Health

RHEUMATOID ARTHRITIS (RA) AND HEALTH INSURANCE: PRIVATE HEALTH INSURANCE

If you are working and your employer provides health insurance benefits, you may not have the option of selecting a specific form of insurance or a specific insurance carrier. (Note: If you are insured through a group plan at work and then lose your job or begin to consider another job, do not drop your health insurance.)
If you do have a choice when it comes to health insurance, we recommend that you examine carefully several types of policies and look into several insurance carriers before making a decision. Choosing wisely is especially important because it is sometimes difficult to make changes in insurance coverage if your health deteriorates in any way.
Selecting the best form of health insurance involves choosing among many variables. Asking the following key questions may help you choose wisely.
For standard policies:
• Is there a deductible? (And can you afford to pay that deductible each year?)
• Are there large co-payments? (If so, do lower premiums offset that expense?)
• What percentage of expenses are you responsible for after the deductible has been met? (Would you prefer to pay higher premiums in exchange for paying a lower percentage of a covered expense?)
•   Is there a “cap” on the amount you have to pay, if a percentage payment applies? (For your protection, there should be.)
For a health maintenance organization (HMO) or prepaid medical insurance:
•   Is your choice of physicians limited? If so, are there a rheumatologist and an orthopedic surgeon experienced in joint surgery on the preferred provider staff? (If the services of these specialists aren’t provided, can you get the HMO or preferred insurance carrier to agree to pay for the services of such specialists if needed?)
• Are you permitted to use only specific hospitals and specific physical therapy services? (If so, find out – by asking your present doctor if necessary – whether the permitted service providers have a good reputation for treatment of RA.)
• Do the primary care doctors in the HMO readily refer their patients for specialty consultation? (They ought to.)
For all insurance:
• Does your policy cover physical therapy, occupational therapy, and the services of a podiatrist? (If not, you’ll probably want to choose a different policy.)
• Is there a prescription policy? (We recommend that you enroll in an insurance plan that pays most of the cost of prescription drugs because arthritis medications can be extremely costly.)
• Will your policy cover durable medical hardware such as splints, braces, orthotics, walking aids? (If there is an additional premium for this coverage, you’ll have to decide whether you would prefer to pay the cost of these aids out of pocket as necessary or whether it is better for you to pay the additional premium on a regular basis.)
Is there a preexisting illness clause that may limit payment for costs related to your RA? (If so, the wiser choice, if it is available, might be to pay a higher premium and obtain coverage for the preexisting condition.)
It is critical for you to examine your insurance options if your employment status is about to change. Be very careful: because you have RA, you may run into difficulties in getting another insurance carrier to cover you. The Cobra law states that you must be allowed to convert your current insurance into an individual policy that is guaranteed at the group premium rate for a given time period. However, before you discontinue your coverage under your former employer’s group plan – or before you allow your former employer to discontinue your coverage – be sure to review your new policy and be certain that it has gone into effect. You will have to pay the premium for this new insurance, of course.
While you are covered under the Cobra law, explore other options: can you obtain coverage under your spouse’s policy, for example, or can you get group insurance through a new job or a professional society? Take every possible precaution to prevent a lapse in coverage. Our experience tells us that insurance carriers are often most reluctant to provide comprehensive coverage to people with chronic medical problems. This is why we emphasize the importance of holding onto one health insurance policy until another one has gone into effect.
*119/209/5*

RHEUMATOID ARTHRITIS (RA) AND HEALTH INSURANCE: PRIVATE HEALTH INSURANCEIf you are working and your employer provides health insurance benefits, you may not have the option of selecting a specific form of insurance or a specific insurance carrier. (Note: If you are insured through a group plan at work and then lose your job or begin to consider another job, do not drop your health insurance.)If you do have a choice when it comes to health insurance, we recommend that you examine carefully several types of policies and look into several insurance carriers before making a decision. Choosing wisely is especially important because it is sometimes difficult to make changes in insurance coverage if your health deteriorates in any way.Selecting the best form of health insurance involves choosing among many variables. Asking the following key questions may help you choose wisely.For standard policies:• Is there a deductible? (And can you afford to pay that deductible each year?)• Are there large co-payments? (If so, do lower premiums offset that expense?)• What percentage of expenses are you responsible for after the deductible has been met? (Would you prefer to pay higher premiums in exchange for paying a lower percentage of a covered expense?)•   Is there a “cap” on the amount you have to pay, if a percentage payment applies? (For your protection, there should be.)For a health maintenance organization (HMO) or prepaid medical insurance:•   Is your choice of physicians limited? If so, are there a rheumatologist and an orthopedic surgeon experienced in joint surgery on the preferred provider staff? (If the services of these specialists aren’t provided, can you get the HMO or preferred insurance carrier to agree to pay for the services of such specialists if needed?)• Are you permitted to use only specific hospitals and specific physical therapy services? (If so, find out – by asking your present doctor if necessary – whether the permitted service providers have a good reputation for treatment of RA.)• Do the primary care doctors in the HMO readily refer their patients for specialty consultation? (They ought to.)For all insurance:• Does your policy cover physical therapy, occupational therapy, and the services of a podiatrist? (If not, you’ll probably want to choose a different policy.)• Is there a prescription policy? (We recommend that you enroll in an insurance plan that pays most of the cost of prescription drugs because arthritis medications can be extremely costly.)• Will your policy cover durable medical hardware such as splints, braces, orthotics, walking aids? (If there is an additional premium for this coverage, you’ll have to decide whether you would prefer to pay the cost of these aids out of pocket as necessary or whether it is better for you to pay the additional premium on a regular basis.)Is there a preexisting illness clause that may limit payment for costs related to your RA? (If so, the wiser choice, if it is available, might be to pay a higher premium and obtain coverage for the preexisting condition.)It is critical for you to examine your insurance options if your employment status is about to change. Be very careful: because you have RA, you may run into difficulties in getting another insurance carrier to cover you. The Cobra law states that you must be allowed to convert your current insurance into an individual policy that is guaranteed at the group premium rate for a given time period. However, before you discontinue your coverage under your former employer’s group plan – or before you allow your former employer to discontinue your coverage – be sure to review your new policy and be certain that it has gone into effect. You will have to pay the premium for this new insurance, of course.While you are covered under the Cobra law, explore other options: can you obtain coverage under your spouse’s policy, for example, or can you get group insurance through a new job or a professional society? Take every possible precaution to prevent a lapse in coverage. Our experience tells us that insurance carriers are often most reluctant to provide comprehensive coverage to people with chronic medical problems. This is why we emphasize the importance of holding onto one health insurance policy until another one has gone into effect.*119/209/5*

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