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Lee
LIF Adolescent
Member since 4/07 758 total posts
Name:
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Insurance Help - I'm a little panicked...
So, let's see if I can explain this in the clearest way possible.
I am currently covered for $10,000 lifetime with Oxford. This is applied to my IVF. My meds are covered under the prescription plan. I have this coverage from my "old" company. I was laid off from there in October of 2007, but was extended benefits until mid-July based on my years of service. Everything was pre-certified and no insurance problems so far. I should mention that my DH and DS are also covered under my plan.
Now, I have started a new job. It is a start-up company started by some guys from my old job who brought me aboard. I officially started there May 14th, but they did not have insurance yet as they were reviewing plans and trying to decide which coverage and provider to choose. I was hoping it would take them until after my first IVF cycle to get this started, but now it seems that they have chosen Empire and are starting to distribute enrollment forms.
Here's my dilemma(s):
- once i fill out the new enrollment form, my coverage is effective as of my May start date.
- my severance agreement obligates me to let my old company know that I am now covered under new insurance so they can cancel the Oxford policy
- I have NO idea what Empire covers for IVF.
- I have NO idea what happens if your insurance changes mid-cycle. I mean, I am LITERALLY 2 weeks or less away from retrieval and transfer. I really don't think I can afford to do this right now without some kind of coverage.
I don't know what my options are. I need to think about my DH and DS too. I don't know if IVF is considered pre-existing and maybe Empire won't cover me at all.
If I sign up for Empire - do I lose all my IVF coverage? If I don't tell my old company until June that I have new coverage - it's probably too late for them to cancel it for June, but I'm not sure I'm comfortable doing that. Would the new insurance co just pick up the pre-cert from Oxford? The only other option for me (I think) is to decline coverage from Empire and COBRA my entire family from now until next MAY which is when the next enrollment period is. Which, in the end, may cost just as much as the IVF.
I haven't called the billing person at LIIVF yet - does anyone have any ideas or advice? Has anyone changed providers mid-cycle??? I'm sick over this and I really don't need the stress right now...
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Posted 5/23/08 10:22 AM  |
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Long Island Weddings
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Gertyrae
Peace out Homies!
Member since 5/05 20046 total posts
Name:
Gerty ®
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Re: Insurance Help - I'm a little panicked...
The problem is that there are a ton of variations of Empire - FM dm24angel for more info - so until you call and find out for sure, there is no way to know exactly what they will cover.
As far as this cycle and future cycles - my guess is that the Oxford plan may be better. You might want to call your old company and find out if you can Cobra the Oxford as opposed to signing up for Empire.
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| Posted 5/23/08 10:35 AM |
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MrsMessina
Thankful for our miracles!
Member since 2/07 7254 total posts
Name:
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Re: Insurance Help - I'm a little panicked...
If you're mid cycle, then hasn't insurance already paid your IVF bill? I may be wrong- but I just took the class the other night and I was under the impression that everyone undergoing IVF has to get 'cleared' by billing first- before starting their cycle- whether paying out of pocket, thru a grant or thru insurance. I would cal LI-IVF and ask them how they charge your insurance... is it 1 group of billing done before your actual IVF cycle starts or is it just a pre-authorization and the bills are paid later...? This may affect your outcome.
I have empire and have NO IVF coverage... no meds, no labs, no sonos, nothing. But I have the Direct POS plan... it covers (I believe) unlimited IUIs and all of the labs, sonos, meds, etc... that come with it- but NONE for iVF. Make sure you get the exact plan that your new co. is going to put you under if you choose to enroll, and ask them what's covered. GL!!!
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| Posted 5/23/08 10:36 AM |
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Lee
LIF Adolescent
Member since 4/07 758 total posts
Name:
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Re: Insurance Help - I'm a little panicked...
Posted by Gertyrae
The problem is that there are a ton of variations of Empire - FM dm24angel for more info - so until you call and find out for sure, there is no way to know exactly what they will cover.
As far as this cycle and future cycles - my guess is that the Oxford plan may be better. You might want to call your old company and find out if you can Cobra the Oxford as opposed to signing up for Empire.
I know that I can COBRA...I guess I could just cobra me and just sign DH and DS up under the Empire plan...sigh...
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| Posted 5/23/08 10:41 AM |
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Lee
LIF Adolescent
Member since 4/07 758 total posts
Name:
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Re: Insurance Help - I'm a little panicked...
Posted by MrsMessina
If you're mid cycle, then hasn't insurance already paid your IVF bill? I may be wrong- but I just took the class the other night and I was under the impression that everyone undergoing IVF has to get 'cleared' by billing first- before starting their cycle- whether paying out of pocket, thru a grant or thru insurance. I would cal LI-IVF and ask them how they charge your insurance... is it 1 group of billing done before your actual IVF cycle starts or is it just a pre-authorization and the bills are paid later...? This may affect your outcome.
I have empire and have NO IVF coverage... no meds, no labs, no sonos, nothing. But I have the Direct POS plan... it covers (I believe) unlimited IUIs and all of the labs, sonos, meds, etc... that come with it- but NONE for iVF. Make sure you get the exact plan that your new co. is going to put you under if you choose to enroll, and ask them what's covered. GL!!!
I haven't received anything from Oxford except the pre-cert letters. I guess I better call LIIVF and see if they have any ideas.
What a nightmare...I mean I am literally "scheduled" for a retrieval on May 31st and a transfer on June 3rd...I am SO CLOSE. I mean, there is no guarantee this one works, but man...to lose coverage this close to the potential finish line is killing me...
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| Posted 5/23/08 10:43 AM |
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MrsMessina
Thankful for our miracles!
Member since 2/07 7254 total posts
Name:
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Re: Insurance Help - I'm a little panicked...
if they're just 'starting' to distribute enrollment forms, why not hold off until you actually receive yours (and find out what your deadline is). If you don't have to enroll until after your ER/ET, then why not act as though you are currently w/o coverage w/ them- since technically you aren't. 
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| Posted 5/23/08 10:47 AM |
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Lee
LIF Adolescent
Member since 4/07 758 total posts
Name:
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Re: Insurance Help - I'm a little panicked...
Posted by MrsMessina
if they're just 'starting' to distribute enrollment forms, why not hold off until you actually receive yours (and find out what your deadline is). If you don't have to enroll until after your ER/ET, then why not act as though you are currently w/o coverage w/ them- since technically you aren't.
Well, this is what I'm thinking of doing, but whenever I enroll, they will put the start of coverage date as May 15th - well before the IVF cycle started. Won't that come back to haunt me at some point? why would oxford pay if they are no longer the primary insurer?
i spoke to liivf - she told me i really should try to delay the start date of coverage by telling them that i have a pre-certified procedure that i am afraid won't be covered...i'm not sure that the hr department of this equity sponsor will be up for "lying" about my start date. I can't believe i may be screwed NOW of all times...
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| Posted 5/23/08 10:55 AM |
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Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
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Re: Insurance Help - I'm a little panicked...
you are losing your coverage in July.. you should be able to sign up for it in July. It's a life event losing coverage.
It shouldn't be pre-existing.
Also, get a copy of the plan document and call them to find out what IF coverage there is. You may be shocked and find out it has a better benefit.
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| Posted 5/23/08 11:22 AM |
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BA2008
Need to find some hope!
Member since 2/08 2485 total posts
Name:
Beth -Ann
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Re: Insurance Help - I'm a little panicked...
The only thing I wanted to add was if its less than 50 employees they may not have IVF coverage at all. I know I called them (we're small co and i'm the plan admin) and they and Oxford (whom I currently have) would not offer me the IVF rider because its not mandated to small business (WHICH SUCKS). I think you're going to have to be open with your new HR department so they can help you here. Good luck.
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| Posted 5/23/08 11:34 AM |
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Lee
LIF Adolescent
Member since 4/07 758 total posts
Name:
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Re: Insurance Help - I'm a little panicked...
Posted by Blu-ize
you are losing your coverage in July.. you should be able to sign up for it in July. It's a life event losing coverage.
It shouldn't be pre-existing.
Also, get a copy of the plan document and call them to find out what IF coverage there is. You may be shocked and find out it has a better benefit.
Well, that's not entirely true. I am covered until July, UNLESS (according to my severance agreement) I get a job that offers insurance coverage then I lose the benefit once I take that company's insurance. I am obligated to tell old comany that I have new coverage. Does that make sense?
Because there are people from the old company besides me at this new one, they would know that I have new coverage available...so I feel like I am in some kind of bind.
I think I also need to slow the "rush" to enroll at the new company. I mean, why should I fill out a form without know how much this will be costing me, if my doctors are in the network, etc. etc. Right? I know none of these things. I should also be given the opportunity to compare this plan and costs with cobra-ing my old plan, as well as the options offered by my DH's company right? I'm feeling pressured into enrolling without all the relevant info. And if I did enroll in June, after evaluating my options, and they put my start date as May - what recourse does Oxford have? This is so crazy.
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| Posted 5/23/08 11:36 AM |
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Gertyrae
Peace out Homies!
Member since 5/05 20046 total posts
Name:
Gerty ®
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Re: Insurance Help - I'm a little panicked...
I would NOT just go ahead without checking.
It's only a phone call to Empire and your old HR dept. I would find out for sure what is going to be covered and if IVF is not (which it probably won't be) then Cobra the Oxford plan. It's a much better plan - IVF is very expensive out of pocket and if they make it retroactive those pre-certifications mean nothing.
It's too much money to take a chance with IMO.
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| Posted 5/23/08 11:38 AM |
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Gertyrae
Peace out Homies!
Member since 5/05 20046 total posts
Name:
Gerty ®
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Re: Insurance Help - I'm a little panicked...
Also, wanted to add...LIIVF does NOT get prepayed. They get pre-approval which is completely different.
I have been using LI-IVF for over a year now and they bill per procedure. Each month I get a notice from Empire/UHC showing how much LIIVF has billed and when.
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| Posted 5/23/08 11:40 AM |
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Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
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Re: Insurance Help - I'm a little panicked...
Posted by Lee
Posted by Blu-ize
you are losing your coverage in July.. you should be able to sign up for it in July. It's a life event losing coverage.
It shouldn't be pre-existing.
Also, get a copy of the plan document and call them to find out what IF coverage there is. You may be shocked and find out it has a better benefit.
Well, that's not entirely true. I am covered until July, UNLESS (according to my severance agreement) I get a job that offers insurance coverage then I lose the benefit once I take that company's insurance. I am obligated to tell old comany that I have new coverage. Does that make sense?
Because there are people from the old company besides me at this new one, they would know that I have new coverage available...so I feel like I am in some kind of bind.
I think I also need to slow the "rush" to enroll at the new company. I mean, why should I fill out a form without know how much this will be costing me, if my doctors are in the network, etc. etc. Right? I know none of these things. I should also be given the opportunity to compare this plan and costs with cobra-ing my old plan, as well as the options offered by my DH's company right? I'm feeling pressured into enrolling without all the relevant info. And if I did enroll in June, after evaluating my options, and they put my start date as May - what recourse does Oxford have? This is so crazy.
ok, coverage available doesn't mean it's good coverage and affordable. The new insurance should be as comprehensive as the old insurance. How would they expect you to take the new insurance when it doesn't cover the medical procedures you are undergoing?
It's none of the other employee's business what coverage you have or have not. It's between you, your old job and the new job.
You need to find out what your new coverage is. That is step one. Without that you can't do anything.
Message edited 5/23/2008 12:09:27 PM.
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| Posted 5/23/08 12:08 PM |
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MrsJoeG
Beyond Blessed <3
Member since 2/08 1482 total posts
Name:
Amanda
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Re: Insurance Help - I'm a little panicked...
OK here is another idea, is there an HR person at your new job that you can talk to about accepting the Empire plan as of July? Tell them you have coverage until then and are currently undergoing treatment that has been pre-certified. If they are just starting to distribute forms then you can see if they can delay your until the beginning of June, after your ET and just make your coverage effective then. OR your other choice is to accept the Empire as of the May start date and pay COBRA for the Oxford plan for May-June. You would have double coverage for that period. But let me add that I do not know if that is possible to do under COBRA as the purpose of the Act is to provide insurance coverage for those who have lost it due to a qualifying event and you are eligible for insurance with another employer. I am so sorry you are dealing with this Lee. Its just about the last thing you need right now!
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| Posted 5/23/08 1:16 PM |
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MrsMessina
Thankful for our miracles!
Member since 2/07 7254 total posts
Name:
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Re: Insurance Help - I'm a little panicked...
Posted by MrsJoeG
OK here is another idea, is there an HR person at your new job that you can talk to about accepting the Empire plan as of July? Tell them you have coverage until then and are currently undergoing treatment that has been pre-certified. If they are just starting to distribute forms then you can see if they can delay your until the beginning of June, after your ET and just make your coverage effective then. OR your other choice is to accept the Empire as of the May start date and pay COBRA for the Oxford plan for May-June. You would have double coverage for that period. But let me add that I do not know if that is possible to do under COBRA as the purpose of the Act is to provide insurance coverage for those who have lost it due to a qualifying event and you are eligible for insurance with another employer. I am so sorry you are dealing with this Lee. Its just about the last thing you need right now!
I think this is a great idea!!! GL!!
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| Posted 5/24/08 12:15 AM |
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