Historically my company has covered 90% of my supplies after a $500 deductible. About 8 months ago we were acquired by a larger company. They are starting to transition the IT portion of my company to one of the other sub-companies of the company that acquired us. We will be paid through them etc. We were told months ago that we MAY transition to their benefits but if we did the plans would be equal or better. HA! They forgot to say unless you have an ostomy and then we are going to royally screw you!!!

So I find out on June 25th that as of July 1st we will be on the new benefits plan of the other company. WHAT???? 5 days notice - are you freaking kidding me? I scramble to find out if partner benefits will still be offered as Suzan is on my insurance since she is self employed and if my supplies are covered. Good news is Suzan if covered - bad news my supplies are not.

I am totally freaked out - I change three times a week on a good week - a bad week could be 5. I tally up the cost of this and I am looking at $767 a month for supplies. Edgepark will give a 20% discount to those whose insurance does not cover their supplies so that brings the total down to $613. Um - that is still about $550 more a month than I am paying now and $550 more a month than I have to spend.

What the hell? Don't they have to give us more than 5 days notice for something like this? I could have been stock piling supplies if I had known. I don't know what to do - I do NOT have this extra money. I can continue on my current plan through COBRA if I want but I do not know if that will cover Suzan since it is a federal program. Also the cost will no longer be pre-tax so even though the cost is supposed to be around the same as it is now by taking it out post taxes it will take a chunk out of my check that I cannot afford to loose. I do use FSA and will be eligible to start that over but I normally use the full $5000 a year on 10% of my current supplies, doc appts, prescriptions etc.

How do others handle this with no insurance? How much do your supplies cost you a month? It's not like I can bargain shop - I have to use a specific system and I am pretty sure Walmart does not carry what I need.

I don't know what to do.....

Hi Tricia,

I'm mortified for you! I can only imagine the panic you must be going through right now! I have no words of wisdom, but hopefully someone a little more savvy with the US health insurance system will be along to help soon.

Fingers, toes etc crossed for an easy resolve to this problem for you.

Take care.

Shell

Tricia,

Here's the deal with COBRA...you will be charged no more than 102% of the total cost of what you AND YOUR EMPLOYER are now currently paying. So, if your employer covers a portion of the premium right now, on COBRA they will not. So you will pay what you pay to the premium now, what the company pays to the premium now and 2% admin fees for the company that administers the program. AND, COBRA is only good for 18 months, so it isn't a long term solution. I'm going to guess the COBRA costs would be similar to paying hte supplies out of pocket.

As for covering Suzan, it shouldn't be an issue with COBRA because you keep the same coverage you currently have (even though COBRA is federally mandated, it doesn't change your coverage). Double check that, but I don't think that is an issue.

Check out some of the other suppliers to see if they can offer any more of a discount than Edgepark.

Also, see if you can petition the new insurance company for coverage, even if it is only for some of the supplies. Sometimes you can appeal the coverage of the plan.

As for if they can do this on 5 days notice, yes they can. Benefits such as health care are optional for a company to offer, so there is no legal requirement for them to give you notice of a change. It isn't great employee relations to do it the way they are, but...

Take a look at the rest of the health plan to see if you will save money on any of your otehr medical expenses - for example, will your co-pays go down? Do they cover services you might want to use that you don't now because you don't have coverage (massage, chiropractic, etc....) to see how much change there will actually be to your outlay of expenses.

Finally, if you don't already, contribute to a 520 plan which allows you to put aside up to $3000 (or it may be $5000 can't remember how much you can do for medical) of pre-tax money to pay for medical expenses not covered by your insurance. This will lower your tax liability and hopefully give you more back or lessen the amount you owe at the end of the year. It won't help with the monthly pain of the money going out, but it may help to keep you whole in the long run.

I would petition for grandfathered coverage for supplies, since your need began before the changes were made. Good luck in this. I found out how un-lovely this scenario can be when my company was sold in the midst of my 4 surgeries, and the new owners decided not to honor any of the promises I had been made for continuation of benefits. I went from having really good Rx coverage to being thrown in the midst of the Medicare Rx fiasco . . . where I now get to pick and choose which meds I DON'T get to take anymore because of cost in the "donut hole."

When I still had my ostomy my ET nurse told stories of people whose insurance would pay for the surgery, but then not the ostomy supplies. Whatever happened to common sense?

Tricia, the more I think about it, the more I think COBRA will not be an option for you. Since the company is still offering you coverage through them, you probably don't qualify for COBRA coverage which is meant to cover you if you LOSE your health coverage (you leave the company or become ineligible for coverage somehow). Check with your benefits dept, but I have a feeling you will be told that since health insurance IS being offered, COBRA isn't a choice.

Gosh, I don't know what to say but WoW! what a mess!
I hope some of the suggestions here will help!
Julie

I just find it really disgusting that a insurance company would NOT pay for ostomy supplies. I'm sorry that you have to deal with this.
Susan

So COBRA benefits will be available to me and they will provide coverage for Suzan as well. I am still waiting on the actual cost, but it is supposed to be equal to what I pay now (Approx $260.00/month). It will just be after taxes and not before taxes. Assuming all this is true this is the route I will take for medical insurance. I can transfer vision and dental with no issues. What irks me is this is supposed to take effect on Tuesday and today is Friday and no paperwork, don't know how much this is going to cost so I can't make a final decision yet...Um - hello? You think you could have had this ready when you made this announcement? I would only take COBRA until the plan year is up at the end of this year. The hope is that then the new company will offer a self funded plan (which is where they sit down with the insurance company and decide line by line what is and what is not covered). At this point I will fight for my coverage.

This week has been way to stressful for me....

Tricia, if your company will give you COBRA and not charge you their portion of the premium, consider yourself VERY lucky. Since they are offering you another plan that will cost them much less than covering you individually through COBRA, they are giving you a pretty big benefit.

You should still take out a 520 plan if you can to make the COBRA payments pre-tax. You usually have to enroll in 520 plans during your open enrollment, so the timing might not work, but if it did it would make your payments truly equal.

Also, keep an eye on the COBRA time clock. It's only 18 months and I know how long benefit negotiations can sometimes take. Even if the company is planning to have decisions made by year end, your situation might not get resolved by then.

Tricia,
Try your states attorney general's office for help appealing your dilema. Thats what I am doing right now for over a thousand dollars in bills my old insurance company is refusing to pay.
I have only just spoke with their office for medical insurance issues and sent them my paperwork, so i don't know how well it will work right now. But I was told by the hospital that the AG's office can often help.
Have you looked into state and federally funded insurance plans? I have since changed to this insurance, and while it won't cover everything, at least i'm not totally screwed anymore.
I had cobra for a few years and my coverage did not change from the way it was previously (it still included ostomy supplies and the same medications).
Good luck with everything.
-sara

Tricia I know nothing about insurance so I have no advice, but I wanted to let you know that I'm thinking about you. I can't imagine how frustrating it must be to have to deal with this. It makes me so sad, to hear about hardworking people that get f-ed over by insurance companies. It's just so wrong. I'm sorry, I really hope everything works out for you

Tricia,

That is a crummy scenario - I feel for you. Does that new policy completely offer a no coverage clause for ostomy supplies - or do they apply towards your total out of pocket maxiums? If they will at least apply to your out of pocket expense at some point they would be covered (so - buy up 2 years of supplies in year 1 so you cut your costs!).

My other thought is that $260/month is quite low for COBRA coverage for 2 people. I would have expected it to be at least double that. Be careful if you go this route and make sure that your cost is what you think it is. You'll also have to wonder what will happen in 18 months - does your employer at that time have an obligation to re-enroll you in a current plan? Or will you be without coverage altogether?

Best of luck....

Rick