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.
Rt&Lt thumb arthroplasty 2012 ; RT TKR & Bilat CTS 2011
Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
C5-C7 foraminotomy 08
Last edited by SpineAZ; 06-18-2010 at 05:14 PM.