Supplemental Insurance

[JoeyG]

Hello there! Bob (my hubby) and I are about 4 months away from the birth of our daughter, who was diagnosed this past week with Tricuspid Atresia. Her 1st surgery will be soon after her arrival (within the 1st week) with her 2nd to follow 4-6 months thereafter.

Though we're overwhelmed by her diagnosis, I'm trying to cope right now by "getting our ducks in a row" financially. We have group insurance through Bob's company, but I'm curious if you all have any thoughts on Supplemental Insurance. I've tried doing some research into it, but I'm not having much luck. For instance, does a fetal diagnosis count as pre-existing to Supplemental Providers (since technically, she's not even a patient until she's born)? Does it help to cover her prescription costs and other incidentals? If not Supplemental Insurance, are their other avenues we should be pursuing, considering we don't qualify for the gov't sponsored programs (Medicaid)?

I also have a concern regarding our insurance provider's lifetime maximum -- have any of you dealt with that considering the multiple open heart surgeries?

My mom thinks I'm worrying about all this prematurely, but if I can strike one item off of our worry list, that's about all I can do right now. I sincerely appreciate any and all advice you can provide. Thank you!

Joey Goodson
Baby girl due 2/28/2010

[QuinneyFamily]

Our son was not pre-diagnosed so we had no idea about his condition and therefore did not have supplemental insurance. But that is the number 1 thing I tell anyone who is newly diagnosed. Get supplemental insurance! I am not sure about the details but I do know that there are families on here who got it prior to the birth of their child. THe cost are never-ending, not just medical costs, but food, gas, and a place to stay for you if you live far away like we do. It adds up fast and the supplemental insurance helps no matter how little it is. I also know Utah has something called SSID. Social Security disbility or something like that. We do not live in Utah but it is something other families have persued. I think somewhere on the IHH website there is a list of 'things to know for newly diagnosed families' that has alot of this information.. Hope this helps
Jennylin

[SBAimee]

I looked into when I was pregnant but was told by the Aflac representative that my sons CHD was now a pre-exsisting condition since we knew about it. I later found out she was misinformed because several other people have been able to get it without any problem and have recieved quite a bit of money as a result. I wish I would have pushed a little harder and asked a few more questions.

Regarding lifetime maximums, I was worried about that too. It's hard to say since every kid is different and spend different amounts of time in the hospital, but remember that the maximum is after they take off all their discounts so it usually takes longer to get there then you think. Just to give you an idea, Jack's 2 open heart surgeries this past year came in at less than $250k.

I know Brynn Homer has good advice and experience on both of these subjects. You should talk to her. I bet she'll chime in.

Good luck, and congrats on your little girl. I know this time is scary, but every one of these kids are amazing little spirits.

Aimee
Mom to Jack, HLHS, 15 months
www.jacksonhardy.blogspot.com

[Chrissie]

We were able to get Aflac, they told us that Kylie wasn't a "real" person yet so they didn't count her or her CHD as a factor, We got $3500 from her 1st open heart and $1000 from her second, it is the ICU plan, it is very cheap about $12 a month and it covers everyone in our family, Kylie was in the hospital for 3 weeks the 1st round and 6 days the second. On our statments it did say something to the effect that we didn't get the full amount because some reason like the patient is under 6 months of age, I will have to look it up and see. I would look into Medicade/care and WIC.

It was so nice to have that money, like Aimee said Kylie's surgeries were about the same price, but not to mention the un-insured costs and deductible, formula, medicine and just the regular baby items. I would say we have paid about $10,000 out of our pocket for Kylie last year for all of her "toys" she needed.
GOOD LUCK!!
Chrissie

[Ellinger Family]

You have to be careful about getting supplemental insurance and medicare or social security. I can't remember which one it is, but the money from the supplemental insurance has to go towards paying one of them. I would ask to speak with one of the social workers at the hospital. I know that they also count that income from the supplemental insurance as income when getting on social security which makes it difficult to get on both.

Supplemental insurance has made all of the difference to us. I wasn't pre-diagnosed though. Also, I wouldn't just get an ICU policy. I would get a sickness/hospital idemnity policy in addition. That way the surgeries are paid at a price irregardless of age and that time spent out of the ICU is also paid on a daily basis.

[JoeyG]

I can't thank you all enough for your responses!! You have seriously eased my mind ...which isn't easy to do these days. And it's not just the insurance advice either -- hearing that your babies have made it through these surgeries at such a delicate age, gives me more and more hope that our baby can do it too.

My husband's company has an AFLAC rep, who I will be contacting immediately. I'll also look into the information on the IHH website; I did some poking around the other day, but I need to spend more time on the site.

Again, I thank you all so very much. I don't know what we would do without this forum! Heart Moms (and Dads) RULE! :)

Joey Goodson

[Heart Mommy]

Welcome to the group, and we hope the arrival of your bundel goes well... Having a heart baby is the hardest thing you will ever love so much... (does that make sense) they change your life so dramatically so fast. As do all children. Although I wouldn't wish it on anyone it is one of the best things that has ever happened to our family.

Here is my .2 Cents on each item.

Supplemental- We have it we love it... We went through Calonial Life with the program that when someone is hospitalized for more than 18 hours we get a pay out... That money can be used for anything from groceries and clothes to hospital bills and baby needs... It is ours... We pay around eighty dollars a month because my hubby's work contributes some... So that meant that We recieved 4,000.00 our first trip to hospital, 2,000 for me for delivering the baby and 2,000.00 for my baby. It didn't recycle every 18 hours just every hospital that ended in a 18 hour stay. We have recieved enough to pay most of our hospital bills... Since we had so many other things crop up. If you can get into it do it do it do it... Our advisor's name is Sherrie Hopkins Her number is 801.446.8206 ext 108... She is amazing. I love working with her.... She also has a cell that you can reach her at.... 801.446-8206.

Life time cap- This was an extremely worrisome thing for me.. It still is... The problem is that you think that we should be covered because we pay into it... Darn thing... Anyway, gator has had three open heart surgeries, many hospital stays, home health, tons of therapy, meds, the pediatrician, Er visits and so much more and we aren't even close to our 2.5 million.... Put it out of your little heart.


SSI(social security income) this was and let me stress WAS and extreme blessing... It helped us float when we were sinking and sinking fast... BUT, it is extremely difficult to get into and to get out of... by get out I mean it becomes a huge finanical burdon later... We now have to pay back an overpayment of close to 2000.00 dollars... WWWWAAAAAAHHHHH!!! so think very seriously about doing this... There are other families in our group that have had to pay back too... It is really stressful...

And last, if it is possible get an inssurance Case manager, it is free with your insurance they check on you and they are another resource to help you understand your hospital bills that seem in another lanuage. We have group insurance with the hubby's job with Select Health... Our case worker is Lara Aiken- I am not sure which type of insurance you have... but I can try and help you with finding other resources with your company...

OH..... One more thing.... Tons of people will want to help... Your brain will be worring about your baby and you will just say that there is nothing that they can do... But they can... If they want to help they can add some $ to a meal card at PCMC... this helps out sooooooo much... It is non intrusive and it helps in the cost... Or they can help with gas money... We live in West Jordan it is only a 20 minute straight shot, but with traffic and lights it is almost an hour so those gas cards helped us so much... I even got a few from a shower....

Good luck....

Brynn
IHH Sec
Momma to Ryleigh(heart healthy age 4) Alex( we call him Gator, HLHS, 2 years old)

[JoeyG]

Brynn -- you are just the best!!! Thank you so much for laying it all out for me.

So far, I've filled out the paper for our insurance to get a case manager (talk about foreign language -- all to get a case manager assigned!!). We have Altius, with a $2 million out of pocket max. Hearing both from you and another heart mom that you're still far from the max has TRULY eased my mind!

I'm waiting for the contact person at Aflac to get in touch with us; Bob's company has a relationship with them -- not sure if they help pay the premiums though. I've taken a couple notes on the policies that everyone here has suggested - I'm adding a note to find out about an 18-hr hospital stay pay-out.

As for the SSI -- I'm almost afraid to look into! I saw a few of the posts of families having to pay money back ...talk about adding insult to injury. As well, I don't believe can qualify for that anyway.

I love your suggestions on tackling the "how can we help?" So far, we've accepted every offer on babysitting our 2 yr old (we don't have family here -- that's what happens when 2 ski bums leave their hometown for these incredible mtns!). I never thought of gas cards (we're in Murray, about 15 min from the hospital) or meal cards through Primary's.

And boy, did you nail it on the head -- our baby girl has been the hardest thing to deal with, that we've ever loved so much! Thanks to her, we have a new appreciation and thankfulness for her healthy big sis, Cate (we never realized just what a miracle she was ..and still is). I think it's also brought my husband and I just that much closer too. As well, I'm not what my Gramma would consider a good Catholic, but I'm definitely praying a lot more these days! This little bundle has already had a profound effect on us and we're still 4mo's away from meeting her!

Again Brynn, I thank you and everyone else SO much for your advice and encouragement. I keep saying it, and I'll say it again -- this forum has been our saving grace!

Joey Goodson
Baby Girl Goodson due 2/28/10 (Tricuspid Atresia)

[AngelMom]

This is something not only to think about knowing you are expecting a heart baby, but to consider if you are not done having a family for future children to be born, especially if you have had a heart baby.

Unfortunately, we did not have supplemental insurance with Hope. What a blessing it would have been to help elevate the financial part of dealing with a baby/child with a complex CHD.

However when we knew we wanted to add another child to our family. . .I sought out supplementary insurance(s) yes, that's right INSURANCES. .there is nothing saying you can't use more than one type at the same time, you just have to pay for each policy.

When I had Cole (who is healthy) back in 2006. . . we had both Aflac and Allstate. Most of it was to cover me while in the hospital because I knew I would need a C-section and so I opted for riders for each of their surgical plans. My Aflac premium is taken out of my payroll, but the Allstate plan was something I purchased from Marty Ferguson, Insurance Agent located in Salt Lake City, Utah.***Stephanie Ellinger has used this agent too***

One thing with the Allstate plan was I had to have it at least 10 months before submitting a claim. We had no problem with meeting that requirement as it took us over 24 months once paying the premiums before Cole was born. It was a little pricy at $105.00 per month, but the pay-out was BIG. We invested just over $2,400.00 to the policy and received $7,800 just from that policy alone!!! Because I don't have paid maternity leave at my work, that money sure came in handy while I was off. When I had Hope I only took off 6 weeks because we needed me back to work to pay bills, and then with Nathan, it had only been 16 months since Hope's birth, so I had very little vacation time. . .I only took 4 weeks off. With Cole because of this supplementary insurance money. . .I was able to take 12 weeks off. It was nice to be able to have that time with him, knowing he was my last baby. Yes, I dropped the policy after getting the pay-out, there was no longer a need to keep it.

The Aflac policy, I received just over $4,000. In both policy's I actually would have been paid another $800.00, but I skipped out of the hospital 12 hours early than the 4 day pay-out for a c-section, so I only got paid for 3 days!!! One thing to keep in mind . .stay as long as possible because it pays out to the day's you are in the hospital recovering.

Good luck, and I would suggest that ANYONE planning on having a baby in the future should look into options.

My Aflac agent loves me. . .I think I own evey policy they have. For me it's a price I pay for piece of mind.

[JoeyG]

First and foremost, Carolyn, I don't know how to thank you for getting this support group put together! I really don't know how my husband and I would be coping without it. It's terrible to think of how many families (including you) had to go through this on their own. So from the bottom of my heart, I sincerely thank you -- you have done an amazing thing for a lot of people!!

As well, thank you for the excellent insurance advice. Bob's company offers Aflac; we have a meeting with the Rep next week to get signed up. However, I never imagined you could carry multiple plans! I will start investigating that asap. Depending on how much the Aflac coverage costs, we might just give Marty a call.

But I can tell ya for sure, after this little missy is born, she's our last. My husband and I took our sweet time having kids, and considering I'll be hitting that 4-0 mark next year ...this very special little girl will be our last. Consequently, we just concerned with getting coverage to help with her hospital and other related bills.

Thank you again ...for the advice and especially this forum. I hope I'll get the opportunity to thank you in person one day soon!

Joey Goodson