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#52772 05-24-2004 04:04 AM
Joined: Jul 2003
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Platinum Member (300+ posts)

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Christine-
I'm so sorry you have to deal with so much right now, but just a note on your medical insurance. Most medical rates are separated by "employee" "spouse" "employee with children" than "family rates". Family rates are always higher as they include a spouse. You will find that the employee with children rates are considerably less. When your husband passes on to a better place it is in the insurance world considered a "qualifying event" and you should be able to go to your employer to sign up without waiting for your annual enrollment period. The employee with children rate will be less than the Cobra for family rate. Let me know if you need more information. God bless you during this heavy time. - Kris


SCC Stage IV left tonsil neck disection 3/02 radiation finished 6/02 chemo finished 9/02
Stage 2A left breast cancer 3/09, chemo and radiation, finished treatment 2/7/10 -Stage 2 right beast cancer 10/14 chemo and radiation
Every day is still a gift :-)
#52773 05-24-2004 07:24 AM
Joined: Dec 2003
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Patient Advocate (old timer, 2000 posts)
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Patient Advocate (old timer, 2000 posts)

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Bobbie,

I am sorry with all you have to endure that you also have to struggle with a heartless employer AND an insurance company. Remember the insurance company is in business to fight your claim and they are not on your side. As your husband is diagnosed terminal, he may qualify for Social Security Disability if you are not already receiving it. You, too, are entitled to benefits if he is qualified plus any children under 16 in the home. Further, he may qualify for health coverage which would allow you to possibly get reduced rates as Kris mentions below your post. If you need a lawyer to help sort some of this out, the American Bar Association may be able to refer you to one that will take your case pro bono. There is also legal aid based on ability to pay in most cities.

Enlist the help of others for the things you don't feel like you are best able to fight with all you have going right now. And don't let any schmucks ever let you or your husband believe for a second that you have lost any of the respect you have earned in life. They are not worth it!

Ed


SCC Stage IV, BOT, T2N2bM0
Cisplatin/5FU x 3, 40 days radiation
Diagnosis 07/21/03 tx completed 10/08/03
Post Radiation Lower Motor Neuron Syndrome 3/08.
Cervical Spinal Stenosis 01/11
Cervical Myelitis 09/12
Thoracic Paraplegia 10/12
Dysautonomia 11/12
Hospice care 09/12-01/13.
COPD 01/14
Intermittent CHF 6/15
Feeding tube NPO 03/16
VFI 12/2016
ORN 12/2017
Cardiac Event 06/2018
Bilateral VFI 01/2021
Thoracotomy Bilobectomy 01/2022
Bilateral VFI 05/2022
Total Laryngectomy 01/2023
#52774 05-27-2004 04:08 PM
Joined: Apr 2004
Posts: 44
Contributing Member (25+ posts)
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Contributing Member (25+ posts)

Joined: Apr 2004
Posts: 44
Bobbie,

I only just noticed the COBRA thread. I'm ashamed that it has taken me so long to notice. You damned right its WRONG and flat out unethical! I am convinced that whatever people put out into the world will come full circle. We may never know the hardships they'll face but I know without a doubt it will bite them...someway. That's karma! You hang tough and perservere. We're all going to get through this one way or another and STILL come out okay.

I don't know your specific circumstances but there may be a catch...

Some things you may wish to investigate...
Was your husband on disability with his company at the time they terminated him? Contact your local department of labor and/or the EEOC regarding his former employer's potential liability for terminating him while disabled.

Secondly, anyone that currently has group coverage - keep group coverage for as long as you can. DO NOT let it laps for any period in excess of 63 days or you will most certainly fall into the pre-existing conditions and waiting periods. If you have come from a group plan to an individual plan - you are subject to any and all exclusions/waiting periods they have written into the plan. Your certificate of insurability means nothing in that case because you are changing plan types. FYI: Most private/individual plans are NOT major medical. Look hard into the details. They usually carry significantly higher deductibles, copays, limited formularies for Rx's, uncovered procedures, etc.

Because I have worked with medical insurance plans as part of my work - I have been mentally going bug-shit (forgive the term) with our situation. (Knowledge is not necessarily power it can make you crazy, too.) Keep your ear to the ground and if insurance companies and employers think they can get away with something - I promise, they'll try. Sorry to sound so cynical but I've learned the hard way...

I empathize with the sense of being so vulnerable. It costs nothing except time to speak with those agencies and they may be able to help alleviate some of the burden/answer some questions.


Caregiver to Uptown/Ed, SCC Stage IV, Base of tongue - Completed Chemo (Cisplatnin/5FU) and 45 days' simultaneous Radiation 10/08/03
#52775 05-13-2005 11:58 AM
Joined: Feb 2005
Posts: 118
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I was terminated by my employer when my Family/Medical Leave Act ended and on 5/1/05 I elected COBRA. I was surprised today when I filled two prescriptions, where my co-pay would be $45, and was informed that I would have to pay full price for each (total of $185) and seek reimbursement through my insurance which is a Cigna HMO. Neither my former employer or the COBRA coordinator informed me about this. Is it standard practice?


Be well. Zenda
12/04 SCC Tonsil, Stage IV T3N2BM0. Mod RND, resect right oropharynx, free-flap, resect right tongue base. Erbitux,Docetaxel,RT X 33. 6/08 Mets lung, hilar lymph node:Carboplatin, Docetaxel. 2010 2nd clinical trial:lung clear, node stable. ORN,trismus,dysphagia. 8-10/2012 cryoablation,brachytherapy,cyberknife to lymph node. 12/12 NED. 6/13 Mets RLL lung: 8/13 cyberknife. 11/13 NED.
#52776 05-13-2005 12:35 PM
Joined: Feb 2005
Posts: 118
Likes: 1
Senior Member (100+ posts)
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I neglected to state in my prior post that I paid my May premium for COBRA in April to assure that I would be "in the system" on May 1. My former employer assured me that I was "in the system." Doctor appointments since May 1 have been no problem and I have paid the pre-COBRA co-pay.


Be well. Zenda
12/04 SCC Tonsil, Stage IV T3N2BM0. Mod RND, resect right oropharynx, free-flap, resect right tongue base. Erbitux,Docetaxel,RT X 33. 6/08 Mets lung, hilar lymph node:Carboplatin, Docetaxel. 2010 2nd clinical trial:lung clear, node stable. ORN,trismus,dysphagia. 8-10/2012 cryoablation,brachytherapy,cyberknife to lymph node. 12/12 NED. 6/13 Mets RLL lung: 8/13 cyberknife. 11/13 NED.
#52777 05-13-2005 02:03 PM
Joined: Apr 2004
Posts: 837
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Posts: 837
Zenda,

I am not an insurance expert, so I can't give you a definitive answer on this. However, I was on COBRA coverage from September of 2003 until February of this year, and when I first started on COBRA there was no change in the way my prescriptions were handled, compared with the system under my prior employer.

Cathy


Tongue SCC (T2M0N0), poorly differentiated, diagnosed 3/89, partial glossectomy and neck dissection 4/89, radiation from early June to late August 1989
#52778 06-08-2005 05:16 PM
Joined: Dec 2003
Posts: 2,606
Likes: 2
Patient Advocate (old timer, 2000 posts)
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Patient Advocate (old timer, 2000 posts)

Joined: Dec 2003
Posts: 2,606
Likes: 2
Zenda,

Nothing should change in terms of coverage when you elect COBRA coverage. It may be a case the pharmacy was not on the preferred provider list. Make sure and ask your customer service rep for future reference. The number should be on your card.

Ed


SCC Stage IV, BOT, T2N2bM0
Cisplatin/5FU x 3, 40 days radiation
Diagnosis 07/21/03 tx completed 10/08/03
Post Radiation Lower Motor Neuron Syndrome 3/08.
Cervical Spinal Stenosis 01/11
Cervical Myelitis 09/12
Thoracic Paraplegia 10/12
Dysautonomia 11/12
Hospice care 09/12-01/13.
COPD 01/14
Intermittent CHF 6/15
Feeding tube NPO 03/16
VFI 12/2016
ORN 12/2017
Cardiac Event 06/2018
Bilateral VFI 01/2021
Thoracotomy Bilobectomy 01/2022
Bilateral VFI 05/2022
Total Laryngectomy 01/2023
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