So, all you dudes with limited insurance, could you get a different insurance before the surgery or would that be wrong?
If it isn't allowed to do such a thing when would it have been appropriate to get a better insurance, before the scans have been taken or something?
What kind of insurance would securely sufficient to cover the surgery?
A different insurance? In what world are you living...
?
I consider myself fortunate to have insurance. I had none prior to the ACA, because I was self-employed with pre-existing conditions. However, with the GOP's sabotage of the ACA, the insurance plans offered have become very limited. Last year there was ONE insurance company offering individual plans in my area.
The plans offered are all HMOs with narrow networks (very limited providers and no out-of-network benefits). This year there were 3 options of insurance providers, but 2 of them were limited to so few providers that they were useless to me. One covered one hospital, 10 miles from our house, and a bare handful of specialists. At least now the company I'm with covers the only tertiary care hospital (e.g. the University hospital, cares for major trauma and complicated illnesses) in town. The other two companies offering plans do not. However, that company (Ambetter) has major issues (see below).
You read of people in other states who are worse off. They had only one option of insurance provider and that company had no providers available in the area they supposedly covered. Centene (owner of Ambetter plans) is in trouble for lying about their provider panesl: claiming they covered doctors they didn't. I'm sure some of that was because the providers terminated their contracts with that company because it had a terrible track record for paying them. This company, Centene, has had
a class action lawsuit filed against it because of these practices. And I just read that it is under investigation
for major securities fraud related to its merger with Health Net, in which they hid a billion dollar loss among other shady practices. So, those of us dependent on this (allegedly) criminal company may find ourselves out of luck for health care.
Those of you who have insurance through an employer may have better options. Or if you have Medicare. Most Medicare Advantage plans are also HMOs with limited provider networks, but there are some PPOs available. And you can change your Medicare plan twice a year now: in the fall and in the beginning of the year. Or you can get a traditional Medicare plan which covers 80% of the cost of care nationwide (but only from providers who will accept Medicare). It's best to combine traditional Medicare with a Medigap plan to cover the costs not covered by traditional Medicare. But make sure you buy the Medigap plan during the six month window available at the beginning of your Part B coverage or you lose the option for guaranteed coverage (with some exceptions; it's complicated).
As for what insurance would "securely cover the surgery," there's no guarantee that any insurance will cover it. You may need to go through an extended prior authorization process. However, a
PPO plan typically will pay a portion out-of-network claims, if approved. The coverage will not be as good as for in-network providers (e.g. maybe 50% rather than 80% of the cost) and will have a higher "maximum out-of-pocket" limit (MOOP, the maximum amount of money you pay for covered health services in a year before the insurance covers all covered costs) for out-of-network claims. For example, if your MOOP for in-network claims in $6,500, the out-of-network MOOP may be $13,000.
To be complete, there are still some individual and family plans (not employer sponsored) on the market outside of the ACA in some areas (but not where I live). However, if you have a serious pre-existing condition, you will not be accepted into these plans. There's also now the strange category of faith-based "health sharing" plans. I looked into the details of these recently. It seems like a big gamble. They are not insurance. Instead they take money from their members and, at their discretion, pay for other members health costs. Pre-existing conditions are denied for varying periods, depending on the company: a year or two is typical. But there is no guarantee that they will ever pay any of your costs. They don't have to, because they are not insurance, and therefore don't come under insurance regulations. I seriously doubt they would cover a major cost like this surgery, especially for a pre-existing condition. If you look into these, please read the terms very carefully and be sure to look at the reviews.
So, the best time to buy your insurance? If you're on the independent market: buy your insurance before you are diagnosed with ME/CFS, and before you have any symptoms of that or anything else. Otherwise your options are: while you are working in a job with good benefits that offers a good PPO plan, but you cannot quit that job! Failing that, then you will need to be married to someone with good insurance (or divorced with continued coverage in your settlement). The final option is Medicare, available after age 65 or after two years on Social Security Disability (SSDI).
I'm sure I've left something out. I'm not an insurance expert, just someone who's had to look into all this stuff.