Switching health insurance while suffering from CP? - Pain Management Message Board

HikingFan · 07-17-2003, 03:56 AM

Just a question for those of you who have had to switch health insurance providers in the midst of CP problems:

I am currently with Kaiser Permanente HMO here in Southern California. I recently started a new job and have to completely switch all my medical insurance to a PPO network. I am worried about how I will get continous and adequate care in the interm while I try and figure out how to get to the specialists I need. I know I will probably have to see a primary care doc in order to get referred to physical medicine or pain management...Here's the kicker...I looked online for the specialist providers in my area, and there are no Pain Management doctors in the network anywhere in Southern California (my company resides on the East Coast, and they have me on a special project out here in San Diego, so their health insurance plans are suited towards the east coast states!)

Had anyone had a similar experience with switching insurance, and if so, how did you manage to bridge the gap in order to not have to start from square one again?

Any advice you could provide would be greatly appreciated. You guys are the best!!!!

Sara

whaleylaker · 07-17-2003, 07:47 AM

Wow,Sara. That doesn't sound like fun! Is there someone in personell at HQs that you can talk to? If not maybe your pain Dr. here on the east coast can persribe a 3 month supply of meds(if that is to become an issue later) while you search. Good luck and hope all goes well, Lake

Shaman · 07-17-2003, 02:31 PM

I'm really sorry you have to go through this. I would call your employer and talk to the benefits coordinator and explain that you have a plan that you like etc. Ask if it is possible to continue on Kaiser and have them pay for it. Some of the companies that I deal with will allow employees to keep their own health insurance for just the kind of reasons you state. They then pay the amount that they would pay if the person was on their plan, and the employee has to pay any difference. The disadvantage to this is that when the employer pays for your helath insurance through their plan it is not taxable income to you and any portion that you would pay is usually pre-tax too. When they do it the other way, they usually include the $ in your check, and you get screwed for the taxes.

Also, ask when your companies open enrollment period is. If you really don't want to switch right now, you might be able to stay on Kaiser through COBRA. Ask if you will be eligible to join the PPO during the next open enrollment if you say "no" now. It may be that open enrollment is in a few months. I don't know what your situation is, but it may be worth it to you to pay for Kaiser for a few extra months out of pocket to give you time to find the right Dr on the PPO. Of course, if open enrollment just passed, this may not be viable.

I feel for you because I just went through the whole switch your insurance thing. The company I was with gave me 45 days notice that they were disbanding the group and I would have no coverage as of July 1. I did manage to get coverage, but I haven't met my new PCP, who I picked out of a book and don't know from Adam! Should be interesting.

I hope you find a brilliant Dr!

HikingFan · 07-17-2003, 03:22 PM

Thanks guys for your advice. Very good thoughts!!

oceanview88 · 07-18-2003, 12:57 PM

Hey Hiking Fan, Insurance companies do make exceptions and will cover out of network providors as in network if you have no other alternatives. At least mine did, However each visit had to be pre aproved and when your titrating meds you can't get the aprovals fast enough, I ended up paying for about half of those visits as out of network although when given enough time to get aproval they would cover some as in network. I would call the PPO and expalin the situation and ask what your options are. I'm sure every compny has it's own policy regarding these situations.

As far as continued care they passed a law a few years ago waving the waiting perriods for pre existing conditions as long as you went directly from one policy to the next.
Good luck, Ocean