Tuesday, November 25, 2008

May Aetna and Golden Rule Insurance Choke on a Turkey Bone.



My husband is out of work. COBRA would cost $1500 a month. The Cigna insurance we carry excludes autism coverage. The law passing in CT excludes the company under ERISA laws.



We looked into private insurance as an alternative. Just a catastrophic plan to save our ass should I finally jump off a bridge or something. Golden Rule insurance will not cover the girls because of their autism diagnosis. Aetna will consider them with a 90% surcharge. Neither covers autism though.



WTF? How is a family supposed to survive???

21 comments:

Angela Warner said...

WTF? is right! This makes me ill. Forget the turkey bone - I hope they choke on their own saliva!

Kim... please don't jump off a bridge! They should be the ones jumping! $1500... yeh right. Who the hell can afford that? Jeeez

Kim Stagliano said...

The turkey bone is more painful... I mean come ON. Denied for a condition they don't even cover????? It's so disheartening.

Amanda said...

I am so glad we have the NHS. It's a bit slow, coverage is patchy but it's free and open to all. I feel for you, I really do.

dianeyellis said...

Kim -
This is why we need to support groups like Autism United that are fighting for us. This totally blows. One day I will share my insurance nightmare with you.
Diane

dianeyellis said...

One more thought....the CEO of United Healthcare makes 80 MILLION dollars a year. Eighty *@#%ing million dollars. And while I think Obama will be a totally cool president, I don't think he can do shit about this. (Pessimist)

Kim Stagliano said...

So my formerly middle class kids, wiht two college educated parents who've worked their asses off will go onto medicaid. Oh it's called "CT HUSKY!" so it has a cute name. It's medicaid. It just shrivels up my insides and steals my breath.

Robin said...

The ironic thing is that autism is not considered "treatable" so how expensive can the medical needs be. We finally found an insurance company that considers my husband and me a "group" so we can't be denied. But because we are a small group, it is expensive.

Gail said...

We need universal health insurance now. During the debates, I remember that McCain described health insurance as a responsibility and Obama said it should be a right. If we had universal health care this would be one less thing you had to deal with right now. ERISA should be amended to keep these self-insured medical plans from excluding our kids. It's outrageous. When my son's speech therapy claims were rejected by our self-insured plan I was told they would only cover speech therapy claims for a child who was fine, something happened and now needed the therapy to get better. I responded that he should get covered because he was fine, then something happened and now he needed the coverage to get better.

Better days ahead for all.

Gail said...
This comment has been removed by the author.
Kim Stagliano said...

John McCain's $5000 would last us about 3.5 months..... I will make it. We will be OK. My kids will be OK. I will not crack. Nope. Not as long as beer is cheap and Mark and I have MadMen on DVD. Many people have reached out to us - it's humbling, encouraging, humbling (oh I already said that) and I can't wait to be on the other side of the pity/charity. I learn so much about WHO offers help, how it's done, who acts, who talks, who offers platitudes, who steps up to the plate. It's an interesting lesson indeed. I have a long memory.

I need one of those Oprah Magic Fairy comes into your life and helps you stories. I can cry on TV. I've lost all semblance of shame. Well, not quite all. I'm still quite proud. Pride just doesn't pay much. I need this for my kids. Fuck Mark and me. I need this for my kids. I need to support them FOREVER. Forever! Shit, there goes my breath again.

(Is there a market for flat chested 44 year old hookers? I'm not without certain talents...)

Jordan E. Rosenfeld said...

And we call this country great...(expletive here). I'm sorry to hear this. Not the happiest of thanksgivings for many people--except of course that we have our families!!

Kim Stagliano said...

Hi, Jordan! Well YOU have a lovely TG coming up with baby Ben! How's he doing? How about the publishing biz right now? Did you see Houghton Mifflin is taking NO submissions? OMG... It's too depressing for words. Kat C. has not found a home yet....

Jordan is a freelance editor, friends.

KIM

Michelle O'Neil said...

Fucking bullshit. I am so sorry Kim.

Kim Stagliano said...

Michelle, isn't it just a joke. We don't cover anything under an autism diagnosis but we won't cover your autistic kids for ANYthing. Oh I am SO going to HuffPo these people. Next week when my head is clear and I'm less blown away. Now I need to concentrate on GOOD FOOD! And I get to see some favorite friends on Friday night. High school friends I adore. YAY!!!!

K Fuller said...

Kim,
I am probably giving you info you already have.
In California if your child is eligible for any state services through what they call a "Regional Center" through the State Dept of Disability it automatically makes them eligible for a Federal program that is called the Medicaid Waiver program. It covers copays and deductibles for our son. Our insurance pays first and the Medicaid Waiver pays 2nd. Of course just they only cover prescriptions,office visits and lab stuff. You have to use providers that accept Medical. It is administered by the county but is a Federal program.
Both you and your husband have paid into the system and this is what it is there for.
Your family picture is on my thought board and I send up a good thought for you frequently.

Kim Stagliano said...

K, thanks. We are in DDS CT, there's an 18 month wait for a case manager. I have applied for CT Kids insurance of course. I can check on our app on Monday and hopefully expedite it. The kids will qualify. I know they'll have insurance. I just wanted to stay off state programs if possible.

And I'd never jump off a bridge. I shouldn't even joke about it. Never. I might push a few people though!

K Fuller said...

Again I am probably telling you something you already know but...
Start the sign up for SSI for all three girls, you can suspend it when your husband goes back to work. Maybe they can help you get moved closer to a caseworker.
you are in our thoughts.

Kim Stagliano said...

We also have something here in CT called, "Charter Oak" which provides access to insurance for everyone. $75 per person per month, which is not bad at all. I have an app for that too. How did I learn about Charter Oak? Did anyone at DDS tell me? My insurance agent? No - a lovely woman from Quinipiac College here in CT emailed me to interview me for an article, I called her, we started chatting and SHE told me about Charter Oak.

So for the folks who claim "poor people are too dumb to figure out the system." (not my readers of course, but there are people who think poor people are stupid and lazy) I'm here to tell you that this woman, college educated, savvy on a stick had NO idea this program existed.... And I was looking for options.

Word ver: INVOL "Our sitation is definitely, "invol." Who the hell would sign up for this? LOL!

Anonymous said...

conspI just heard an ad for Aetna Medicare. They offer free gym membership to the elderly. There is something dreadfully wrong with the insurance industry when they won't cover essential services for children with autism. Our children can't help being born with or acquiring autism. (My son had a friend in elementary school who was born with a maxiofacial disorder. His parents had to pay more for insurance to cover his many necessary surgeries. His mother found out that if he had been injured in an accident, the insurance would have fully covered his reconstructive surgeries. But that is another story in itself!) Let the gyms give discounted memberships to the elderly and funnel that money to the basic services our children so desperately need. Are the CEOs really worth all that money? I doubt it. How can they sleep at night?

Tim said...

Tell me about it. My wife is ready to shoot me. There is some good news. I started a training program with a life insurance company this week. So who knows if live another 90 days maybe we will get some insurance again.

What are your thoughts. I am going to be on a national media program with Denis Leary. I almost think it is time to mend the bridge and get him to be more vocal and supportive of us?

Tim - Tanners Dad

Kim Stagliano said...

Hey, Tim. I'm all for it. I think Leary has been an advocate for autism - but his style just whalloped up (and so we reciprocated.) Go for it. K