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Health benefits question

Discussion in 'Journalism topics only' started by anotherjrcsurvivor, Feb 9, 2009.

  1. The newspaper group that owns my paper changed health benefits plans as of Dec. 31/Jan. 1. So the medical center to which I am going for treatment of a terminal illness notified me they do not accept the new health plan. Despite the serious nature of my illness, I have managed to continue doing my job. I have developed a trust/rapport/etc. with the doctors and nurses at this medical center. I also love doing what we do, but will take whatever action is necessary and prudent to address the situation. What courses of action can I pursue, understanding that any and all scenarios are in play? In other words, H-E-L-P!
  2. WriteThinking

    WriteThinking Well-Known Member

    I think I would consult with a lawyer -- one who specializes in medical cases, or perhaps, workers' comp (because they would probably know about related issues) -- and see what your options might be.

    I've heard of companies occasionally making exceptions/allowances for individual employees and their situations when needed, and your case certainly sounds like one of those types.

    Of course, you probably would have to be someone considered special/important by your employer in order to get the company to play ball. You'd probably have to be someone that it wants to help, and believes it would be advantageous for it to help.

    But I think you should look into it. There may be a way you could remain with your current medical-care providers.
  3. txsportsscribe

    txsportsscribe Active Member

    will the new plan not allow for out-of-network doctors? you'd have to pay a little more but you'd keep that comfort level.
  4. Here's an update, and it might be helpful to others in similar situations:
    According to a representative of the new health insurance company, I can apply for a "transition" waiver. It will take a week or so to get the document in the mail, and then it is to be filled out by me and my specialist. It then goes back to new health insurance company for approval. If I understood correctly, if approved they likely will waive an $800 out-of-network deductible and reimburse at 65 percent of billed costs.
    While the health insurance rep did the expected and tried to steer me to an in-network medical center, when she understood my commitment to my current doctors and nurses she steered me in the right direction. So we'll see what happens.
    Only negatives: (1) I have a show-must-go-on doctor appointment coming up before all of this gets straightened out, so I'm going to be out some money for a while. (2) It's yet another bunch of paperwork.
    It's time we ink-stained wretches hire agents like the TV folks.
    Thanks to those who passed along advice.
  5. Ace

    Ace Well-Known Member

    Reimburse at 65 percent?

    What would happen if you went in-network?
  6. WriteThinking

    WriteThinking Well-Known Member

    If I may ask, how about an update on your actual health?

    How are you doing? Is the treatment working in any way that you see is helping, extending your life, or improving/maintaining the quality of it?

    My hope and prayer is that you're doing well, or at least, as well as you possibly can in the situation.
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