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RNwithPD

Kick 'Em When They're Down

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Just wanted to share some frustrations with all of you and hope that you have better luck than I do. (WARNING: Long-winded rant!)

 

I changed careers several years ago after going back to school to get a degree in nursing, and started working for my current employer (a major hospital in my area) in the fall of 2008. When I started, I enrolled in the short-term disability insurance program and have been paying approximately $50 per month for it since. After being diagnosed with PD last summer, I started checking into my benefits package at work and discovered some disturbing information.

 

First, the short-term disability insurance is renewed every year and the insurance company asks questions at renewal about any changes in your health in the past year. A co-worker of mine went through the renewal process a few months ago after being diagnosed with MS just a few months prior to that, and they refused to renew his insurance after he had been paying for it for years! My renewal is coming up soon and I fully expect to loose my short-term disability as well.

 

Second, I started checking into our long-term disability insurance program and found that I don't qualify for it until after 5 years of service - which will be in October 2013. However, there is a pre-existing condition clause that states that if I have any pre-existing conditions in the 12-months leading up to the start of the insurance, those conditions will not be covered (i.e. they won't cover me if I become disabled due to PD).

 

Third, my wife and I work for the same healthcare system but have separate medical insurance policies. I couldn't cover her and my step-daughter on my insurance without showing proof that I am legally obligated to provide my step-daughter's health insurance - which I am not. So, we decided to just stay on separate policies at the time, not realizing that I would end up getting PD. The problem now is that if I should become disabled, I will lose my insurance and can't be covered by hers due to pre-exisiting conditions. As you all are probably aware, Medicare doesn't start coverage until 24 months after the date of approval for Social Security Disability.

 

SO....it appears that my career change and my PD diagnosis came together at just the right point in time to really screw me! LOL! If I become disabled, I will have no income and no insurance until I get approved for SSDI and Medicare. I guess I had better find a really good MDO specialist because, one way or another, it looks like I'll be working to age 67.

 

Again, I hope you all have better luck than me! :-)

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RNwithPD,

 

It seems like your employer disability program is practically worthless if you have to go through a health exam every year. I'm in the process of applying for Social Security Disability and I can tell you that it's no picnic either. Depending on your state, it can take 3 years to get approved. I hired an attorney after my first denial and she said that reconsideration (the second appeal) is almost always denied. It then goes to a hearing in front of a judge. That takes another 18 months to two years to get scheduled. If approved, I'm looking at possibly five years until medicare. Thankfully, in the early stage, this disease is not too expensive to treat. You might want to start documenting all of your symptoms and discuss your situation with your doctors so that they will support your SSDI claim. Best of luck.

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I agree with starting to gather documentation for an SSDI claim. It's a lengthy process and most get denied the first time around.

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I looked at my long term disability insurance: The only thing long term about it is the time it will take to get it. The language is some strange mixture of lawyer, doctor, insurance agent, and Social Security Disability Bureaucrat. When I originally signed up for it, it sounded perfectly reasonable. But now I realize that it’s written to benefit anyone but the person who needs it. I think it’s purposefully designed to get people to buy it and be extremely difficult to collect. I understand the need to defend against fraud but my policy seems to go way beyond that.

 

Ok, now that I’ve had my rant I feel a little better.

 

Thanks RNwithPD!

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Thanks for the replies. Ken: I came to the same conclusion. They make it look as though they're providing disability insurance but they're really not. They collect premiums until it looks like they're going to have to pay out and then they dump you. I'm considering consulting a disability/elder law lawyer for planning for the future.

 

Kevin

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Don't get me started!! When my case is out of litigation, I'll tell all, in the meantime suffice to say, I had long-term disability for 23 years, but when it came time to collect... apparently, 100% disabled is not disabled enough. $#%@##%%^*##!

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RNwithPD: are you certain u won't be able to get health ins thru your wife? In my experience group policies don't (can't?) exclude pre-existing conditions... Good luck!

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Xaxa,

I think you're right...especially considering that my wife and I are both employed by the same company. We're going to try it this fall during open enrollment and see.

 

I've also received some good news about the long term disability insurance coverage at work. They switched to a new insurance company effective July 1st and, according to the new policy documents, they will cover a preexisting condition after a 2-year waiting period effective after the first 5 years of employment. In other words, if I can make it 5 more years without becoming disabled, I will be fully covered by both short and long term disability insurance! Things are looking a little better!

 

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RN

 

Wrote a reply. Read it. Then erased it. Just rant, which is akin to whine.

 

As my friend says " $#%@##%%^*##!". Which translated means you are young, don't forget to enjoy yourselves. Right now.

 

roy g

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Ugh I feel your pain. I too work for a hospital and just started a new job in a new facility. We paid for Cobra x 4 months after being told that with a lapse in coverage they are more apt to look into your conditions before insuring you.

 

But assistance? My husband doesnt qualify for a thing, since he has not worked and paid into the system. Really annoying seeing how we (USA) pays so much for other people but won't for us since Im an RN and apparently make *coughs* too much money.

 

Yeah sure..

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Jody,

 

LOL...I hear that all the time. People think that nurses make a lot of money. In my opinion, CNA's should make what we make, and we should be earning about twice as much.

 

Kevin

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Kevin,

Are your insurance policies individual Policies or group policies through your work? If they are group policies then the insurer can not exclude individual members of the group based on pre-existing conditions, they must accept the whole group or none of the group. If these are individual policies which your employer offers at a discount then that would be diffrent. Also you need to figure in what type of employee you are, some employees in healthcare are actually independent contractors, so thier insurance is not part of a group policy even if they recieve as part of a benefit package. I would be curious to see how your insurance company is justifying it's practices. You might want to contact your state insurance commission if you are being excluded from a group insurance, that is illegal.

 

PS I'm I life insurance claims examiner, previously liscenced to sell health and life insurance in all 50 states.

 

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Donald,

 

I talked to the people in HR this spring and they said that I am fully covered by both long-term and short-term disability, but I guess the proof is in the pudding so to speak. We'll see what happens when I actually get around to trying to collect on my benefits.

 

Kevin

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Kevin,

 

Glad to hear you got some good straight answers, it seems that with insurance questions there is alot of fear that causes misunderstandings on how things work, alot of people don't understand that diffrent lines (Life, Home, Disability, ect)all work alittle diffrently and what you know about one type doesn't translate to understanding all of them. As an insurance professional I barely understand disability insurance as it isn't a line I work in, But one of my co-workers was an adjuster for disability insurance for years, I just ask her. Also don't confuse long term care and long term disability.

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Kevin - find out what your long term disability pays. I was fortunate that my former employer provided a long term disability benefit that pays me 60% of my then curreny salary til age 65. Since I was making 6 figures, the LTD payment is substantial and my husband agreed it was a no brainier for me. Good luck

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Be sure to get the "full plan" description from your employer's disability insurance carrier. We hadn't done that and had planned on 60% of salary plus SS disability plus a small pension. On our attorney's advice we requested the "full plan" as my husband was in the process of getting ready to retire on disability. We found (on page 34 of the "full plan") that my husband's employer's disability company pays the 60% only until you qualify for SS disability and then pays the difference between SS disability and the 60%. They do the same for the company pension. We were able to defer the pension until he turns 65 and will get a few more dollars a month. Apparently, this is a very common clause in employer's disability insurance plans, we just didn't know that.

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Golden,

 

I printed a copy of the disability policy the other day and it does contain the language concerning a reduction in benefit in the amount of SSDI payments. I also found that my HR department was wrong when they said that I'm fully covered (or will be when I reach 5-years of service in October and the plan becomes effective), even after I informed them that I had already been diagnosed with PD. The policy states that if I have a "preexisting condition" within the 6 months prior to the effective date, then no benefits will be payable for disability as a result of that pre-existing condition unless the disability occurs at least 24 months after the effective date. In other words, I won't have long term disability coverage for PD until October, 2015. I was watching some videos on YouTube the other day produced by a disability lawyer, and she said that it's a big mistake to trust your HR department because they are not lawyers and don't always know exactly what the policy says. In this case, she was definitely correct.

 

Kevin

 

Kevin

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One thing someone told to remember as my husband was going through the disability process is that "HR is not your friend", they are usually working to protect the employer's not the employee's interests. One of my husband's doctors encouraged us to think similarly about the disability companies. In our phone interviews, we worked from a written list of talking points that included the symptoms his doctor saw most problematic for him continuing to work (in some cases these were not the ones we saw as the biggest problems). We were amazed at how, usually through casual conversation, they would try to take us down a path that wasn't part of our script (Are you feeling better today?, What do you have planned for the weekend?, etc.). We found they knew nothing about PD.

 

Kevin, Would accommodation under the ADA act be something to consider between now and October 2015? Might ensure shorter hours, change in shift times, or different responsibilities, etc. Here's a link with information that helped us: http://askjan.org/media/PD.html

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I would add... be prepared to fight HARD if you have to. My insurance company refused to pay in the beginning and, eventually, I had to seek legal help. It didn't get to court because we settled (can't name the insurance company or the settlement amount because we negotiated a higher amount for a confidentiality agreement), but I was asked to prove that I was "sufficiently disabled" for benefits. What??! Well, they explained, although my doctors had signed me off as 100% disabled, they--the insurance company--felt I was something less than disabled because I could, generally, feed myself, communicate, and take care of my personal hygiene needs. So, basically, they felt they should only have to pay out if I were functionally, a vegetable--this, despite the fact that their policy said no such thing.

 

The point is, they turned me down four times before I totally lost the plot and contacted an attorney! Even THAT was a bumpy ride. I talked to three attorney's by phone who only wanted to know how close to a million dollars the settlement could potentially be, because anything less was not worth their time. I finally got an offer from the insurance company on my own, but to say it was an insulting amount is to understate it by a long, long way. I took the offer to a really cool attorney who negotiated a 1000 times better settlement and took lower than his customary fee because, he said, my case was so worthy.

 

So, here's the takeaway: Insurance companies want to take money, but they will do anything and everything they can to avoid giving any back, even when it is owed, so be relentless in pursuing what is due you. Read your policy very, very carefully!

 

Good luck to you,

Kim

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My husband has a small private disability policy that we paid premiums on since the early 1980s. It has been paying a monthly benefit since he retired on disability in April 2012. Last month, we got an offer from the company for a "lump sum payment" that would be a little more than half of what he would receive if we keep getting the monthly benefits until he turns 65. The letter was worded to make it sound like a good deal in case you were no longer disabled, you would have received this money. Since we know his PD is not going away, we thanked them nicely and turned down the "optional" offer. Yesterday, we got a letter thanking us for notifying them we had declined the offer and, in another envelope, an entire set of new forms for a "review" of his claim. Coincidence?

 

We'll fill out the forms, go see his doctors, check to be sure all the paperwork gets in, do any phone interviews, and he'll still be disabled from PD. I'm confident the monthly benefits will continue but why does it have to be so complicated?

 

Full disclosure - My husband was diagnosed when he was 50 so I guess I shouldn't be posting here but your topics and feedback are great!

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I am painfully aware of how the insurance industry operates. I've had homeowner's and auto claims before that I had to fight to get the proper payout. As far as accommodations are concerned, I am somewhat limited by the fact that I can't place an undue hardship on my employer. Because 12-hour shifts are the norm for nurses, if they cut my shifts back to 8 hours it would just mess everybody else up - so that's not an option. I can request that they only schedule me every other day so that I can rest between shifts (which they are already doing), plus a couple extra things such as not being pulled to other areas of the hospital, not being forced to be the charge nurse, etc. Eventually, though, I'll have to switch to a different position such as case management or nurse education. However, after reading my disability policy, I will make sure to switch back to nightshift on the unit and make sure that my last day of work is a weekend. My policy states that they DO include shift differentials when calculating disability payments, and that they calculate the monthly payment based on the last shift you work before becoming disabled. SO, if I work a weekend night shift and then file, I'll get about $6.50 more per hour calculated into my disability payments. Every penny counts.

 

Kevin

 

P.S. Golden...it almost seems that their "offer" was a veiled threat - either accept our 50% buyout or take a chance on losing your coverage.

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Whoo hooo!! Got all those pesky forms filled out and mailed to the disability company. We were slower than planned at getting them done. Keep your fingers crossed that we get the notice the benefits will continue. I'm confident this time around.

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