Crohn's Disease Forum » Ulcerative Colitis Forum » Health Insurance & GI Costs


05-24-2018, 03:22 PM   #1
S7N!
 
Join Date: May 2018
Location: London, United Kingdom
Health Insurance & GI Costs

Hi All,

First time posting, Would any US citizens near to FL be able to help with some questions.

I am living in the UK and I am in the final steps of making the decision to move and live in Florida.

I am finding it very tough to get information on Health Insurance and medication for an individual with UC.

I have moderate to severe UC, Currently take 4x Pentasa daily, 1 x Humira Pen weekly. Seem to have a flare up once a year
Strangely a new one starting today.

As above can anyone with a similar condition give me an idea of the steps I would need to take in regards to be treated in case of a flare and also to get the Humira if needed. Though I must say I am doubtful if it is working and have probably started to become immune to it.

Being on the NHS system here, I get the treatments sorted for me.

Obviously, I know there will be costs (A LOT MORE) but just wanted an idea of what the might be and how to go about getting it all sorted before arriving.
(If it is even possible!)

Thank you for reading.
S7N!
05-24-2018, 05:11 PM   #2
my little penguin
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Join Date: Apr 2012

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Will you be employed in the US ?
Employers tend to provide health insurance as part of their benefits package with salary /vacation
Since you wonít be a US citizen insurance becomes tricky
If itís not coming from your employer

Medical health insurance covers some of the doctorís visits and hospital stays tests etc...
Prescription drug plan covers drugs like humira
But you would need prior authorization from the prescription plan
This can take months and must be submitted by the prescribing physician (GI)
It will takes months to get into a GI as a new patient 2-3 months is the norm
(For pediatric GI anyways )

One parent had a Dd work in Disney (Florida ) from Australia

I believe she bought international insurance and sent over humira (mother brought it by plane )

So prepare to take a few months to get the drug
And ask your future employer what insurance they offer to non us citizens
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05-24-2018, 05:32 PM   #3
S7N!
 
Join Date: May 2018
Location: London, United Kingdom
Hey,

Thanks for your reply.

No employer, one of the very little ways to get into the US is an E2 Visa in which I buy a business and become the employer.

So I would say not to that for now.

So, I am likely going to have to wait months to see a GI

Any idea on costs for an individual with this condition annually?
05-24-2018, 06:24 PM   #4
my little penguin
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Join Date: Apr 2012

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It depends
Without insurance
Humira is approximately $3000 a box (2 syringes)
GI appt $200-400 for one appt

Here is a company (no idea if they are good bad or indifferent )
But has a flow chart for green card holders etc..,,
https://www.visitorguard.com/obamaca...nd-immigrants/

Basically you will need to google
Health insurance for non us citizens
Since that is a very special category

Far different from a us citizen or employer sponsored
05-24-2018, 06:25 PM   #5
my little penguin
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Join Date: Apr 2012

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Oh and routine blood work that is required every 3-4 months
Runs around $1000 or more
05-24-2018, 06:40 PM   #6
S7N!
 
Join Date: May 2018
Location: London, United Kingdom
Wow, that is a great link.
I wasn't ever considering entering without insurance, my condition like most of us has a mind of its own... Its fine for a while and then boom, things get a little rough >.<

I followed the Visitors insurance link on there and noticed that for myself, spouse and children I could buy insurance for:

TOTAL: $3,414.60 for
13 month 1 days of coverage

Co Insurance Information:
In network, plan pays 90% of the first $5000, then plan pays 100% up to policy maximum per year

Deductible:
250 annually

Pre Existing Conditions Information:
Covered up to $50,000 up to age 70 for sudden unexpected onset of non chronic pre-existing conditions.

Forgive me for being incredibly uneducated in this area but does that not seem a little to cheap?
05-24-2018, 06:54 PM   #7
my little penguin
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Join Date: Apr 2012

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$50000
Isnít going to cover much especially if they are out of network
Network means the insurance company and hospital /doctors have agreed upon pricing
So ďlowerĒ cost is charged or accepted as payment

Out of network means the hospital /doccan charge a higher amount
And any amount not covered by insurance you are responsible for
Which can be in the thousands


Also most ďcheap ď insurance do not cover expensive procedures or expensive drugs like humira

Itís hard to get coverage for biologics in the US even with good insurance

Even the same brand name commeryinsurabce in the us -blue cross blue shield is a big company
Has bare bones covers nothing insurance
To the elite plans which cover a lot (but still not every thing )

Fecal caloprotectin tests are generally not covered by any insurance
($150-300) per test

Insurance has a deductible which is the amount you pay out of pocket prior to the insurance covering anything
Sometimes labs count towards the deductible
Sometimes they donít
Once you hit the deductible for the year(resets every year)
Then the insurance pays up to 70,80,90% of the total bill
And you pay the rest
Thatís if they consider the procedure /test /doc appt covered
If not you get the whole bill

MRE can be up to. $10000
Add in scope /doc appt and blood test and your insurance is maxed out

For us citizens (at least for now ) insurance is NOT permitted to have maximum payout per year or lifetime

Hope that helps
05-25-2018, 03:11 AM   #8
S7N!
 
Join Date: May 2018
Location: London, United Kingdom
Thank you again.

It does help indeed. It is really tough as my decision on coming to the US is currently based on the outcome of the Insurance.

I think I am best off contacting a few different companies and see what they say, though I have done this in the past and they were not overly helpful.

With the above information in mind, I will try and work out what cover is needed as a rough idea.

Could always go back to the UK for a few weeks
05-25-2018, 05:03 AM   #9
my little penguin
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Join Date: Apr 2012

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Pre Existing Conditions Information:
Covered up to $50,000 up to age 70 for sudden unexpected onset of non chronic pre-existing conditions.


Just re read this
I bolted the non chronic pre existing conditions

Crohns /UC is considered a chronic pre existing condition
So odds are any treatment would NOT be covered

Call different companies and get clarification

But I think that is going to be the main issue

In past in the US insurance used to be able to deny coverage for pre existing conditions
The way the laws are written for now they canít for us citizens
But apparently for non citizens they still can

So the insurance would only cover your other normal person sickness (flu colds etc..,) and nothing from UC if I read that right
05-25-2018, 05:46 AM   #10
S7N!
 
Join Date: May 2018
Location: London, United Kingdom
Oh no that's not good.

05-25-2018, 06:55 AM   #11
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
To give you an idea employer sponsored insurance
The employee can expect to pay typically 5000-10000 per year in premiums
Woth the employer paying the rest

When you are a single self employed the rate goes way up
High deductible high max out of pocket low premium plans rarely cover anything
And are only for those who are healthy

Those that are sick
Need low deductible high premium low max out of pocket plans

Best of luck
05-25-2018, 07:01 AM   #12
my little penguin
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Join Date: Apr 2012

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What is the Acute Onset (or recurrence) of a Pre-Existing Condition?
The Acute Onset or Recurrence of a Pre-Existing Condition is the sudden and unexpected outbreak, or recurrence, of a Pre-Existing Condition which occurs without warning. It is typically of short duration, rapidly progressive, and requires immediate care. For coverage to be effective, the Acute Onset of a Pre-Existing Condition must occur after the effective date of the policy. Plans offering benefit will typically require that treatment be obtained within 24 hours of the sudden and unexpected onset or recurrence. Important: A Pre-Existing Condition that is chronic, a congenital condition, or that gradually becomes worse over time will not be considered Acute Onset. Further, plans would exclude coverage for known, scheduled, required, or expected medical care, drugs or Treatments existent or necessary before the Effective Date of coverage.

From

https://www.internationalinsurance.c...conditions.php
05-25-2018, 03:05 PM   #13
S7N!
 
Join Date: May 2018
Location: London, United Kingdom
Hey,

I filled in a few forms last night and as you would expect I have had emails from a few reps trying to follow up the lead.

I have replied and asked them to call me, a few of them are also based in the UK so I may be able to get them to explain it a little easier for me to understand. Coinsurance, deductibles, out-of-pocket all gets a little confusing lol

Tuesday I expect a call, I will let you know what is said. any other questions you think may be worth asking?

Oh and back on the Prednisolone for a week... fingers crossed huh


Thanks
08-19-2018, 10:41 PM   #14
garryg
 
Join Date: Aug 2018
Location: Georgia
So much good information in here! Thank you!

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