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Old 06-17-2010, 09:24 PM   #1
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Red face Aetna SRC maxout. What to do? Stroke.

Hello everyone.
*Since English is not my first language, please forgive my mistakes in writing.

A friend of mine is in a serious trouble. She, a part-time worker, has "SRC Aetna", a limited benefit health insurance and reached a maximum benefit ($10000 only for life time.....omg) due to her recent hospitalization.

She has been hospitalized for a month now.

She and the hospital made an agreement on payment of hosp. bill. (Discounted significantly)

She is now applying a state funded group health insurance. But is a HIPPA cert. from SRC (limited benefit plan by Aetna) to be accepted as a credible coverage towards pre-exisiting condition? It's not a comprehensive health plan.

I know I could have called the insurance company for her but I do not live in the states.

If the insurance imposes pre-existing exclusion to her stroke, any medical treatment of stroke will not be covered a year or so. She is in a good recovery. Now she receives an intensive PT at the hospital.

But what if she needs another hospitalization due to stroke......paying out of pocket will force her bankrupt.

She is married and just turned 56. She and her husband own a house. So she might not be qualified for medicaid. But if she is considered as disable.....?
What if she files for divorce.....from her husband in order to become on her own (no job and disable) to become medicaid recipient.....horrible/ huge sigh.

Oh it's a long story. There are some insurance companies accepts people with pre-existing condition under individual plan. But the premium is sky high like $3000 per month.

However, it might be better than paying hospital bill out-of pocket for a year......
Any info that will help her situation will be appreciated.

 
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Old 06-18-2010, 04:05 PM   #2
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Re: Aetna SRC maxout. What to do? Stroke.

Sorry, I wrote out a whole note and somehow deleted it.

Many people fall into the trap of the limited benefit plans (with lifetime maximums at $10,000 or even higher). But a few days in ICU and extended hospitalization will eat that up quickly. People are attracted to these plans due to the low cost, but they are paying for something that would barely cover something as simple as a broken leg that needed surgery for stabilization. She first needs to find out if her Aetna SRC plan is credible coverage. If it is, then any new credible coverage she gets, within 63 days of the end of the old plan, will result in no Pre Ex.

If she's still in the hospital then the billing person and/or medical social worker will work to see what kind of plan they can get her on. Recently we were looking for individual health insurance for my husband and even though he his healthy and has Type II diabetes under control no one would take him. So he could only take what is called a "Portability Plan" which may be something they try to find for your friend. But, these are very expensive. They are not based on health so they charge quite a bit. For my husband the costs ranged from $750 to $1000/mo depending on the coverage.

As for things like divorce, that often does not work. She can be shown to be a resident of her home and if the divorce timing is suspect (happens only when there is a financial need) it may not work and may backfire. I saw an article recently where state plans look backward to see about assets, marital status, etc. Also, even if she was to divorce him is her name on the house? the land? her cars? any business they have? These are all assets.

The best thing she can do is have the hospital staff work to find her some kind of plan she qualifies for, which may be hard. But it's better to do this when a crisis arises, such as this, than when someone is planning for needs and can't find the right emergency coverage.

I hate to say it, but you have to think of it this way....if you had a house with no insurance and during a storm lightening hit it and it burst into flames...could you call and insurance company and get coverage? No, because the claim is occurring while you are seeking coverage. She has the same problem, she's hoping to find care that will cost maybe $500/mo but meanwhile while she's in the hospital her care could be costing maybe more than $500/day.

Unless her husband has coverage where he can add a spouse when her coverage ends OR he gets a new job where employees and spouses are covered immediately, then there is no option for affordable coverage such as people get via employment. Many employers in the US have an employee wait 3, 6, 9 or 12 months of employment before getting coverage. My husband's new employer will cover him the 1st of the month following 90 days of employment. Spouses are covered the 1st of the month following 6 months of service.

I'm sorry there is no easy answer. If she has hospital billing and social worker staff around her trying to find a solution that is the best move right now.
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Last edited by SpineAZ; 06-18-2010 at 04:14 PM.

 
Old 06-24-2010, 12:46 AM   #3
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Re: Aetna SRC maxout. What to do? Stroke.

Dear SpineAZ,
Thank you very much for your suggestions.
My friend is scheduled to be out of the hospital this weekend. She has been in a great recovery but still her insurance situation is up in the air. She has applied for state sponsored insurance but has no idea about pre-existing will be imposed or not.
She might have to apply for individual health plan since the state she lives does not allow insurance companies reject people with serious health condition.
It will be very expensive but, no choice.
Once again thank you very much for your quick response to my posting.

 
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