# UK to US with special needs child. Health Care cover questiosn.



## Kellie2012 (Jul 9, 2012)

I've had a look on the forum and I've also asked people on my FB page and frankly I'm starting to get scared. I always thought we could get covered. Now I'm being told we might not because of pre-exisiting conditions, but I was told that they don't discriminate against pre existing conditions anymore. I've also just been told we wont be touched by health care insurance for the first year! I'm not sure what Josh's employer will cover as he hasn't got the job yet so we don't know, but I was lead to believe that we may pay up to $600 a month to cover everything, so I've budgeted for that. Am I completely wrong? Can somebody please explain to me in a "US Healthcare for Dummies" kind of way please. I really need to know what I'm facing. 

Just an overview:

She has a undiagnosed chromosonal abnormality which leads to mild developmental delay and growth problems.

Medication:

Melatonin 4mg
Growth Hormone injections

Dr's Under:

Endocrinologist
Geneticist
Paediatrician
Physiotherapist
Orthopaedics
Urgologist


----------



## Crawford (Jan 23, 2011)

The US health system is unlike anything that you will have experienced in the UK.

The US health system is a private, for profit industry where there is a cost for all treatments, drugs, hospital stays etc.

The majority of people in the States are covered by health insurance provided by their employers. The *employer* usually pays something towards the monthly premiums. The *employee* pays a monthly premium and, depending on the rules and regulations of the policy, also pays towards the cost of treatment. Some people pay a fixed co-payment - anything from 20 dollars for a doctors visit, 100 bucks towards an MRI, 200 dollars a day for in-hospital treatment - others, pay a percentage of the cost of treatment, say 20% of the overall cost. 

There are also deductibles in most plans which mean that the insurance will not pay for anything until YOU pay for all treatments up to this deductible. Deductibles range from as low as 200 bucks to as high as 7,000 dollars.

There is usually a maximum out of pocket cost per annum

Insurance through the employer is called Group insurance. It has some rules regarding pre-conditions, but nothing like Individual Health Insurance.

Premiums for Group Health Plans are cheaper than Individual Health Plans

If you do not have Group insurance through an employer, then you are in the realm of getting Individual Health Insurance. Here is where you enter strict rules and regulations regarding pre-conditions. The health insurance companies are under no obligation to give you a policy and if they do they can charge what they like.

Under the Affordable Health Care Act of 2010, children under 18 cannot be refused health insurance cover; however that does not control what you can be charged with an Individual Health Plan.

If your husband does not get employment right away, he should not encounter the problem that some new immigrants get if and when they apply for an Individual health Plan. However, like all others you will encounter the pre-conditions issue if you find that you do need to get an Individual policy.

With your daughter's conditions, you should be realistic that your health costs are going to be way above the average if she really does need to see all these specialists.

I don't know who have given you the 600 a months for costs but this could be just your premium, and not your out of pocket, deductible charges.


----------



## Crawford (Jan 23, 2011)

With regard to how to find doctors:

Your Insurance Plan will have a list of in-network doctors. These are doctors who have agreed to take your insurance plan and will provide a discount to the Plan administrators.

If you go outside of this list you will end up paying more.


----------



## twostep (Apr 3, 2008)

Melatonin 4mg
This is an over the counter penny item.


----------



## Kellie2012 (Jul 9, 2012)

Crawford, thank you so much for taking the time to explain it all, I'm so grateful!! I think I've been struggling to get my head around it as, like you said, it's like nothing we experience over here!!

Does $600 a month sound over the top or reasonable considering my daughter? I have started looking at quotes from Individual insurers just to get an idea/worst case scenario ect. 

She doesn't need all those drs at once. Those are who she is currently under, but some she only sees every 12mths and so on. She'd likely need a paediatrican and physio from the outset. Possibly orthopaedic.


----------



## Crawford (Jan 23, 2011)

Kellie2012 said:


> Crawford, thank you so much for taking the time to explain it all, I'm so grateful!! I think I've been struggling to get my head around it as, like you said, it's like nothing we experience over here!!
> 
> Does $600 a month sound over the top or reasonable considering my daughter? I have started looking at quotes from Individual insurers just to get an idea/worst case scenario ect.
> 
> She doesn't need all those drs at once. Those are who she is currently under, but some she only sees every 12mths and so on. She'd likely need a paediatrican and physio from the outset. Possibly orthopaedic.


Since we don't know all your circumstances (ages etc) it is difficult to say.

Recalling some other posts on this subject I would say that 600 a month for a family of three certainly is not over the top, in fact almost cheap. Where did you get this price from?

I would expect the actual costs per annum to be more than this if your child visits doctors regularly.

The quotes you will get online for individual insurance will give you an entry level quote. You won't get the final quote until you submit a full health history applications. You have to keep in mind too that apart from your child, pre-conditions will come into play. 

The final quote* may *be the same as the one on-line, however this will increase after an initial period (usually three months) and will increase annually after that - the annual increase will depend on your age, history during the year and general cost of living medical costs.


----------



## Kellie2012 (Jul 9, 2012)

Crawford said:


> Since we don't know all your circumstances (ages etc) it is difficult to say.
> 
> Recalling some other posts on this subject I would say that 600 a month for a family of three certainly is not over the top, in fact almost cheap. Where did you get this price from?
> 
> ...


Josh is fine and healthy. I'm fine other than a gastric bypass last Aug and weight issues. It's mostly Aaliyah I'm worried about. I don't want to compromise her health. Im 29 Josh 24 Aaliyah 9. In a way Obama Care sounds great because they don't discriminate against pre existing conditions, and I was lead to believe they don't now, but now being told that actually they do!!! I'm getting very stressed now.


----------



## Crawford (Jan 23, 2011)

Kellie2012 said:


> Josh is fine and healthy. I'm fine other than a gastric bypass last Aug and weight issues. It's mostly Aaliyah I'm worried about. I don't want to compromise her health. Im 29 Josh 24 Aaliyah 9. In a way Obama Care sounds great because they don't discriminate against pre existing conditions, and I was lead to believe they don't now, but now being told that actually they do!!! I'm getting very stressed now.



So YOU have pre-conditions. You are unlikely to be offered an individual health plan with your history.

Obamacare only covered pre-conditions for children


----------



## Kellie2012 (Jul 9, 2012)

I do, but nothing that will require long term care, I'm more concerned with my daughter. So long as pre-existing conditions are covered for her and it won't bankrupt us I think we will be okay. Feel very nervous now though. I hope my husbands potential jobs will cover her.


----------



## twostep (Apr 3, 2008)

I do not want to sound harsh but where is the discrimination? As long as a carrier sets rules and stays within these set boundaries the company is within its policies. Insurance is an industrie. Yes, there are some pretty tight checks and bounds but the bottom line in a free market is profit.

It will be rather difficult for you to get coverage with what you describe here. It will be very difficult to get coverage for your daughter. Even the health care plan which will start being put into motion by the current administration cannot force a physician to accept patients. 

Crawford - do you know know when the full coverage for kids will actually be in place?


----------



## Kellie2012 (Jul 9, 2012)

I've been told about PCIP which is somewhat of a relief.


----------



## twostep (Apr 3, 2008)

Kellie2012 said:


> I've been told about PCIP which is somewhat of a relief.


Read through the actual requirements.


----------



## Crawford (Jan 23, 2011)

twostep said:


> I do not want to sound harsh but where is the discrimination? As long as a carrier sets rules and stays within these set boundaries the company is within its policies. Insurance is an industrie. Yes, there are some pretty tight checks and bounds but the bottom line in a free market is profit.
> 
> It will be rather difficult for you to get coverage with what you describe here. It will be very difficult to get coverage for your daughter. Even the health care plan which will start being put into motion by the current administration cannot force a physician to accept patients.
> 
> Crawford - do you know know when the full coverage for kids will actually be in place?


The coverage for children came into being in September 2010. Some details are here:

Children's Pre-Existing Conditions | HealthCare.gov


----------



## twostep (Apr 3, 2008)

Crawford said:


> The coverage for children came into being in September 2010. Some details are here:
> 
> Children's Pre-Existing Conditions | HealthCare.gov


Thanks:>)


----------

