Scenario: You have a child with a catastrophic disability

Are you entitled to help from the government to pay for your medical bills? Are per-child caps on catastrophic disability subsidies moral? Is there a reason why parents must pay out of pocket before being reimbursed for their child's medical bills, or should parents be able to receive medical care with the expectation that the government (state or federal) will help them pay for it?

no handouts...and we can't change insurance coverage or they will not receive care. We suffer with ridiculous insurance increases.

I mean, doesn't the Health Insurance Portability and Accountability Act of 1996 (thank you Clinton) limit the exclusions on pre-existing conditions for participants in a group plan? Can you change carriers for the entire company?

Nothing to stop them from raising the rates on all your employees - that totally stinks. I take it you are a small business owner and this is really hurting you and all your employees. Something must be done.

father in law was insurance agent before his death and said he tried to do everything he could...he wished he had gone into another field as found insurance companies so greedy and unethical.

Does indeed guarantee you cannot be denied health coverage if you switch from one insurer to another. However, it does *not* provide provisions that keep insurance companies from significantly raising the premiums for those who have conditions that meet HIPAA's requirements.

Likely if this family did attempt to switch insurers themselves, they could face a greatly increased premium though they would have a new coverage policy that would include a "renewed" cap ($1 million caps are pretty much standard to most health insurance plans). I do not however know if or how much more the employer would have to pay out if he/she switched insurance providers. Although I'm pretty sure the employer would not be legally allowed to disclose private medical info on the employees and their families, it wouldn't surprise me if the insurance companies are somehow excepted by law to be allowed to share this type of info so the new insurer can determine the new premium rate. Does anyone know if this is true?

I'm assuming this family has applied for and been denied SSI Disability? There are a number of exceptions and financial formulas used to determine eligibility for SSI so it might not be a waste of time to re-apply, especially if the mom can show that she had to quit a job to care for the child. SSI is based on the child's income level (adjusted according to the family's situation - family size, net income, cost of living in their area, etc.) and the impact of the medical issue on the child's life functions. Severe heart defects requiring constant medical monitoring *can* qualify, especially if the family can show hardship due to medical costs related to the initial disabling condition. The more thorough the financial and medical information the family can provide, the better a chance the family has to be approved for SSI.

If the child qualifies for SSI, the child also automatically qualifies for either Medicaid or Medicare coverage, and *this* is the real reason families of disabled kids bother with the application process for SSI. We had SSI for our disabled child for several years and used Medicaid as a secondary coverage to my husband's insurance coverage through his employers. We didn't even have to pay co-pays for regular doctor check-ups as Medicaid covered all costs that insurance did not (a wonderful help when your child sees 6 different specialists).

It may also be worth investigating if their state has an income exception for families with disabled children in it's CHIP program, allowing them to buy coverage from CHIP. I don't personally know of any states that do this, but it can't hurt to try to find out if it can be done.

Hope this helps...

coverage on account of this one child? What state are you in? Does the state have a catastrophic disability act?

and not to my knowledge.

which it sounds like what you're talking about? A couple has a disabled child...they have ins. coverage, but there's a cap on it? That sort of thing? Or do they not have ins. at all? Are the parents poor or wealthy?

Not enuf info. But if the parents are wealthy, no reason that my tax dollars should pay for their child's illness, right, when they can pay for it themselves, after the ins. coverage runs out?

that doesn't discriminate on the basis of wealth? It's possible that there's a good reason to do so. I'm just asking.

This question is based on a scenario I learned about recently at work. The child in question has spina bifida and was hospitalized for 17 months, partly because during the hospitalization he developed a bed sore. The child is only 12 years old and the family has $7,000 left in their catastrophic disability program account until he's 18. I think the cap is $1,000,000, so this tells you how quickly families run through their allotment, especially when health care costs sky rocket. The family has to pay out of pocket before they're reimbursed. The mother doesn't work because she has to take care of the child. It's a mess!

(at least for smaller co's.) To shop your health policy, you must provide a list of employees & covered dependents plus their ages(not their names--that would be an invasion of privacy!) and any past high-claims, future claims (say one employee's wife is pregnant)you might have knowledge of, etc. Insurance carriers who see a preemie or older employees or anybody requiring ongoing care on your roster will generally refuse to even QUOTE for you.

Once the family exhausts that baby's million dollar lifetime cap, there's usually a state-funded program available. Not sure of the details, jsut that my cousins twins (not preemies, either--) hit their caps by the age of 2, and the state of Indiana picks up a lot of it now, somehow.

If they fire the employee with the million dollar baby (or the employee quits or switches to a non-benefit eligible status) can they then apply for new insurance?

And if this person is then rehired when the new insurance policy is already in place...



I guess I'm off track. The point is how screwed up our country is that a family should have to go bankrupt, and a company's financial security (and that of all of its employees) is threatened because of a sick child.

in the US toward people in need SUCKS. To put it less incitefully, I think our attitude has changed radically. There was a time in the mid-century when I believe it was taken for granted that Americans owed each other the opportunity to have a decent quality of life. This may have been more an ideal than a reality, but I think it was based on an ethic that was real. This ethic has been steadily vanishing since the Reagan era, and the Bushist era has all but killed it. It's now taken completely for granted that it's tough shit what you're going through but I've got mine, Jack. Compassionate conservatism dictates that families in such straits go get succor at church--and if they're not religious, tougher shit. The ethic has changed. Or better put, the ethic has disappeared.

money, while others do not, because they don't have money. This happens a lot in our society. For example, I don't get a free meal from the Salvation Army at Thanksgiving because I'm not poor. But if you're poor enough, you do. Nothing discriminatory against me in that. I have the $$$ to buy my Thanksgiving dinner.

This is the way Medicare works, also, for some things, I understand. Medicare won't pay for a nursing home for an elderly person, until that elderly person has run out of most of his/her personal assets.

Social programs are to benefit those in need. We don't currently have a national social program to pay medical expenses for the poor, do we? So it really is up to a person's insurance company to devise the rules, such as you must pay out of pocket and then the ins. co. will reimburse you. They have to cap expenses in order to project costs, in order to set premiums.

This is one of the good arguments for a national health program. But then, under some national health programs, the option for such specialized care just wouldn't be there in the first place. Too expensive. And cost providers would leave the business before outlaying expensive treatments for minimal $$$. But even with national health programs, the wealthy always have the option of buying their own private insurance.

This is a sad situation for sure. But for the grace of God go I, huh? I guess what happens when the ins. runs out is the family spends/sells its assets, and then applies to the state for state-paid care.

indigent to get help.

Been there done that.. no one helps you, you just kind of struggle along until they are an adult and they are the indigent one.

Society should help those that are disabled before the parents are ruined.

I will never retire with any amount of money because of it.

but the individual's and the family's. I'll bet most DUers, even, have bought that. But why should this be the case? (I'm not asking you, of course.) I don't think it would be the case in any other society than a modern "liberal" industrial democracy. Or else it's just this particular illiberal one. I wonder what the policies are like in Canada, Asia and Europe.

Do you and the small number of other people in your city to whom that happens divide the entire budget of the fire department among yourselves, or does everyone pay for fire protection?

There is no goddam reason why medical catastrophes should be treated any differently. The biggest and cheapest medical risk pool of all is the entire population of the country!

:toast:

They talk all about letting the markets handle everything. Unfortunately, markets are primarily concerned with dollars and cents, not human compassion.