Hi,

I've been gone for quite a while, but I've also been correspinding with quite a few families of mmers. I have one family that needs help getting their little girl with down's syndrome and mm insurance coverage as she was dropped when policies were changed. If anyone has any ideas, please let me know.

thanks,
jesenia

Hi Jesenia,

I am an insurance agent in Ohio. I need to have some clarification about the insurance this individual had. Was she covered by group insurance through an employer and if so, what is the size of the employer (meaning how many employees) or was she on a non-group insurance plan?

Also, what state does she live in? As an Ohio agent, I can't give insurance advice outside Ohio. I can however, try to direct you to the appropriate people in the state this individual resides. Every state has their own approved insurance carriers and laws governing insurance coverage.

If she was covered under a group plan and that plan is under COBRA regulations (depends on size) there is COBRA continuation coverage. Although it can be very expensive depending on the actual cost of the coverage for that particular plan and the added 2% administrative fee that comes with COBRA continuation coverage.

The chances of her getting coverage singularly are probably slim other than a catastrophic coverage or some type of organization or state sponsored program because she is considered a high risk unless one of the parents are employed where the employer insurance is automatic with no pre-existing clause.  Catastrophic insurance coverage comes with a high deductible sometimes in the $10,000 to $20,000 range or higher.  On the flip side, some insurers will singularly insure her but exclude coverage for the Downs Syndrome and the MM which is really why she needs the insurance coverage the most.

There may be options available. For instance, if an individual becomes a member of say a Chamber of Commerce or the Farm Bureau, they can get coverage through those organizations based on the entire group so the risk is spread over all members making the coverage more affordable.  Also, depending on what state she lives in, that particular state may have some type of coverage for children like a program here in Ohio called Healthy Start.

My suggestion without all the particulars of this individual case is to contact the state department of insurance where this little girl lives and ask them if there are any options based on this child's particular circumstances.

I hope this helps direct you in a positive move forward to try and obtain health insurance coverage for this little girl.

Hugs,

Lore

 

Hi, Jesenia.

I am a social worker in NH.  I agree with all that Lore said, and have only one thing to add - my only other suggestion would be for the family to speak with the SW at the hospital where they are treated for the MM.  The SW dept there will be familiar with the state programs for that particular state, and can assist them through the application process.  

I can tell you that in NH, there are two forms of state funded health insurance - one is dependent on the family's income, and there is one for children with severe medical conditions, and does not take family's income into consideration.  There could be other programs that the hospital itself offers for patients there.  If they call the SW there, he or she will be able to help them.

Good luck, and take care!
Kristen

 That's all very good advice.We have private insurance but a secondary state insurance that covers all of Kathleen's co-pays which can realy add up with all her specialists and orthotics she wears.I believe most states have coverage for children with seriouse medical issues adn dissabilities.My daughter also ahs Down Syndrome as well as MM ,if this mom wants someone to chat with, feel free to give her my e-mail
mgrace5@nycap.rr.com
Kathleen was diagnosed and had ehr operations at 5 yrs old.She's now 9 and doing great,just a lot of effexts from the seriouse strokes she suffered.
Mary Grace

Jessina,
     I will help anyway I can  if you are in Michigan, I was recently successful in getting my son approved through MCSHCS, and made some contacts and learnt quite abit along the way.
Mike