WHAT INSURANCE COMPANIES COVER TPN/HOME IV ???

[ESAKKO]

I HAD SEVERE HYPEREMESIS WITH MY FIRST AND ONLY PREGNANCY SO FAR. I COULDN'T EVEN SWALLOW MY OWN SALIVA. MY INSURANCE WAS TRING TO ENCOURAGE ME TO GET AN ABORTION BECAUSE OF THE HIGH COSTS FOR THEM. MY ISURANCE WAS THROUGH A PAST EMPLOYER WHICH I HAD QUIT AND RECEIVED COBRA. I HAD AETNA HMO AND NOW MY INSURANCE IS DUE TO EXPIRE. WHAT INSURANCE COMPANIES WILL COVER TPN CAUSE I AM CURRENTLY UNEMLOYED AND MY HUSBAND IS SELF EMPLOYED AND MAKES TO MUCH FOR ME TO GET APPROVED FOR INSURANCE THROUGH THE GOVERNMENT. I CAN'T FIND ANY INSURANCE THAT WILL COVER ME IN CASE MY FUTURE PREGNANCIES WILL BE JUST AS BAD. PLEASE HELP!!!

[ptfrog19]

In Maryland, I have Carefirst (Division of Blue Cross and Blue Shield). The actual plan I have is called BlueChoice. They covered 100% of EVERYTHING. Hospital stays, TPN, IV Therapy, Home Health Nurse visits...everything associated with all the problems I had was 100% covered, no deductibles, no copays, no money out of my pocket. It saved my life not having to worry about where I was going to get the money to pay any of that stuff especially since I couldnt work. The same policy even covered the Zofran, granted for that I did have a $20 payment towards each prescription, but compared to $500 for 12 pills, Id gladly pay the $20. I didnt have any problems with them whatsoever filling the prescriptions as much as I needed. I HIGHLY HIGHLY recommend them, although not sure if they are in your area or not.

[JennyK]

Insurance policies vary from state to state. Perhaps you could call your state insurance commissioner and see if they can give you help finding companies to apply to. It's usually big bucks to buy a policy that is not through an employer group. You also may be denied based on your history. Good luck.

[Trubiedoos]

In CA it's covered 100% by Pacificare HMO and Pacificare POS.

[aaronsmommy]

I can't imagine that you would be able to purchase an individual policy that covers pregnancy. They reject people for all kinds of stupid reasons, and a history of hg would actually be a pretty reasonable one for them to reject you for.

Is there any way your husband could get a employer sponsored plan - with himself as the employer? He may have to have a group to get an employer plan (which would mean covering an employee or two, does he have employees? Could you be an employee and then get him qualified as a group?

I would guess that all companies cover home health, but it would depend on the actual policy. You will need to make sure that it is listed as a covered benefit, and pay attention to any limits of # of visits, time periods, or any exclusions. Also pay attention to any copays/coinsurance, as coinsurance for home health and hospital visits will add up fast, and also what the annual maximum out of pocket expenses for you are (and what gets included in this).

Any chance you live in CA? They have some great state sponsored insurance here for middle income people who don't qualify for Medicaid.

[carrielynch8]

I live in MD and I have an individual PPO plan through Carefirst BlueCross BlueShield and after meeting my deductible of $1000, the TPN/home care was completely covered. From the cost of all of the drugs and hospital visits I went way of the $1000 deductible within a few weeks. During one of my many stays, the social worker at the hospital was actually the one who told me about TPN and called my insurance company to help me get set up. I would maybe ask the social worker from the hospital you plan on delivering at. They deal with cancer patients that need TPN and might know off the top of their head which company would cover it. Good luck!

[mrsbigdog]

First point...you might want to check into this. If your husband is self-employed is it possible to add you as an employee? You could lower his pay in order to show paying yourself at least minimum wage. Aetna, United and Blue Cross all offer small business health plans that cover companies with as few as two employees I believe. When I checked into them the price wasn't cheap but it was better than paying out of pocket. Maybe that could be an option for you to check.

In 2005 I went through three different group insurance policies while pregnant.

Blue Cross/Blue Shield of Maryland PPO plan. We had a $1,500 deductible and then we were responsible for 20% of the home health bills. They did cover everything on the home health bills after our portion and the 20%. This was through my employer.

When my job was terminated we added the family to the policy at my dh's employer, Aetna PPO. This plan had a $1,500 deductible and again the 20% but picked up on the day BCBS stopped. They covered all of the home health bills after our deductible and 20%. Once I was weaned off my PICC they covered my Zofran (28 pills at a time). I had to pay a $20 copay for the Zofran every two weeks but that was it.

Near the end of my pregnancy dh's employer's policy year rolled over. We were given the choice to stay with Aetna PPO or change to Aetna HMO. Staying with the PPO would have meant paying another $1,500 deductible for the some of the extra ultrasounds and hospital costs. I spent about four hours on the phone with the HMO people verifying that they would continue to pay for my Zofran ODT and was assured that they would since it was on the approved list. I called several times and spoke with several people. As a result we switched to the HMO so we would only have to pay the $500 co-pay for the hospital bill at delivery. The first time I went to get my Zofran refilled would only give me 14 pills and said that was the absolute total they would cover, the rest would be out of pocket. My dr and I both argued with them about it but they refused to budge unless we woud retry all of the possible meds they listed in a letter. We had already tried several with no luck and knew I didn't react well to others on the list. I was only a few weeks from delivery so we cut my dosage and induced early.

Dh's newest employer has Aetna PPO which covers home health at 100% with no co-pay or deductible.

Every policy that is written is different whether it is for an individual or company so there is no way of knowing if something will be covered by a certain company because even policies from the same company will have different coverage. The best is to read all of the fine print in any policy you are offered in order to determine if it has the coverage you need.

Good luck...Donna

[ESAKKO]

Thanks for your replies. Great source of information. I still can't find a policy that will cover 100% home IV therapy. I have to go find a job in order to get it and put my daughter in day care. That is my only option I guess.

[krdoty]

I would not suggest United Healthcare to anyone who has a choice. They are great if all you need is preventative care. Not so good otherwise. We have had them since the beginning of the year and I have spent entire days dealing with them. (That is not an exaggeration!) They are not paying for lab claims that the Certificate of Coverage says are covered items. They do not, as a hard and fast rule, pay for nutrition. They specifically exclude TPN even if it is the sole source of nutrition. I am told that they will cover the tubing and the nursing care, but not the actual nutrition that goes into the tube. The only way to get around that is to go in patient, and that only works because they are required to pay board regardless of what "food" the patient can eat.

I was extremely satisfied with Cigna when we had them. I did not have TPN or home health, so I can't speak to those aspects of coverage. But they did cover Zofran for my entire pregnancy. My doctors had to get preauthorization to prove that it was medically necessary, but once the paperwork was submitted there were no questions asked. Medical necessity just had to be confirmed with a one-page form from my doctor every 3 months. We rarely had a problem with Cigna rejecting claims that were supposed to be paid, and the reps were extremely knowledgeable. I am already lobbying with my husband's employer to switch back to Cigna for 2009.

[MichellevsHG]

I have Highmark through Blue Shield and everything was covered, PICC, home health, IVs, etc. The only thing they gave my Ob a hard time with was the Zofran Rx - because of the expense. A phone call from her put them straight, and I never had trouble again.

[PaschaB]

I realize that my situation is most likely in the minority here, but this is what happened to me:

During my pregnancy with HG, I had Medica insurance. I live in Minnesota. Under my insurance policey, my "pre-natal" care was covered at 100%--no co-pays, no deductibles, nothing. Then I was hospitalized for 2 weeks (bills totalling over $56,000 for the stay alone), got a PICC line, TPN, lipids, zofran pump, Benadryl, and home care visits by an OB nurse three times a week (I am allergic to tape and the adhesive that was holding my PICC line in place, so the dressing had to be changed and repositioned to a different angle often).

The Zofran cassettes that went into my pump cost $1,300. That cassette lasted 42 hours, just under two days. I was on those 24/7 from my second month of pregnancy to my 7th. My co-pay for hospital visists, etc was 10%, which meant I would have to pay $130 for every 2 days I was on Zofran--5 months worth! Not to mention the home visits, supplies, TPN, lipids, etc.

I called my insurance company when I finally got rid of what I called my "octopus lines" and asked if I was going to get one huge bill all at once, or if they would allow me to make payment plans. Their response was: "You're not going to get a bill. It's all covered at 100%."

I didn't think he understood me right--I told him I knew my office visits were covered, but what about the rest? He again responded that it was ALL covered under pre-natal care. The hospital, meds, PICC line, EVERYTHING.

I started crying to the point my husband thought I had just received some awful news on the phone. I felt like I had won the lottery. I know not all insurance companies will cover things like that (my friend's insurance company wouldn't cover zofran for her at all because of the price).

And this may sound like really backwards advice, and it won't work for everyone, but if you can, get some sort of job in healthcare--as a secretary, nursing assistant, etc. (I was an NA.) Even with the...ahem..smells , people will give you a free pass on those patients when they know you have HG. And you will have excellent insurance coverage. And people are very understanding that you need to take a lot of bathroom breaks and sit down a lot. Healthcare is one of the most understanding fields when you're suffering from HG.

By the way, pregnancy (and anything related to pregnancy) IS NOT a pre-existing condition when starting a new job and insurance. At least it's not here in MN. Best of luck to you!

[aaronsmommy]

Healthcare is one of the most understanding fields when you're suffering from HG

You're kidding right? My boss, an Ob/Gyn, said things like "I wish I had hg so I could lie in bed and read books all day" and after watching me get a picc line, zofran pump, and lose 20 lbs, when I finally said I needed to take time off from work, he asked "Why?" Ultimately, I lost my lob there. I know of at least one other person who was fired from a job in a medical office (also here in CA where it is clearly illegal to fire someone for being out of work due to hg). I remember one nurse here complaining that her coworkers would laugh when they would give her the smelly patients and it would make her throw up.

Hospitals and large groups do usually have good benefits, that's true, but most smaller doctor's offices do not offer health insurance to their employees.

I'm glad you had a good experience, but I think it is like everything else, it really depends on the specific situation, and especially the people that you work with.

[PaschaB]

[quote="PaschaB"]I realize that my situation is most likely in the minority here, but this is what happened to me:




Like I said, I know my situation would probably be in the minority. If you work in a healthcare area where they make comments like that, erspecially in an OBGYN office, then it is obviously not the right place for you to be. I was lucky, I had a good job with understanding people.