that is federal law. I have a pre-existing condition that I have had since I was a very young child (type I diabetes...my pancreas fails to produce any insulin), so I have dealt with insurance issues forever. You probably won't have any need to "work around the system" because the system's laws protect you. Even with lapses, often you can get coverage after a short waiting period.

Don't worry about the money. Money need be the least of your worries. Money will work out. Also, congratulations on your daughter's test results so far.
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