costs and insurance

Guide for Uninsured Multiple Sclerosis Patients

Mandy Crest Health Guide March 26, 2009
  • The financial impact of multiple sclerosis cannot be overstated, whether you have medical insurance coverage or not, it becomes a large part of your struggle with the disease. Like it or not, MS and money are go hand in hand.

     

    Obviously, the best scenario is employer provided group coverage. If you've got that, you're in decent shape. If you've fallen into the sink hole that is individual coverage, as I have, life gets rather complicated. If you have no coverage at all, your burdens are greatly increased. But before you let yourself fall into that category, make sure that you fully explore all your options for insurance. Even after exhausting all avenues, keep on the lookout for changing laws and new programs. Health care reform is in the air.

     

    Insurance broker Steve Tucker reports that "One of the biggest challenges I have had to deal with through the years has been trying to help the uninsurable. Unfortunately, in most states, if you have one of a host of "pre-existing" medical conditions you are labeled as uninsurable on an individual health insurance policy. Uninsurable status can last for many years and sometimes for life, depending on the specific pre-existing condition you have been diagnosed with."

     

    Before giving up on obtaining insurance, Steve makes the following suggestions:

     

    * If you have a corporate tax i.d. number you can purchase a small group health insurance policy from most insurance carriers. With this scenario a minimum of two people (often husband & wife) who work for the same corporation can apply for a small group health insurance policy. After a period of time, or in some cases immediately (depending on how many months you have had prior health insurance coverage without a lapse) pre-existing conditions will be covered provided that they are a covered expense on the policy.

     

    * Enroll in your state's insurance high-risk pool -- if your state is fortunate enough to have one -- and if you can afford the premiums.

     

    *  The two aforementioned options should be pursued first, as the better options (if available and affordable), but there is now another option. American Medical & Life Insurance Company of New York is now offering Defined Benefit Health Insurance Policies to the uninsurable. There are only three restrictions to obtaining these quality Defined Benefit Health Insurance Policies. They are as follows:

     

    1.) You may not be a Medicare recipient.

    2.) You may not be receiving disability benefits.

    3.) You may not be receiving workers' compensation benefits.

     

    There are no other underwriting requirements. This means that regardless of your pre existing condition American Medical & Life insurance company will issue you a Defined Benefit Health Insurance policy. 

     

    * Beware of scams. Your state's department of insurance can confirm that you are dealing with a licensed health insurance agent. Before making payment or signing on the dotted line, perform your own due diligence. 

     

    So what if you've done all of the above and you still find yourself among our country's nearly 50 million uninsured? Continue to research and pursue all insurance options. In the meantime, there are other resources available to the uninsured, but it's going to take some time and a great deal of persistence.

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    * Contact your local chapter of the National Multiple Sclerosis Society. You can peruse the website for general information, but it's best to call and speak to someone who may be knowledgeable about assistance and low-cost programs that are available in your area.

     

    * If you already have an established relationship with a doctor, explain your situation and ask if they will provide discounted services and/or payment plan options. If not, ask if they know who will.

     

    * Contact your local Public Health Department for information.

     

    * Contact the National Organization for Rare Disorders (NORD) for information on assistance programs. 

     

    * Depending on your age, health, and work status, you may want to look into The Centers for Medicare and Medicaid Services or the Social Security Administration's Disability Programs. 

     

    * Out-of-pocket costs for medical necessities (mobility aids, etc.) can be deducted on your federal income tax return. Make sure you obtain and keep a copy of your prescription or note from your doctor as supporting documentation.

     

    * Do not let a lack of insurance cause you to ignore warning signs of serious medical conditions. Federal law requires that an emergency room provide you with stabilizing care regardless of your ability to pay. A payment plan can be worked out after you are stabilized.

     

    * Reach out to other MS patients or those with similar chronic illnesses. They just may be your best source of information.  

     

    There are a number of programs designed to assist with prescription medications for multiple sclerosis, usually requiring proof of income. Among them are:

     

    * Chronic Disease Fund

    * Free Medicine Foundation

    * Needy Meds

    * Partnership for Prescription Assistance

    * Rx Assist

     

    Having MS and no insurance -- or inadequate insurance -- is a bitter pill to swallow. I cannot in good conscience say that you will be able to access all the services you need. We just have do the best we can with the resources at our disposal. And by all means, contact your representatives in congress. Put a human face on the state of health care! 

     

    Additional Information:

     

    The Consolidated Omnibus Budget Reconciliation Act (COBRA)

    Health Insurance and Resource Center

    Patient Access (assistance for the under-insured)

     

    Special thanks to C. Steven Tucker, Insurance Broker & Subject Matter Expert for The Wall Street Journal & Fortune Magazine - President, Small Business Insurance Services Inc. for providing information for this article. www.smallbusinessinsuranceservices.com