Crohn's Treatment and Medical Insurance

[ImDan]

I am a UK citizen and have been offered a job and sponsorship into the US with 100% medical benefits.

I was wondering does this actually cover all appointment, treatment and medication costs of Crohn's?

Such as If I were to start a biologic would this be 100% covered or are there still costs for us individually?

 

[Lisa]

It depends on which health insurance plan/company you have. Health insurance companies here usually have documentation available to review showing what medical costs are covered, if there is full coverage, co-pay (set amount you are responsible for), hospitalization coverages etc.

For example, with my health plan I get through my employer, a visit to the doctor, lab work, x-rays costs me a $20- co-pay each, hospital admission $0-, Emergency Room visit $70- co-pay, but the best thing is my Remicade infusions are covered under my hospital benefits and cost me $0-! Other people have different plans where they have to pay a percentage, usually 20% of the cost.

 

[ImDan]

It depends on which health insurance plan/company you have. Health insurance companies here usually have documentation available to review showing what medical costs are covered, if there is full coverage, co-pay (set amount you are responsible for), hospitalization coverages etc.

For example, with my health plan I get through my employer, a visit to the doctor, lab work, x-rays costs me a $20- co-pay each, hospital admission $0-, Emergency Room visit $70- co-pay, but the best thing is my Remicade infusions are covered under my hospital benefits and cost me $0-! Other people have different plans where they have to pay a percentage, usually 20% of the cost.

Thanks so much for the info.

The details on my contract say:
"Dental, vision and medical insurance for you and paid 100%"

Do you think I still need to account for any costs with this?

 

[Lisa]

Yes, I read that as saying your insurance cost is paid, but you need to find out what insurance plan you will have and what the coverage is through it.

 

[Clash]

Until reading this I never thought about how hard it is to explain US insurance polocies.

I agree with Lisa, It sounds like the employer will cover your premium each month (cost of the policy).

So now you need to find out the set up of your policy.

Most plans have a deductible or an amount you have to reach before insurance starts picking up part of the tab. Our employer plan has a deductible of 500 dollars a year per individual or $950 for the family (whichever is reached first)

Some policies have a copay which is an amount that you pay at time of service, say like a dr appt. (We don't have a co-pay but I've seen some 20.00 up to 75.00 and it can depend on the service you are going to)

Our policy has an out of pocket max so after the deductible the policy pays 90% until we reach 1500.00 then it pays 100% from then on for that year. On our policy the $500 dollar deductible counts toward the out of pocket max so after we pay the first $500 the insurance picks 90% of the medical charges up to $1500 then it picks up 100% for everything over that for the year.

Also, note that in the US, remicade has a patient assistance program that is not based on financial need. Ifor you have insurance it will pick up your out of pocket expense for remicade. So insurance pays it part the remistart picks up the remaining part you would owe.

Lastly, along with health insurance there is prescription ins plans that with some employers is rolled into to health plan. Prescription plans pay the bulk of your prescription costs and leave you with a small percentage of it. With our plan we pay nothing over $10 bucks.

When my son was on Remicade the remicade infusions went through you medical plan and humira went through your prescription plan. That may have changed, tagging my little penguin to see if she knows.

Also, I think I remember the website How Stuff Works may have a good explanation of how US employer polocies work.

You can contact the HR dept of the company and have them connect you with a resource officer that can go over the meat and bones of their coverage as far as out of pickets costs such as copays, deductibles, coinsurance or out of pocket maxes.

Hope this wasn't too confusing.

 

[my little penguin]

Remicade goes through medical for most us insurances
And humira prescription plan
Bcbs of Massachusetts I believe is trying to or has switched to prescription for remicade


The thing to be careful of some insurance carriers and plans are better than others
So you could have a plan that pays 100% but ....
That is only 100% of the medical procedures and drugs etc that the plan has decided to include and cover .
Some plans only cover a few things and others cover a lot.
You would need to get a copy of the compete benefits booklet
And then check your employers /insurance website

Cost could be no premiums ( money from your paycheck monthly to have insurance )
So ask about that
Ask for deductible and what isn't included in the deductible
Some things still cost you money but don't count towards the deductible
Once deductible is met most plans do go to 80,90 or 100%.

We had a100% plan once
All visits hospital stays prescriptions and infusions were covered 100%
No cost out of pocket after deductible was met

But
Still had to pay premiums from each pay check
And nothing was paid by the insurance until after deductible was reached