Switching Insurance Plans

Get help finding a doctor or discuss questions about/difficulties with your insurance or employer.

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Switching Insurance Plans

Postby Carolyn » Jun 25, 2004 6:26 pm

Okay I just found out from dh that they are awitching insurance plans. The new one has three tiers for medicine and zofran is not on ANY of them. I am just starting to have some good days and now I am really getting stressed out that I am going to have to do battle all over again to get what I need for this pregnancy. I thought that the only thing I had left to battle at this point was HG and the visiting nurses who want to wean me off of the zofran. So long as I have my OB I have no worries from the visitng nurses but now I have a worry over this new insurance company. It takes over next month. I am also worried that they won't cover my doctors out of state now either. The insurance we had before was out of state but had comparable doctors. Now I have no idea they didn't even give us a list of their doctors. Okay I can get off my soap box now, just needed to throw that concern out. Thanks.
Carolyn
Brandan 02/22/97
Bryce 07/25/98
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Postby otiam » Jun 25, 2004 7:48 pm

Carolyn,

Do not get stressed out yet. Who knows you may not even need the Zofran by the time they switch....don't get worked up because that can make your HG even worse. I would maybe have your husband do some investigating....maybe he needs to call the new insurance company and get the information. Since you are being treated right now and do not want any disruptions in your treatment I would have him check it all out now. He may need to also talk with his employer about how this works when you are already under the medical care and it's covered as to what happens when you change insurance. If you have any of the information and your husband does not want to call them..I will help you also. I can make a phone call or check into it if they have information online. I really just do not want you to stress about it...just keep thinking about yourself and getting through each day. Let everyone else worry about what will be paid and how. Ok...I know that is easy for me to say but I just am looking out for you!!!

Amber
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Postby Carolyn » Jun 25, 2004 7:57 pm

Amber,

I appreciate being looked out for. You know how some men not all can be. I have to work I am already stressed out enough with carrying all the bills now. I have no control over this switch. Arrgggh. I think I will still need the zofran as they are switching over 1 July and I am on iv zofran with a picc line because even the odt zofran didn't work for me. I have been hospitalized twice until they put me on this hydration therapy and a taper of prednisone I couldn't keep anything sown at all.
I just looked in the paperwork and they do have a website it's myuhc.com. I will check it out but I am kind of notorious for not being computer literate. I am lucky I can post in the forums. Thank you for your supportive attidtude though no one understands what this is like no matter how much they care about you. Take care.
Carolyn
Brandan 02/22/97
Bryce 07/25/98
4 Angels
EDD 12/05/04
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Postby aaronsmommy » Jun 25, 2004 8:33 pm

If you are on zofran IV and I'm assuming getting it with your home health supplies then you have nothing to worry about the zofran. Their formulary applies only to the medications you go to the pharmacy and get. So, in order to get the ODT it looks like your doctor will have to fill out an authorization form, but as long as you continue on home health it should be automatic, and from what I can tell, you should be able to get the zofran ODT with the authorization if and when the time comes to switch to pills.
If your doctor isn't a provider with them, a lot of times you can get an exception to continue with the same doctor if you are in the middle of a pregnancy when your insurance changes. Hopefully that won't be an issue.
The only thing that might need to change is if they contract with a different home health company. Of course, it doesn't sound as if that would be a problem for you! Are you with Matria? They usually tend to be pretty good at understanding hg if you are not (although sometimes I did get the whole "have you tried crackers?" routine when I would get a new phone nurse, the ones that came to the house though were amazing).
Aimee

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Postby otiam » Jun 26, 2004 2:55 pm

Carolyn,

Of course the website is password secure. I will try to play around again tonight after my daughter goes to bed. But it is true the meds that would be affected are the over the counter. IV meds usually are covered because that is considered more medical....I also wondered if you have Matria. I also had them when I was pregnant and they really understand HG. I also think you should be able to keep your doctor because you have a complicated pregnancy. I think you just need authorization from the insurance company after you switch. They may just need to call you doctor if he's not on the list. Let's just hope he is and then we have nothing to worry about. Keep us posted ok? If you need anything let us know.

amber
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Postby Carolyn » Jun 26, 2004 6:38 pm

Thank you both I feel a lot better now. Yes I tried to get information from the website as well but we are not members until 1 July so it was useless as I had no idea what to do after that. Couldn't get to anything useful. I am going to call my doctor's office tomorrow and ask if they take United Health. If they say no then I am going top wait until I actually see my doctor again before I tell them because I am hoping he knows what to do to get around that. He's pretty good at dealing with insurances and pharmacies. I do get it from the home infusion company but even their nurse wants to wean me off of it and my doctor has been writing the prescription for me to have it AS I NEED it. At first I got it from my pharmacy while the whole insurance was being straightened out with the home services but now I get it from the vna's pharmacy it's great. I'll let you know what happens after the big awitch and thanks again.
Carolyn
Brandan 02/22/97
Bryce 07/25/98
4 Angels
EDD 12/05/04
Carolyn
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Joined: May 30, 2004 8:40 pm
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Postby otiam » Jun 26, 2004 10:09 pm

Carolyn,

Hang in there. Let us know if you need anything and good luck. I hope everything goes smoothly for the transition to the new insurance....I will keep my fingers crossed.

Amber
1 time HG survivor
Hannah 6/17/02
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Postby NanaWeez » Jul 13, 2004 5:27 pm

Carolyn...

Don't rule out getting aggressive with insurance companies.

While I was a full-time caregiver for my daughter with severe HG like you, her insurance company was giving my daughter's husband and me fits. The company was in California and I was caring for my daughter in Utah.

During one of our conversations, they were being impossible beyond belief, saying that she needed to drive down to California or they wouldn't pay for any more meds, supplies or equipment.

I said,

"My daughter is on an IV with a feeding tube in her nose. She can't even sit up without vomiting. How can she drive to California?"

They said that was their policy--period.

I was furious. Although I have always considered myself a mild-mannered, polite person, I practically yelled into the phone,

"WHAT DO YOU WANT HER TO DO...DIE?????"

The meds and supplies were on our doorstep in one hour.

Good luck.

NanaWeez
:wink:
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Postby RebeccaM » Jul 14, 2004 2:29 pm

You're Anna's mom, aren't you? You are just amazing for having gone through 6 pregnancies, 4 of them being HG. I always wanted 6, but I don't think I could do more than 2 or 3 with HG. I guess we'll see! Also, it's so great how you were so supportive of Anna while she was suffereing from HG. I also live in Utah (West Jordan) and was able to meet up with Anna a couple of times. It's great to talk to people who have been through the same thing. I love this forum and website! It helps me so much.
Rebecca
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Tierra Ashlee 9/15/03
Eli Spencer 7/16/05
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Postby NanaWeez » Jul 14, 2004 5:13 pm

Yes, I'm Anna's mom.

My HG episodes were not even close to what some of the women on this forum have gone through and are going through! What amazing women!

Thank you for your kind words. I'm just glad Anna made it through as well as she did--and that now we have Elizabeth--who is such a JOY! She was worth every minute of suffering (easy for me to say).

Talk to you later...

NanaWeez :wink:


RebeccaM wrote:You're Anna's mom, aren't you? You are just amazing for having gone through 6 pregnancies, 4 of them being HG. I always wanted 6, but I don't think I could do more than 2 or 3 with HG. I guess we'll see! Also, it's so great how you were so supportive of Anna while she was suffereing from HG. I also live in Utah (West Jordan) and was able to meet up with Anna a couple of times. It's great to talk to people who have been through the same thing. I love this forum and website! It helps me so much.
NanaWeez
4-Time HG Survivor
Mother of 6
Helped Daughter through 2 HG pregnancies
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