Saturday, July 9, 2011

The Screw That Turned

Thank you commenters for giving me some directions to turn to in my insurance mess. I did look up some information on the The Omnibus Budget Reconciliation Act of 1993 (OBRA’93), and found out why I have been so screwed...

"Health insurance plans that are not employer-sponsored plans (i.e. individual plans) are not subject to Federal regulation. Those plans are regulated by state law. Fortunately, many states have their own laws that prohibit discrimination against adopted children in connection with health insurance. If you are covered by an individual plan, you should check the laws of your own state to determine your rights.

Mark T. McDermott, J.D., is a Washington, DC attorney. He is a past president of the American Academy of Adoption Attorneys and currently serves as the Academy’s Legislative Chairman. He is also an adoptive parent."

I have an individual plan. So, on top of finding a good attorney on Monday, I have a referral for an insurance agent. I will see about switching my insurance from an individual plan to a business plan, but I will qualify only if I am considered an employee, too, because it looks like there is a 2 employee or more limit and I only have one employee. I am also looking into Shriners. There is a hospital about 100 miles away, but I don't think they deal with Jie Jie's main issue. I'll find out.

This whole situation is now invading my dreams. I can't seem to escape it even in sleep.


CompassionMama said...

We ran into a similar problem, but luckily caught it in the homestudy stage. We had to switch from individual insurance to group (business) insurance. All you need is two employees including yourself. My husband and I are self-employed and we added me to payroll and got two separate plans so that we would qualify. The only snag you might hit is that your employee has to accept your plan. The whole problem added two months to our paperwork, but I am so glad we caught it then. So sorry for your stress!

Karen said...

CompassionMama-I dont see a problem with her employee accepting the plan, because she doesnt have to use it...However, the business plan might be just as expensive for her as the individual plan, after paying for herself and her employee.

One thing that you might also want to consider is, (if it is a temporary hike in fees for your daughter) have you considered going to your church to ask if they can sponsor part of the monthly fees until they get lowered down? I know that's asking a lot of your church, but honestly, IMO, that's part of what the family of church is about....helping members in need. Unless, Kaiser is saying that the higher rate is not promised to go down. Then that would be a lot to ask of the Church.

Karen said...

OK I just realized, K's employee would have to pay some monthly premiums as well....which could be a barrier in going along with it...didn't even think about that.
Sorry you have to go through this K, I hate that people have to go without treatment/health seems so counter productive to humanity.

Anonymous said...

If it comes to it, do you have a friend or relative who needs insurance? It was probably fifteen years ago, but my former partner and I had insurance through our small business. Two "employees" were required, so we added her sister, a recent college grad who didn't get insurance through her job, as an employee on paper. She paid her part of the premium, we paid ours and it worked well.

Joannah said...

I am so sorry for all you are going through. :(

China Dreams said...

Just turn it over to the attorney. Let him/her do the worrying and the legwork. They can file a complaint with the California Department of Insurance for "Alleged Misrepresentation by an Agent, Broker, or Solicitor" and another for "Problems Concerning Premiums and Rates".

I believe that you should also contact your elected representatives, your insurance commissioner, and your governor. That puts some of the burden back on you, but you've got a lot of Democrats in office-make them live up to their ideals by helping people like you who "fall through the cracks" in the current system-and I would still use the attorney.

Looking forward to a positive post that brags about you getting a good night's rest!