Moving to the US - healthcare & insurance for UC?

Hi and welcome to the site!

For the Affordable Care Act, I found this:

"Pre-Existing Conditions. Under the Affordable Care Act, health insurance companies can't refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts. They also can't charge women more than men."

For some of your questions:

2. Are you able to get any sort of medical records from your current doc to take with you? Possibly tell them that you're moving to the US and see what they can supply you with. With any new doc, they are more than likely going to make their own evaluation based on your situation. I know when I saw my very first doc he said I had Crohn's. When I got my second opinion, he ran his own tests etc and changed it to U.C.

3. All employers are going to be different. I've been quite lucky. My employer has amazing healthcare with United Healthcare and has covered every aspect of my UC, including all the surgeries related to it.

a. My insurance has covered the vast majority of my prescriptions. I pay very little out of pocket for them, usually $10. Some have been higher in the $30 range and one in the $60 range and some I've paid $0.

5. That's going to depend on what coverage you get. My general doctor I pay $30 a visit, my specialist visits are $60. Procedures are going to depend on your coverage, deductible etc. I have a $1000 deductible each year and I pay out of pocket till I meet that amount and everything after is covered 100%

Thanks for the info, both of you :)

So unless I'm misunderstanding something, the picture you're painting is much less scary than what I had in my head.

To clarify, any and all insurance policies have to cover anything resulting from the UC itself (medication/doctor visits/procedures) in the same way that they cover anything new?

If that's the case, as long as I find a job which provides decent insurance or pay for such a plan myself (which I can elect to do, right?), I'm good to go? I mean sure, from what I understand I may have to go to certain hospitals or use certain brands of drugs, but I won't have to worry about getting stuck with a huge hospital bill if I follow the insurance's rules?

Sorry if I'm flooding too many questions here. It's just that people gave me so much doomsday talk about healthcare in the US that I've been extremely worried. I don't expect everything to be convenient or easy, but just knowing that I can get whatever medication and treatment need without worrying about huge costs would be a huge improvement for me.

Your employer pays a good part of your health insurance premium (sometimes 3/4 or 2/3 of the employee's total cost of that policy), and the rest comes out of your paycheck as an automatic payroll deduction. It's pretty no-hassel, as you just join their group plan, sign a few forms.

Often you have a choice between several plans of varying cost. To make the total health policy premium lower, the trend has been transferring more out-of-pocket costs onto you and I, when we actually make use of our health policy in the forms of copays and deductibles paid for services/tests/etc. You might see one high-deductible plan as a choice that has a lower total premium but big deductibles before they payout on anything (e.g., you're responsible for the first annual $3,000 in health costs billed and then afterwards they pay the rest). Great if you're young and healthy, as you'd probably save some money and never use that policy for much. Bad for us chronically ill folks who use our policy frequently.

Usa healthcare can and does bankrupt households. Having insurance is a good protection against it, but not foolproof. Lower income households are the most vulnerable and unable to keep up with their copays, deductibles, and uncovered procedures (out-of-network doctor or facility, etc.) sometimes even when covered by health insurance. Most middle-class families keep up but it certainly adds up to financial-tightness, and occasional debt when you get sick. It's a far from perfect system.

Generally most are fine. Just know the Insurance dictates the facilities, doctors, procedures, medications and other things they'll pay for. Always double-check with the insurer (online lookup, call, or policy book) when your unsure if something will be covered, before doing it.

59768, I moved from Germany to the States about 5 years ago. I was lucky to get a job right away which covered my pre-existing condition at this time. I chose a plan with a deductible so I have to pay everything out of my pocket until the deductible is met.

1. I intend to take a 90-day supply of Salofalk and Imuran with me into the country. Has anyone here experienced any problems with this? If so, suggestions are welcome. Naturally I will have my prescription at hand as suggested by the instructions given on .gov websites.
– I had no problem even bringing Humira to the States. You shouldn't have an issue with Salofalk (enemas and pills) and Imuran. Have your doc write you a note to bring with you.

2. Once my supply of these medications gets low (or if I start having any symptoms before that), I will have to go see a doctor. Will they have to diagnose me again or is there a way to make them accept a foreign diagnosis? I really don’t have to go through another colonoscopy just to confirm my condition so they can prescribe the medication I need to continue taking.
– I took my diagnosis with me and translated it myself. Of course my new GI wanted to scope me but he pretty much took my word for it and prescribed me meds. Your new GI won't take you off your current medication just like that.

3. When I do end up finding a full time job there, I will be covered in my employer’s insurance plan, right? Will this insurance cover my UC too even though I’ve already been diagnosed with it? More specifically:
– As far as I know you'll be covered. Group plans are the best in my opinion.

a) Will this insurance cover the prescriptions I’m going to presumably need to continue taking the mesalazine and immunosuppressants (whatever their local brand equivalents may be)?
– Mesalazine and azathioprine are mostly available as generics. You shouldn't have a problem getting them.
b) What about the doctor’s visits to get them prescribed, periodic blood tests to make sure I’m doing fine, and any other procedures or hospital stay I may end up needing if I flare?
– Blood tests are pretty cheap. I pay about $15-30 for one every three months. A scope of course will be more. I paid $1500 out of pocket for my last one in June. But it goes towards my deductible so I don't mind. My advise: See if you can get a Health savings account with your future employer. Mine gives me $1000 every year

4. If my job search ends up taking longer than expected, can I individually get insurance to get all these covered? Or will any insurance I get be covering only whatever happens to me after I get insured?
– I think it should be possible now however they might charge more.

5. Assuming I am able to get insured. What kind of additional monthly costs am I looking at for typical doctor visits, procedures and medications related to UC? (Presumably having insurance doesn’t make that zero, right?)
– Again it depends on which type of plan you choose. If you choose a copay it's different. I always had a deductible so I pay everything until approximately August of the year and after that they pay for everything else. You'll have to calculate for your meds monthly and blood tests every three months. Ideally you only have one scope per year depending in how long you've been sick.

6. And finally, how much money do I realistically need to save and set aside to not have to spend every waking moment worried about the possibility of seeing blood in my stool and being buried in massive debt from medical costs after another flare?
– I would put aside $1500-3000 to be sure.

May I ask from which country you're moving to the States?

Hello, sorry bout the diagnosis but you came to the right place. People here have been very kind.

1. I intend to take a 90-day supply of Salofalk and Imuran with me into the country. Has anyone here experienced any problems with this? If so, suggestions are welcome. Naturally I will have my prescription at hand as suggested by the instructions given on .gov websites.

1A: that is a great idea to bring a 90 day supply of your meds. Those meds are available here but you might need a different brand.

2. Once my supply of these medications gets low (or if I start having any symptoms before that), I will have to go see a doctor. Will they have to diagnose me again or is there a way to make them accept a foreign diagnosis? I really don’t have to go through another colonoscopy just to confirm my condition so they can prescribe the medication I need to continue taking.

2A The doctors will take your current diagnosis. obviously, if the doc has questions or if it is time for a routine exam/test the doc will order that.
I cannot stress enough how important I think it is to find a PCP (or GP) before you come, but even more important, is to set up an appointment with a Gastroenterologist. the GI should be a specialist in IBD and should be preferably be practicing out of an academic medical institution, with an IBD center. Where are you moving?

3. When I do end up finding a full time job there, I will be covered in my employer’s insurance plan, right? Will this insurance cover my UC too even though I’ve already been diagnosed with it? More specifically:

a) Will this insurance cover the prescriptions I’m going to presumably need to continue taking the mesalazine and immunosuppressants (whatever their local brand equivalents may be)?
b) What about the doctor’s visits to get them prescribed, periodic blood tests to make sure I’m doing fine, and any other procedures or hospital stay I may end up needing if I flare?

3aA insurance will cover the meds you are on now
3bA doctors visits, tests, and hospitalizations are all covered. depending on what type of insurance you choose you will have to pay more or less.
there is a monthly fee to pay and then after that things start to get more complex. some have to pay a certain price per service and some have a flat fee to meet and then after that point they are covered at 100 percent (my family plan is 3000 at 100 percent and 3000 at 20 percent for a total of 6000 yearly for the entire family. after that everything that is a covered service is free.
if you choose a HMO plan you choose a PCP and they refer you to specialists. if you chose a more expensive plan- PPO you can choose from a wide range of providers and not need a referral.
you will also need to go to an "in network provider" so if you have Blue cross blue shield, you need to go to a doctor that takes that insurance (Most docs take BCBS)

4. If my job search ends up taking longer than expected, can I individually get insurance to get all these covered? Or will any insurance I get be covering only whatever happens to me after I get insured?

4A some will pay retroactively for expenses but not all. You can purchase it privatly but it will cost more

5. Assuming I am able to get insured. What kind of additional monthly costs am I looking at for typical doctor visits, procedures and medications related to UC? (Presumably having insurance doesn’t make that zero, right?)

5A I answered this in #3 but make sure to choose a good insurance if possible (I recommend BCBS, I work in a doctors office doing medical billing part time and they are of the best to deal with)

6. And finally, how much money do I realistically need to save and set aside to not have to spend every waking moment worried about the possibility of seeing blood in my stool and being buried in massive debt from medical costs after another flare?

6A if you plan ahead, you may be able to figure out how much your medical bills will cost. i.e. your premium and if you have a deductible and you are covered at 100 percent for prescriptions and visits after that you can add the cost of the deductible to the amount of your premium and voila, you will have the max amount of money you will spend on a given year.

many meds to have patient assistance ( I would think the 5 ASAs will, imuran is not so expensive and is available in generic so proabably does not have any coupons assosiated with it

based on your new location, start looking for a job
calling insurance companies to get quotes
and finding a GP and a GI and making appoitments with them

Good Luck!!

Just a note on insurance coverage. Health insurers cannot (by law) deny you coverage for a pre-existing condition. However, they can and do deny reimbursement for specific medications, even if prescribed by your doctor.

E.g., if your doctor says you should take medications A and B, the insurer can say "we think there are lower cost alternatives, X and Y. We'll pay for X and Y, but not A and B." This varies by insurer. They can also say "we won't pay for medication A until you have tried the lower cost X and the doctor has confirmed it is not working."

For example, my doc prescribed Entyvio. The insurer said, "Humira is cheaper and just as effective; we'll only pay for Humira." So I took Humira for 6 months. Then my doc wrote a note that Humira was not working, and we got Entyvio approved.

Most insurers have a list of drugs they routinely pay for (may take some work to find this). But a lot of the newer, pricier drugs are not on the list, and approved by exception. And you can't necessarily get a clear answer as to whether such a drug will be approved until after you have purchased insurance and your doctor has given a written justification for it.

All of this varies by insurer. My experience is that large corporations tend to have insurance policies that are pretty friendly. An individual policy can be quite different.

Wow, thanks for all the great responses everyone! You have all been very kind indeed to put in so much time and effort to help me out. This has been a difficult time for me (though I’m sure it’s probably incomparable to what many of you may have gone through) and seeing all this means a great deal to me. Thank you :)

Apologies for not being able to respond earlier, I don’t get much time on the computer these days.

I certainly feel a lot less worried about the insurance issue after reading everything you’ve all been saying. Sure, the system definitely seems far from perfect, but it’s not perfect anywhere. It sounds like as long as I’m smart about choosing my plan and do my best to prepare for the realistic scenarios, I don’t have to live in constant fear of going through something like the many horror stories I’ve read about peoples’ lives suddenly going down the drain because of medical costs.

I certainly don’t plan to skimp out on getting the insurance matter settled to the best of my ability (and means of course).

notyoursicklygirl,

The plan is definitely getting a job (and insurance) before having to go to a doctor. Hopefully the 3-moths worth of meds I’m bringing will help make sure that happens in the right order. But as I’m sure you can imagine, I’ve also recently learned that you can’t always expect life to go according to plan.

So hearing that it wouldn’t be the end of the world alone is reassuring enough for me, thanks.

iPoop,

Thanks for explaining the process. I will be keeping my eyes open for their options when I find that job. Is it considered acceptable to ask about what kind of insurance they provide during the interview process? Should I be telling potential employers about my UC?

Speaking of telling people about my UC, if I end up having to get an individual plan, I definitely need to tell them – right? Doing otherwise sounds like it’d be …fraud?

ks1905,

Thanks for the heads up, I’ve never been a politically inclined person but I will consider what you said. Is there any way to be safe (at least for a while) no matter what happens to the ACA? Like signing a 2/3/5/10 year insurance contract where they don’t get to change the pre-existing condition issue as long as I stay on the plan? If something like that were possible, would I have to remain in the same state or are there plans which work in the entire country?

Andrina,

Thank you for taking the time to type all that out :)

I’ve talked to my doctor and apparently they can easily provide all the documents I need: A note/prescription for the medication, my medical history, test results and all that.

The fact that you were able to have your doctor accept the diagnosis you translated yourself is encouraging. Though whether or not the border control people will be as understanding when I’m going to try passing through with a suitcase filled with hundreds of pills, enemas, and a bunch of my other medical supplies like 6 months worth of contact lenses and solution could be a different matter entirely.

I don’t expect the fact that I haven’t set foot on US soil in over a decade, or the fact that I’m coming from Turkey to make them go any easier on me either. I’ll be looking for ways to get some more official looking translations of my diagnosis and prescription to be safe. Apparently the consulate has “Notarial Services”. It’s not cheap, and I’m not sure if it has anything to do with my case here, but it may be worth looking into. Just thinking out loud at this point, but of course I’d certainly welcome any input if you happen to have any to offer on this.

Thanks for the figures you gave with the procedures. Examples like these help put my mind at ease compared to having no idea about the general range of prices.

So if I understand correctly, the plans have either a deductible or a copay? What should I consider to be decent numbers for these – is it possible to get a plan with a yearly deductible of less than $2000 and no copay for example? I also have no idea about the monthly payments for the insurance itself – for a decent plan (through my employer) should I expect something around $100? $200? (god forbid) $500?

Oh and to be clear, in plans with a deductible, everything is 100% on you until you meet it then, right? Procedures, hospital stay, doctor visits, medication – the insurance companies don’t touch anything until you’re past the deductible? What happens if you move states, change jobs or change plans – your deductible “counter” for the year gets reset and you’re screwed?

DBwithUC,

Thank you for pointing out the wait times, I had no idea. I assume whether my employer’s plan has one or not will be clear when I’m signing up? If it does, can I simultaneously get an individual plan while I’m still technically on the employer’s plan too but waiting for that timer to run down?

Dikid,

It certainly seems like you have a point about finding the right place. So much well-meaning support here it’s actually taking my mind off the unpleasant nature of what we’re discussing. I truly appreciate it :)

I’d love to find a doctor before I move, but where I move depends entirely on where I end up finding acceptable employment. For the time being, it’s to Arkansas where some of my family is. But whether my stay there will be a week or a year I do not know yet.

I think I have a pretty good understanding of how the insurance system works now, thanks for clearing that up. It looks like I should be alright as long as all of these terms are clear when I’m getting the insurance and I can prepare for the expenses accordingly - provided that they’re within my means of course.

platinumpixie,

$450-550 a month, just for the insurance, not including these deductibles and copays for individual insurance? Ouch. Right, so finding a job, any job is definitely my first priority then.

Can you use the money you put in these FSA’s towards your deductible and copays or is it only for separate expenses not covered by your insurance? If you can, it certainly sounds like a great option to look out for, thanks for letting me know.

I will keep your tip about academic hospitals in mind too. Though I assume I’d have to check with whatever insurance I end up getting to make sure they cover that specific hospital, right?

Casey_LB,

Thank you for explaining the medications issue. It certainly doesn’t sound perfect, but I suppose it makes sense. I don’t mind having to go through the hoops if it means I’ll be able to live a (relatively) normal and productive life while being able to afford it.

So to be clear, when you go to see a doctor and they prescribe you medication, you call up and ask your insurer first to see what you can get? Do you then have to go back to the doctor to get the prescription changed into something they cover or is this just handled automatically at the drugstore where they presumably know which company covers what?

Cadillacwomen,

Thank you for the input. So to be clear, even if the ACA is repealed and everything goes back to the way it was, I can reasonably expect to find some way to get my existing UC covered? Without unrealistically high payments?

Everyone here is painting a picture of a system which may not be perfect, but certainly seems reasonable and manageable. Where did all the horror stories of people going bankrupt from medical expenses in the US come from – were they all just irresponsible people who didn’t bother getting any insurance at all?

59768, welcome back. I honestly don't think that you need your letters from your doc notarized. You should be fine just taking some letters. I wrote a letter in english and told my GI to sign it so I could take my Humira with my hand luggage on the plane :)

about the deductbile. It's my understanding that it's either or. There is also an Out of Pocket Maximum. Maybe someone else can explain this better. When I was by myself I paid $80 for my insurance and now with a husband I pay about $151 biweekly. I don't pay everything 100% even though my deductible isn't met yet. They already cover a lot of things. I know that my scope was $1500 out of pocket but it was a total of $4280 and the insurance paid the other $2780.

And yes if you change insurance during the year, your deductible resets and you start from zero. Happened to me the first year after I got hired on and switched insurance. It was sooo expensive to start over (got hired in November!). My advise: Keep your insurance for the rest of the year via Cobra. This means that you pay your and your employers part together and you're able to keep it until you can enroll for the next year.

I hope this clarifies it a little more. I'm glad you're coming out of Turkey. I can't imagine the situation right now after the coup attempt.

Regarding deductibles/copays:

As an example, my plan as a single person and because I chose the "gold" plan through my employer, my deductible is $1000 and I have a copay in addition to that for any doctor's visits and medications. The copays are either $20 or $40 for specialist. If I have an ER visit and I'm not admitted to the hospital it's $100. If I go to physical therapy, it's $25/visit. There are some exceptions such as women's yearly gyne visit and pcp yearly physical. Until my deductible is met, I am responsible for 10% of my medical expenses because I chose the "gold" plan. The "silver" plan would have been 20%. My employer also offers an HSA plan which is like a healthcare investment account. I love this idea but since I'm a high use medical care patient, I would never have money in the account to invest. If you don't use medical services very often this account is amazing because you can invest the money in mutual funds, let it grow and use it for healthcare expenses when retired. The hospital also contributes $1000 to the account. I believe the maximum amount of money you can put in the account is $3000/year but it's been about 2 years since I did the research. Also, you pay everything until your deductible is met as opposed to a % as I described above.

Regarding FSA account:
This money can be used for any medical expense. I use it for all of my medical and pharm copays as well as dental. One year I used it for my dental night guard which was about $400. The only expense I can not use it for is any expense that isn't covered by remistart. So say they covered my remicade but I had $150 bill remaining for placing my IV and the IV fluids. I have to pay out of pocket rather than FSA. This is a condition of the remistart program since it's a financial assistance program. I max out my FSA account each year with $2500 and usually run out by October and the rest is out of pocket. That is one of my complaints of the ACA because it used to be $5000 max.

There are many variations with the plans. A high deductible plan is less expensive and a low deductible plan is usually expensive. The 450-550 quote I mentioned was for a low deductible plan but you could pay less if you're willing to have a high deductible such as $3000 or more. Hopefully your job search will be fruitful and insurance will fall into place. Good luck!