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Group Employee Benefit Plans/Switching Employer Insurance

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Question
Hello Shirley.  Not sure if you'll be able to help with this or not, but the company I work for has recently switched insurance carriers.  My wife has had several health problems throughout her life.  Long story short, she's had over 17 surgeries, most to correct a problem earlier in her life, and a few recently for other ailments.  Her problem is due to her long health history, she's been on pain meds for the past 12 years.  They have been prescribed to her by a highly recommended pain doctor (not some quack just pushing pain meds).  They originally tried several alternatives before coming to the meds and dose that work for her.  Our new insurance company does not believe in pain meds (they are expensive) and prefer a more holistic approach.  She has had her pain doctor and a few others write to the insurance company describing their stance on her need for the pain meds with no luck.  Her last appeal has been denied.  Her pain doc is not in our new network.

SHE IS NOT A DRUG SEEKER as the new insurance company would have us believe.  I know she is an insurance companies nightmare, but bad things happen to good people.  She is very active, 5'5" and 122 lb., walks every day either outside or on a treadmill.  Without insurance coverage her meds will cost over $800/month.  While you may not be able to give specifics, if this were you, what would be your next step.  I'm open to out of the box thinking in this, but I don't see how a new insurance company can dictate what has worked for and kept her in good health.  Any advice is appreciated.

Answer
That's a tough one. Is your doctor in the network? If you not may have to get a doctor in their network and have him talk to your wife's doctor. Your wife's doctor can probably prescribe someone in network. If the doctor is in network his diagnosis should not be a problem. Otherwise getting private insurance is expensive but might be worth it in the long run. There are no longer preexisting conditions.

Shirley

Group Employee Benefit Plans

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Shirley McAllister, CPP, PHR

Expertise

I can answer questions about Benefits plans, Health and Retirement, Erisa, Hippa, Cafeteria 125, Cobra and 401K. I cannot answer questions about stock option plans or other retirement plans.

Experience

I have been 25 years with my current International company. I am the Health Plan benefit administrator and I am also the Retirement Plan Trustee. I am the Human Resource Director.

Organizations
SHRM APA

Publications
I.O.M.A. B.N.A.

Education/Credentials
PHR in Human Resources CPP in Payroll

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