HealingWell
Search Close Search
☰

Helped needed from those in the US, please

Support Forums
>
Crohn's Disease
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 9/22/2009 9:30 AM (GMT 0)

Hello  :-) .  I should probably start with the basics; I'm Jonathan, I'm 27, I've had Crohn's Disease since about age 12 and I live in Norfolk in the UK :-) .

I recently got engaged, though as my fiancee lives in New England, we've been looking into which of us should move country; her to the UK or me to the US. There's pros and cons of each, but what could make a big difference is how much healthcare might cost for me over in the US. I'm aware that's not an easy question to answer and is further complicated by the current talks of healthcare reform in the US, but I have got a couple of questions that I hope someone on here can help me with, please :-) .

Is it generally possible [and advisable?] to find an insurance policy that recognises and covers things related to Crohn's Disease? Would it be a case of easy to find one that will, but would cost considerably more or is it more common that you'd find policies would specifically exclude things related to existing conditions like Crohn's and you'd have to look harder for one that would cover it?

I'm currently lucky in that my condition is stable and rarely troubles me, I don't require regular trips to healthcare professionals for it, etc, but I do have my daily medication of Pentasa, along with suppliments like a folic acid tablet and an iron tablet. Would I be advised to be getting such medication through insurance [assuming that's possible] and just pay the co-pay or is it better to not factor those in and just pay "over the counter" type prices once I have a prescription for them?

I'm not trying to pry by asking for exact figures people have been paying, just trying to get my head around the system for the moment and finding out what would be the best/most sensible/usual way things are done for people with Crohn's in the US :-) .

Thank you!

Posted 9/22/2009 9:37 AM (GMT 0)
If you get a job, or your (future) wife has a job, most employers offer group health coverage. This means everyone pays the same rate and has the same coverage. There may be a waiting period for pre-existing conditions, but maybe not. If you are planning on getting your own private policy directly from an insurance company, you will likely not have much luck. Insurance companies can (and likely will) deny you because of your crohn's.
Posted 9/22/2009 12:18 PM (GMT 0)

jsayer88 said...
I'm currently lucky in that my condition is stable and rarely troubles me, I don't require regular trips to healthcare professionals for it, etc, but I do have my daily medication of Pentasa, along with suppliments like a folic acid tablet and an iron tablet. Would I be advised to be getting such medication through insurance [assuming that's possible] and just pay the co-pay or is it better to not factor those in and just pay "over the counter" type prices once I have a prescription for them?

The answer to this question depends upon your coverage--your plan. Usually, though, presuming you work for a company with a group plan, you would simply pay a co-pay.

Also, in hopes that this thread does not go political due to the nature of things regarding health care currently in the US, I'll simply state that it seems that all sides AGREE on one thing: Insurance companies should not be able to deny you coverage due to pre-existing conditions. Therefore, hopefully in the future this will not be a concern for anyone seeking coverage.

Just want to point out that childcare is a HUGE expense for anyone who doesn't have family around to help. You might also want to consider whether you will eventually have children and if either of your parents might be able to help with childcare. That might be a determining factor, too! Just a thought! smilewinkgrin
Posted 9/22/2009 12:47 PM (GMT 0)
As long as you have group coverage through an employer you should be relatively OK. Usually you have your choice of several different plans, each with different costs to the employee that will be taken out of the paycheck before you ever see it. Then based on what type of plan you have picked you will have different types of responsibilities during the year. You could choose a traditional insurance, where you are responsible for say 20% of all bills and they are responsible for 80%. Not the best if you end up with an unexpected hospitalization (Happened to me when I was diagnosed), but usually the cheapest for the employee. Then there are types of HMO's and PPO's basically you pay a co-pay when you go to the doctor, or if you need to go to the emergency room. There are rules about getting your doctor's approval before you see some specialist, but not all, depending on the plan. Your co-pays for office visits can be anything from $5 - $20 or more, I have an HMO and pay $10 an office visit, and $50 to go to the emergency room unless I am admitted in which case there is no fee. I pay nothing for any hospital stay. I pay nothing for any tests. I usually can get in to see any doctor I need to in a matter of days, sometimes the same day. The same thing with tests. It is rare that I have to wait very long for tests. I honestly don't know what we pay a year for this, but we pay for family coverage, and you would only be paying for self and spouse, so it would be different anyway. Also, ours includes a separate dental plan and eye plan that all get lumped in together.

As far as the waiting period for pre existing conditions. We have had to deal with it every time my husband has changed jobs. It has always been 30 days. After 30 on the job I have been covered in full. I worry during those 30 days. We have been able to buy COBRA but I don't know if you could do that coming from another country. Basically, you keep your insurance from where ever you had it (previous job), but pay a premium price. Its a short term thing and still really a lot better than a huge hospital bill.

Most group plans have tiers for their prescription coverage. Basically you pay one co-pay for generics, a higher co-pay for brand name, and an even higher co-pay for brand name drugs that are not common, like some of our meds. I was on Pentasa for years, but I can't remember which tier it was. I think my co-pays are $10, $20, $35. Most of my meds are $10 and of course things like prednisone that is cheaper than dirt gets charged to me at the actual price (about $3 per 100 pill). Most supplements are not automatically covered, like Iron. You could try to get a doctor to write a letter, but if it is less costly than the co-pay, it isn't worth it.

If you do decide to come to the states and you have an employer policy, maybe you can get put on it before you come and not get rid of you current one in the UK, that might avoid the whole pre-exisiting condition thing.

I hope some of this helps.
Posted 9/22/2009 2:08 PM (GMT 0)
It also might depend on the job situation for you both. Do either one of you have a job that could support you both? But in all honesty I would worry about what if the worst case happens and you are not able to work?
Posted 9/22/2009 5:22 PM (GMT 0)

I think I agree with everyone else on this.  If you get your insurance through an employer and you have never had a lapse in coverage (usually considered to be about 60 days without insurance) than most of the insurance companies cannot penalize you for the pre-existing conditions.  That being said, if you do not get your insurance through your employer or HAVE had a lapse in coverage, be prepared for them to not cover anything related to your Crohn's or stuff that their "medical experts" can claim is related to the Crohn's. 

It's normally much, much cheaper to use insurance and pay either your co-pay or your co-insurance (depending on your plan) for the types of medications we take.  My insurance covers 80% of my med costs and I pay the other 20% within a minimum and maximum that they have established (my insurance requires me to use the mail order pharmacy which is a lot of crap...it's more expensive for me, but my insurance is through UPS and they are the ones who get paid to ship the meds, so it all goes to them).  But, my insurance won't cover stuff like the syringes to give myself methotrexate, so you may still find that there are some things you pay full price for.   

Just to give you some extremes...UPS used to have great, cheap insurance and my husband could cover myself and him for FREE to us (now it's crappy insurance and costs over $1800 a year for us).  My parents, on the other hand, have their own business which is considered "high risk" because they do construction.  Their insurance is about the same each month (I think she said $1400 or $1600 a month) as mine is for a year!

Posted 9/22/2009 10:01 PM (GMT 0)
All these replies have been immensely helpful already, thanks everyone :)
Posted 9/22/2009 11:08 PM (GMT 0)
I would encourage you to check out the Web site of the insurance department for the state in which you plan to reside. Rules about coverage vary greatly across the US. As others have mentioned, if you plan to be working for a large company or get insurance through your future wife, a preexisting condition is not likely to be a big problem. If you plan to be self-employed, that's a whole different ballgame, and then state regulations are of great importance (as is not allowing coverage to lapse). A handful of states have guaranteed coverage (you can't be refused for coverage, although there will probably be a 12-month wait period for the coverage of the preexisting condition) and community pricing (everyone pays the same premium, but that premium is usually relatively high). These consumer protection clauses are in force primarily in a few of the very liberal "blue" states in the northeast US.

Felicitations on your upcoming marriage!
Posted 9/22/2009 11:25 PM (GMT 0)
I am origionally from New England have since moved to the other coast. I am unsure what state you are thinking of moving to if you do come to the US. If you need help finding a GI in Southern New England I know a great CD specialist in RI then again if you are going to northern or western New England I am sure others on here will be able to assist in helping you locate a Dr here if that is where you decide to relocate to
Posted 9/25/2009 3:58 AM (GMT 0)
I have been to GI's in Maine, NH, and Mass too.
Posted 9/27/2009 9:07 PM (GMT 0)

Writer said...
As others have mentioned, if you plan to be working for a large company or get insurance through your future wife, a preexisting condition is not likely to be a big problem.

Felicitations on your upcoming marriage!

Thanks! :-)

The common thought seems to be that an insurance policy through the people you work for seems to be the easiest [and best?] way of finding cover... Would it be fair to say that most people here find that policies through their employers [or those of their partner] provide sufficient cover for our condition, so then prescription medication and visits to healthcare professionals are just subject to a co-pay? I'm sure I've over-simplified it, but on the whole is that the way most people on here do things?

In answer to the other question which some of you have asked, she currently lives in southern NH, almost on the border with MA, so we'd likely be living in one of those two states. We'll need to look into which will make the most sense :-)

Posted 9/28/2009 1:30 PM (GMT 0)
I live in MA just below the NH border. I have never had any issues with employee based coverage and my Crohn's. Everything I have ever needed was covered (See my above post to your question). The only thing was the 30 day wait period at the start of employment. But you will find that with just about any policy. One really good thing about this area is that if you have anything 'special' going on Boston is just down the road. I have a GI I see in Boston once a year just to make sure my local guy is one the right track, but also if you need any special testing or a second opinion you are in one of the top teaching areas in the country.
Posted 9/28/2009 3:36 PM (GMT 0)
I know what I would do. I would stay in the UK. Sure you might get good insurance from a job in the US, but then you are handcuffed to that job. Plus there is no guarantee you wont get laid off.
Posted 9/28/2009 3:48 PM (GMT 0)
I can't get healthcare coverage at all in the US. Don't bet on healthcare reform happening anytime too soon, it will take a long time to get through the red tape. I am not saying I don't think it will happen, just that it's not going to happen overnight. I personally would love to live in the UK. Europe generally affords a better lifestyle. Here life is about work, especially in the north east. You are your job. If you are a capitalist and a go-getter, you may have a lot of success here but if you're an average person, you will work and work and not get too far. Just my opinon.
Posted 9/28/2009 6:02 PM (GMT 0)
Firstly, since you would be coming in from out of the country, employer-based health plans could put a wait of as much as a year before they will cover pre-existing conditions such as your Crohn's. If you plan to be married right away, you could be covered under your wife's policy as soon as you marry. She should be able to check with her human resources representative to see what the terms of coverage would be.

You'll find that we have more different medications available here, but the cost is much more than you may be accustomed to, because the government doesn't contract in bulk for them. If you don't have insurance, almost all pharmaceutical companies have assistance plans; here is a link to the web page for the Pentasa program:

http://www.pentasaus.com/Consumers/PAP.aspx

I believe another societal difference you will find is that it's much more difficult to get on disability assistance in the US.

Congratulations on your engagement and I wish the two of you much happiness regardless of where you eventually settle.
Posted 9/28/2009 6:12 PM (GMT 0)

notsosicklygirl said...
I can't get healthcare coverage at all in the US. Don't bet on healthcare reform happening anytime too soon, it will take a long time to get through the red tape. I am not saying I don't think it will happen, just that it's not going to happen overnight. I personally would love to live in the UK. Europe generally affords a better lifestyle. Here life is about work, especially in the north east. You are your job. If you are a capitalist and a go-getter, you may have a lot of success here but if you're an average person, you will work and work and not get too far. Just my opinon.

Actually I AM willing to bet that it will never happen.  To many corporations would lose too much money if there was a public option.  Stay in Europe!
Posted 9/29/2009 12:14 AM (GMT 0)
Well Mike, I am not sure what to think. I don't think Obama is the type to back down on it but I agree with you that it is not beneficial to a lot of US corporations. Money makes the world go round... I hope it happens but you're right, it might not.
✚ New Topic ✚ Reply