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pickles16
Real Estate Professional
Member since 11/07 17227 total posts
Name:
Jen
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Insurance Question
So, this really is BS!!!! I work for a company based out in Cali, so my insurance is a Cali insurance company, and I'm on the PPO, so basically all the doctors in NY are considered out of network! Plus, Cali has a law that employers can offer Infertility to be covered but they don't have to give it to us, so guess what....I'm not covered...I'm just thinking long term and if I will have to go to a RE nothing is covered!!! I can go on DH's insurance, but not until open enrollment which is in DEC, which is way later than I wanted to see a RE if I wasn't pregnant by then....His HR is saying unless its a life change he can't add me...anyone in this situation, or know how to somehow go around this situation?!?!?!?
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Posted 3/27/08 10:55 AM  |
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SweetTooth
I'm a tired mommy!
Member since 12/05 20105 total posts
Name:
Lauren
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Re: Insurance Question
I'm not sure how this works. Even though the company is based in CA, you work in a NY office right?
I would think that you would have to be covered under NY laws then.
There are a lot of companies that have headquarters in one place but have offices in other states.
I would have DH check with his HR department - if you lose your coverage, he should be able to put you on his, even if its not open enrollment.
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| Posted 3/27/08 10:58 AM |
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pickles16
Real Estate Professional
Member since 11/07 17227 total posts
Name:
Jen
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Re: Insurance Question
Posted by SweetTooth
I'm not sure how this works. Even though the company is based in CA, you work in a NY office right?
I would think that you would have to be covered under NY laws then.
There are a lot of companies that have headquarters in one place but have offices in other states.
I would have DH check with his HR department - if you lose your coverage, he should be able to put you on his, even if its not open enrollment.
I called to find out about that and they said that I'm still covered under Cali law bc the provider of the insurance is in Cali....I thought I can only "lose" my insurance if I lose my job??? Am I wrong?
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| Posted 3/27/08 11:00 AM |
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NinaLemon
It's a boy!!!
Member since 10/07 6453 total posts
Name:
Jeannine
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Re: Insurance Question
Marriage is considered a life change - I don't know if there is a time period you have to accept the insurance within; but if you are still within that time period you do not have to wait for open enrollment.
Here is a link to HIPPA
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| Posted 3/27/08 11:05 AM |
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pickles16
Real Estate Professional
Member since 11/07 17227 total posts
Name:
Jen
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Re: Insurance Question
It's 30 days, in June we'll be married 3 years Thanks though!!! I'll figure this out somehow hopefully
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| Posted 3/27/08 11:08 AM |
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kmac
Two under two!
Member since 5/07 3703 total posts
Name:
Kris
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Re: Insurance Question
Posted by pickles16
So, this really is BS!!!! I work for a company based out in Cali, so my insurance is a Cali insurance company, and I'm on the PPO, so basically all the doctors in NY are considered out of network! Plus, Cali has a law that employers can offer Infertility to be covered but they don't have to give it to us, so guess what....I'm not covered...I'm just thinking long term and if I will have to go to a RE nothing is covered!!! I can go on DH's insurance, but not until open enrollment which is in DEC, which is way later than I wanted to see a RE if I wasn't pregnant by then....His HR is saying unless its a life change he can't add me...anyone in this situation, or know how to somehow go around this situation?!?!?!?
I actually just went throught this. I was on my husbands insuarance and it was great insuarnce, however it would cover all testing but NO procedeures which obviously would be an issue. I then called my insurance and they said if they got a letter from my DH's company stating that I no longer had medical through them they would pick me up for the following month. They cover up to $50thousand in IVF. I'm on cycle 14--we gave it some time but I finally get to see an RE in April!!! 
I talked to the lady in my HR about the issue and she was really helpful. I think as long as your company writes a letter stating they are no longer covering you, your dh's insurance would have to pick you up. HTH! 
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| Posted 3/27/08 11:33 AM |
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SweetTooth
I'm a tired mommy!
Member since 12/05 20105 total posts
Name:
Lauren
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Re: Insurance Question
Posted by pickles16
I called to find out about that and they said that I'm still covered under Cali law bc the provider of the insurance is in Cali....I thought I can only "lose" my insurance if I lose my job??? Am I wrong?
I'm not sure, it wouldn't hurt to find out. That CA ins. thing still sounds fishy to me. I don't get why you would have CA insurance even though you live and work in NY.
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| Posted 3/27/08 11:33 AM |
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pickles16
Real Estate Professional
Member since 11/07 17227 total posts
Name:
Jen
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Re: Insurance Question
Posted by kmac
Posted by pickles16
So, this really is BS!!!! I work for a company based out in Cali, so my insurance is a Cali insurance company, and I'm on the PPO, so basically all the doctors in NY are considered out of network! Plus, Cali has a law that employers can offer Infertility to be covered but they don't have to give it to us, so guess what....I'm not covered...I'm just thinking long term and if I will have to go to a RE nothing is covered!!! I can go on DH's insurance, but not until open enrollment which is in DEC, which is way later than I wanted to see a RE if I wasn't pregnant by then....His HR is saying unless its a life change he can't add me...anyone in this situation, or know how to somehow go around this situation?!?!?!?
I actually just went throught this. I was on my husbands insuarance and it was great insuarnce, however it would cover all testing but NO procedeures which obviously would be an issue. I then called my insurance and they said if they got a letter from my DH's company stating that I no longer had medical through them they would pick me up for the following month. They cover up to $50thousand in IVF. I'm on cycle 14--we gave it some time but I finally get to see an RE in April!!!
I talked to the lady in my HR about the issue and she was really helpful. I think as long as your company writes a letter stating they are no longer covering you, your dh's insurance would have to pick you up. HTH!
OOH Thank you so much!!! I just told DH that he's looking into it!!!!!
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| Posted 3/27/08 11:36 AM |
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SweetTooth
I'm a tired mommy!
Member since 12/05 20105 total posts
Name:
Lauren
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Re: Insurance Question
This is the NYS law regarding IF and insurance:
Insurers are required to cover the diagnosis and treatment of correctable medical conditions and shall not exclude coverage of a condition solely because the medical condition results in infertility. Private, group health insurance plans, issued or delivered in the state of New York providing coverage for hospital care or surgical and medical care are required to provide coverage for the diagnosis and treatment of infertility for patients between the ages of 21 and 44, who have been covered under the policy for at least 12 months. Certain procedures are excluded from this requirement, including IVF, GIFT, ZIFT, reversal of elective sterilization, sex change procedures, cloning, and experimental procedures. Plans that include coverage for prescription drugs must include coverage of drugs approved by FDA for use in diagnosis and treatment of infertility. (New York Consolidated Laws, Insurance, Section 3221(k)(6), Section 4303(s).)
So wouldn't you have an insurance plan DELIVERED in NY state?
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| Posted 3/27/08 11:36 AM |
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katiebug
I'll love you for always
Member since 2/08 4624 total posts
Name:
Katie
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Re: Insurance Question
Message edited 7/16/2012 8:16:57 PM.
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| Posted 3/27/08 11:42 AM |
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pickles16
Real Estate Professional
Member since 11/07 17227 total posts
Name:
Jen
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Re: Insurance Question
Posted by SweetTooth
This is the NYS law regarding IF and insurance:
Insurers are required to cover the diagnosis and treatment of correctable medical conditions and shall not exclude coverage of a condition solely because the medical condition results in infertility. Private, group health insurance plans, issued or delivered in the state of New York providing coverage for hospital care or surgical and medical care are required to provide coverage for the diagnosis and treatment of infertility for patients between the ages of 21 and 44, who have been covered under the policy for at least 12 months. Certain procedures are excluded from this requirement, including IVF, GIFT, ZIFT, reversal of elective sterilization, sex change procedures, cloning, and experimental procedures. Plans that include coverage for prescription drugs must include coverage of drugs approved by FDA for use in diagnosis and treatment of infertility. (New York Consolidated Laws, Insurance, Section 3221(k)(6), Section 4303(s).)
So wouldn't you have an insurance plan DELIVERED in NY state?
Believe me thats what I thought as well!!! I called up my provider and they were real aholes, they basically said that because the insurance provider is out of Cali and the insurance is Blue Sheild of Cali, I would be covered under Cali law, so any claim from a RE would be DENIED!!!!!
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| Posted 3/27/08 11:48 AM |
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NinaLemon
It's a boy!!!
Member since 10/07 6453 total posts
Name:
Jeannine
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Re: Insurance Question
Posted by SweetTooth
Posted by pickles16
I called to find out about that and they said that I'm still covered under Cali law bc the provider of the insurance is in Cali....I thought I can only "lose" my insurance if I lose my job??? Am I wrong?
I'm not sure, it wouldn't hurt to find out. That CA ins. thing still sounds fishy to me. I don't get why you would have CA insurance even though you live and work in NY.
It does happen this way, my company is based out of NJ, they buy separate medical for NY employees, but we still get NJ dental - it is awful because everyone is out of network
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| Posted 3/27/08 11:53 AM |
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SweetTooth
I'm a tired mommy!
Member since 12/05 20105 total posts
Name:
Lauren
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Re: Insurance Question
Wow, I can't believe that. That really stinks, I'm sorry you have to go through this, as if dealing with all of the medical issues isn't enough!
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| Posted 3/27/08 12:13 PM |
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pickles16
Real Estate Professional
Member since 11/07 17227 total posts
Name:
Jen
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Re: Insurance Question
Posted by SweetTooth
Wow, I can't believe that. That really stinks, I'm sorry you have to go through this, as if dealing with all of the medical issues isn't enough!
Thanks!!! I'm going to see if we can get off this insurance and put me on DH's!!!
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| Posted 3/27/08 12:31 PM |
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MrsS2005
Mom of 3
Member since 11/05 13118 total posts
Name:
B
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Re: Insurance Question
I know you called your provider, but you should also call the NY State Insurance Department. Perhaps you will get a different answer as to which laws apply to your insurance coverage.
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| Posted 3/27/08 12:56 PM |
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pickles16
Real Estate Professional
Member since 11/07 17227 total posts
Name:
Jen
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Re: Insurance Question
Posted by MrsS2005
I know you called your provider, but you should also call the NY State Insurance Department. Perhaps you will get a different answer as to which laws apply to your insurance coverage.
I did, they said the same thing, that I'm covered under Cali laws and not NY, which is beyond retarded....
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| Posted 3/27/08 1:07 PM |
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