Health Insurance and Coverage Questions

[Insomniac]

Seems like there is a good mix of people on here from different countries/regions/backgrounds so I thought I'd put the question to all of you.

Many people in the U.S. have health insurance through work, and the coverage can vary drastically. I'm interested in a part that I would guess, most people don't look very closely at, and probably doesn't mean much until you need it.

Physiotherapy (physical and occupational therapy) coverage is what I'm wondering about. I have a need for it, but my problem is the amount I need (spinal cord injury), I can't get. So any benefit I get is basically lost year to year. I've had a few insurances, and the coverage has varied. 60 visits a year, 30 visits per condition per year, 30 visits maximum lifetime and for 1 year I had 30 visits that could be extended based on "medical necessity".

For those of you in the US, what kind of coverage do you have? For those in other countries, if you have universal health care, what kind of coverage do you get? I appreciate any information you can share.

[jonovision_man]

For those of you in the US, what kind of coverage do you have? For those in other countries, if you have universal health care, what kind of coverage do you get? I appreciate any information you can share.

It varies from province to province in Canada, but in Ontario it is no longer covered.

There are exceptions - if you're under 20, over 65, are disabled, or suffered your injury as a result of your work, for example. And if you're in a car accident, it's covered as part of your auto insurance.

Most people in Canada who work have coverage from their work health insurance, which is private insurance much like U.S. insurance to cover those things health care doesn't: Prescription drugs, dentistry, physio/massage therapy, eyeglasses... so it would be quite similar to what you have I'd imagine.

jono

[Ankf00]

i have similar limits on physiotherapy in my plan

[cameraman]

We have double coverage. Both plans cover outpatient physiotherapy so between the two we are set.

[Insomniac]

I appreciate you guys responding.

[Insomniac]

We have double coverage. Both plans cover outpatient physiotherapy so between the two we are set.

Double coverage is a weird thing some times. I remember having it at one point. My primary covered 85% of something, and the secondary covered 100% (I think). In any case, between the two, it wouldn't be covered 100%.

[cameraman]

An interesting quirk in the law, at minimum here in Utah, is the method they use to determine whose policy is the primary insurance for your kids when you have double coverage. It will be the policy of the parent whose birthday comes first in the year. It doesn't matter which policy would be the better financial deal for the parents, it is 100% the dob of the parents. :shakehead

[Spicoli]

Go work for the government. The pay sucks, but you get a lot of days off and the ins coverage rocks. :thumbup:

[Insomniac]

Go work for the government. The pay sucks, but you get a lot of days off and the ins coverage rocks. :thumbup:

I hear this often. I recall looking into it, and the health plan didn't seem any better. Maybe I should look into it again. I can live with a pay cut and the lame work if I can get unlimited physical therapy.

[cameraman]

Go work for the government. The pay sucks, but you get a lot of days off and the ins coverage rocks. :thumbup:

That be very true of the Federal Courts & University of Utah.

Got to admit the insurance (and God knows the salary...) was better at the high dollar law firm but the vast reduction in stress of switching to the Court system was worth the cut.

[Spicoli]

I hear this often. I recall looking into it, and the health plan didn't seem any better. Maybe I should look into it again. I can live with a pay cut and the lame work if I can get unlimited physical therapy.

Yep. In our case, I make better money than wifey, BUT she has better benefits (and job security :p) than me. I'm 1099 now, and have no 9-5 responsibilities, etc. The freedom in my schedule + benefits of hers make it a win - win.

One of the things that negotiated me a better pay plan was NO helthcare, etc.

Her government plan has wekend a little ove the last few years, but its still better than anything you can get (within a decent payment) in the private sector. And IIRC, they HAVE to take pre-existing consitions in Gov.


good luck.

[Insomniac]

Yep. In our case, I make better money than wifey, BUT she has better benefits (and job security :p) than me. I'm 1099 now, and have no 9-5 responsibilities, etc. The freedom in my schedule + benefits of hers make it a win - win.

One of the things that negotiated me a better pay plan was NO helthcare, etc.

Her government plan has wekend a little ove the last few years, but its still better than anything you can get (within a decent payment) in the private sector. And IIRC, they HAVE to take pre-existing consitions in Gov.


good luck.

Thanks Spicoli. I took a look at the OPM (http://www.opm.gov/insure/07/planinfo.asp) web site to see what the Health Plans they offer said. No luck with the national plans, KS (where I live) or WV (the company I work for now and have a lot of government contacts). The most I saw was 60 days. And they all said "no long-term rehabilitation".

It's funny though. The American Physical Therapy Association's web site says:


Is physical therapy coverage adequate? If you should have an injury or illness requiring rehabilitation, you will need a plan that offers an unlimited number of visits to a physical therapist or that allows for the number of visits to be extended if needed.

I asked them if they could tell me where I can find that plan. Right now, I think I have a couple choices. Try to get a job at a Rehab facility like Healthsouth or get a hold of a head hunter and tell them the only thing I'm looking for is unlimited physical therapy.

It's crazy that the whole purpose of "insurance" is for catastrophic events and the majority of people who need a significant amount of rehab, won't be able to get it.

[cameraman]

The sixty day limit for us is for inpatient pt/ot rehab. On an outpatient basis pt/ot rehab is essentially for as long as it is deemed medically necessary.

[Insomniac]

The sixty day limit for us is for inpatient pt/ot rehab. On an outpatient basis pt/ot rehab is essentially for as long as it is deemed medically necessary.

That's really good. Who is your Health Plan provider?

[cameraman]

University of Utah/Blue Cross or Valucare plans

[Spicoli]

Thanks Spicoli. I took a look at the OPM (http://www.opm.gov/insure/07/planinfo.asp) web site to see what the Health Plans they offer said. No luck with the national plans, KS (where I live) or WV (the company I work for now and have a lot of government contacts). The most I saw was 60 days. And they all said "no long-term rehabilitation".

It's funny though. The American Physical Therapy Association's web site says:



I asked them if they could tell me where I can find that plan. Right now, I think I have a couple choices. Try to get a job at a Rehab facility like Healthsouth or get a hold of a head hunter and tell them the only thing I'm looking for is unlimited physical therapy.

It's crazy that the whole purpose of "insurance" is for catastrophic events and the majority of people who need a significant amount of rehab, won't be able to get it.

Insurance coverage is a VERY frustrating experience.

I know that when I had decent coverage during my L5 Microdisc, the plan wanted me to FIRST go through PhysTher, then cortisone shots, then surgery as a last resort. What they DIDN'T tell me was that they only covered 50% of my outpatient visits for PT. That completely set me off, as I got a bill for about $500 co-pay after some 8 half hour 3-a-week PT visits. My doc rec's surgery after seeing my XRays (I took a fall about 10 feet straight onto my SeaDoo GTX after launching off a 8-10 foot roller off the jetty at our place on Lake MI - OUCH! :eek: ) but the "plan" wanted me to go through all this "cheaper" stuff first. I had Sciatica - was the worst thing ever. Yeah, they send you the cheapest route first, not what necessarily is the best treatement.:rolleyes: I'm sure everyone here has stories about similar experiences.

PT works well for some things, and is a rip-off for others. But re-reading your first post, sounds like with a Spinal C injury, you know what works and PT is it.

Brainstorming: Maybe try to find a company that is PT related and see if you can work out a position with them - IT, Sales, Admin, whatever. Its obviously cheaper to the employer to "barter"/negotiate your PT needs with an employer if PT is one of their offerings. It could be a Hospital, PT clinic (there are thousands of them) PT school/university; or a company that sells merchandise/supplies/equipment to a PT provider.

Just some thoughts.

[Joelski]

I work for a healthcare system that includes two area hospitals. They refer to therapeutic services as complimentary medicine, and services such as massotherapy are now included under our coverage as well as discounted and encouraged by the hospitals in order to keep staff "on their feet". Massotherapy in particular is covered at a reduced co-pay of $10 per hour! Complimentary medicine which also includes aroma therapy, hypnosis, and lifestyle improvement classes, has only recently been recognized by many health insurance organizations as valid preventive healthcare, and the company I work for really embraces it. They see a huge benefit in decreased illness and lost time injuries.

[Ankf00]

No idea what you do at UTC, but if you're in tech or prod ops maybe check over at RTN. I have yet to meet an ex-emp who didn't rave about the benefits after switching over to LMT, BA, LLL...

[Insomniac]

No idea what you do at UTC, but if you're in tech or prod ops maybe check over at RTN. I have yet to meet an ex-emp who didn't rave about the benefits after switching over to LMT, BA, LLL...

I don't work at UTC. :) I can check into Raytheon again, at least when I graduated in 2000 they didn't have anything spectacular as far as the health plan went. The hours (80/9) and environment out in Tucson were quite nice. Although, given the war, I'm kind of relieved to not have been doing work on missiles. I'm okay with helping NASA with IV&V (although it's getting quite boring/simple now).

Anyone know or recommend head hunters in the high tech industry? Might as well put someone to work for me.

[Insomniac]

Insurance coverage is a VERY frustrating experience.

I know that when I had decent coverage during my L5 Microdisc, the plan wanted me to FIRST go through PhysTher, then cortisone shots, then surgery as a last resort. What they DIDN'T tell me was that they only covered 50% of my outpatient visits for PT. That completely set me off, as I got a bill for about $500 co-pay after some 8 half hour 3-a-week PT visits. My doc rec's surgery after seeing my XRays (I took a fall about 10 feet straight onto my SeaDoo GTX after launching off a 8-10 foot roller off the jetty at our place on Lake MI - OUCH! :eek: ) but the "plan" wanted me to go through all this "cheaper" stuff first. I had Sciatica - was the worst thing ever. Yeah, they send you the cheapest route first, not what necessarily is the best treatement.:rolleyes: I'm sure everyone here has stories about similar experiences.

PT works well for some things, and is a rip-off for others. But re-reading your first post, sounds like with a Spinal C injury, you know what works and PT is it.

Brainstorming: Maybe try to find a company that is PT related and see if you can work out a position with them - IT, Sales, Admin, whatever. Its obviously cheaper to the employer to "barter"/negotiate your PT needs with an employer if PT is one of their offerings. It could be a Hospital, PT clinic (there are thousands of them) PT school/university; or a company that sells merchandise/supplies/equipment to a PT provider.

Just some thoughts.

I competely understand where you're coming from with regards to health insurance and the effectiveness/non-effectiveness of PT. It will definitely depend on what the problem is, and I think the therapist as well.

In my case, there isn't anything surgical that would help me. My injury is incomplete and PT helps to get me going in the right direction. I need to get to a point where I can at least maintain my improvements thorugh normal daily activity so I can leave PT and not come back months later right back where I started.

Right now, I'm trying to figure out if I should look for a job with better benefits (or a higher salary, say an extra $20k net), figure out a way to make more money (start my own business or become a trader) or take Michael Moore's advice and find a province in Canada that allows unlimited PT and hook a canuck (http://www.hook-a-canuck.com/). ;)

[Ankf00]

I thought you were at Sikorsky...

9/80's are allsome if you have a <15min commute, 2 long weekends a month :thumbup:

[Insomniac]

I thought you were at Sikorsky...

9/80's are allsome if you have a <15min commute, 2 long weekends a month :thumbup:

Almost did, but decided not to. May've been a good thing since the position was to work on the displays in the cockpit of the Comanche.

And you get a "short" day on the other Fridays. They also have a Christmas shutdown.

[Ankf00]

well that sucks, the only other "short day" 9/80 I've heard is is L-3, and they only switched to that last year. RTN & LMT still do a solid 9/80.

the xmas 2 weeks is money http://www2.hornfans.com/wwwthreads/images/icons/smokin.gif