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Mumto2
Blue Jay
Joined: Nov 27, 2007
Posts: 90
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 Posted: Mon Jun 09, 2008 10:28 am Post subject: just after advice as we are thinking of moving to the states |
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| hi my son has asd and adhd, we are currently waiting for him to go on stimulant medication to help him at school. We are currently thinking of moving to the States, nothing set in stone, Over here he will get his medication on the NHS, do you pay for medication in the States. I know this might sound really awful and I dont mean it sound like that but we want to find out about every single thing before deciding on what we do as our son is paramount. If the medication helps him I dont want to take that away if we move and find it hard to afford it... thanks for any help x |
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sinsboldly
Free Range Aspie
Joined: Nov 22, 2006
Age: 58
Posts: 8075
Location: Oregon, USA
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| Posted: Mon Jun 09, 2008 11:07 am Post subject: |
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do you know what State you will be moving to? State Agencies (and awareness) varies widely from State to State.
Merle |
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jat
Snowy Owl
Joined: Mar 30, 2008
Posts: 152
Location: Pennsylvania
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| Posted: Mon Jun 09, 2008 11:11 am Post subject: |
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There is no national health insurance in the States. What will be covered will depend mostly on your job(s) and the health insurance provided by your employer(s). For most people, there is a co-pay for prescriptions, and the amount varies, depending on the plan. The plan depends on the employer - and often the employee's choice (usually the employer has more than one choice, and the employee chooses the plan, but has to pay into it, at different amounts, depending on the plan).
In Pennsylvania, disabled children (including children on the autism spectrum) generally qualify for state medical coverage (medicaid) regardless of their family income. Once a child receives this coverage ("MA"), most medications are covered.
For all medications, the insurance companies have "formularies," lists of medications that are covered. If your child is taking something that is not covered, it can be possible to get it covered, but it is a lengthy, difficult process that includes demonstrating that the similar medications that are covered do not work. |
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Mumto2
Blue Jay
Joined: Nov 27, 2007
Posts: 90
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| Posted: Mon Jun 09, 2008 11:59 am Post subject: hi |
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| okay thanks for your help, we really need to do our homework before we make a decision, you have been very helpful. My husband wants to move to Florida, but like I said its just a thought at the moment and we really need to look into it properly. |
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jat
Snowy Owl
Joined: Mar 30, 2008
Posts: 152
Location: Pennsylvania
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| Posted: Mon Jun 09, 2008 12:52 pm Post subject: |
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| I would also look into the school situation very carefully. |
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EvilTeach
Sea Gull
Joined: Mar 15, 2007
Age: 48
Posts: 212
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| Posted: Tue Jun 10, 2008 11:39 pm Post subject: |
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You are in for a rude awakening.
The US currently does not condone socialized medicine.
Happily it keeps the taxes lower, and the quality of care higher.
In practice, health insurance is something you get via your job,
and can vary enormously in what it covers.
I recommend you consider Pennsylvania as your future home.
It appears to be an Aspy friendly state. |
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2ukenkerl
Phoenix
Joined: Jul 20, 2007
Posts: 4882
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| Posted: Wed Jun 11, 2008 6:27 am Post subject: |
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You should also tell us WHERE you are from.
As for insurance? FORGET what you have heard! Insurance is a GAMBLE! You basically bet AGAINST yourself. Think about it! The goal is that it is there if you need it. The insurance companies hope you will never need it, so you pay them for NOTHING!
The insurance companies EVEN have ODDSMAKERS(called actuaries)! Their ONLY job is to figure out how likely you are to have a certain condition, so they can set terms/price. Insurance companies HATE it when the odds are stacked AGAINST them!
Part of this type of thinking is that they LOVE to be able to say "Pre existing condition". In the US you can counter it by showing that you WERE covered elsewhere. I don't know if they accept foreign insurance. If they don't, then you will basically have NO insurance, EVEN if you are willing to pay! BTW I should know! I was without insurance for about a YEAR WITHOUT knowing it!
I had a card, and a number! They SAID I was insured, and they took my money! When time came for them to pay, they said THIS isn't covered, as it is a PRE EXISTING CONDITION. It took a couple months to get them to agree I WAS covered and thus they HAD to cover me!
FURTHER, the US is another government so they might not allow the drugs you want/need also.
FURTHER, and don't ask me why, drugs may go by ALIASES, so even if the drug IS here you may have trouble finding someone that knows what it is. |
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Mumto2
Blue Jay
Joined: Nov 27, 2007
Posts: 90
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| Posted: Wed Jun 11, 2008 8:27 am Post subject: |
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hi, we are in the UK, we have no private medical insurance as a family, obviously we are covered by the NHS. I just want people to know im not asking becasue we want to ponce of the state  - (thats something that seriously riles me) I just want to find out as much as I can for my son. I would like to say thanks for your replies  |
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2ukenkerl
Phoenix
Joined: Jul 20, 2007
Posts: 4882
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| Posted: Wed Jun 11, 2008 10:07 am Post subject: |
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| Mumto2 wrote: | | hi, we are in the UK, we have no private medical insurance as a family, obviously we are covered by the NHS. I just want people to know im not asking becasue we want to ponce of the state - (thats something that seriously riles me) I just want to find out as much as I can for my son. I would like to say thanks for your replies |
Yeah, I don't know if the US companies would honor that insurance. As I said, it CAN be a problem. You can't even TRULY believe ANYONE! As I said, I was TOLD I was covered until THEY had to do something. It then took like 2 MONTHS to get things straightened out. And this are complicated here. For normal insurance, the company might send you a bill, and also sends the insurance company a bill. It could take MONTHS for the insurance to pay. Until they DO, you don't know if they will. There are also deductibles(reset each year, and you pay up to this), percentages(they only pay a certain amount), and caps(once they hit a certain amount, they may not pay more).
HECK, I want RESIN fillings, and the insurance company won't pay for them unless you can SEE them. They WOULD pay for mercury amalgam ones though. Why don't they pay at all? Because THEY want the CHEAP ones!
So they pay based on:
1. is it a NEW condition?
2. Is it the cheapest alternative?
3. Do THEY think it is not overkill? If you need a new heart valve at 60, and the one that only lsts 6 years costs less, they will pick THAT one!
4. Is it medically recognized?
5. Do they feel you need it?
If they can't answer YES to all those questions, they may not cover a penny. |
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Triangular_Trees
What is right is sometimes found on the left.
Joined: Jul 18, 2007
Posts: 2053
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| Posted: Wed Jun 11, 2008 12:26 pm Post subject: |
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| 2ukenkerl wrote: | You should also tell us WHERE you are from.
As for insurance? FORGET what you have heard! Insurance is a GAMBLE! You basically bet AGAINST yourself. Think about it! The goal is that it is there if you need it. The insurance companies hope you will never need it, so you pay them for NOTHING!
The insurance companies EVEN have ODDSMAKERS(called actuaries)! Their ONLY job is to figure out how likely you are to have a certain condition, so they can set terms/price. Insurance companies HATE it when the odds are stacked AGAINST them!
Part of this type of thinking is that they LOVE to be able to say "Pre existing condition". In the US you can counter it by showing that you WERE covered elsewhere. I don't know if they accept foreign insurance. If they don't, then you will basically have NO insurance, EVEN if you are willing to pay! BTW I should know! I was without insurance for about a YEAR WITHOUT knowing it!
I had a card, and a number! They SAID I was insured, and they took my money! When time came for them to pay, they said THIS isn't covered, as it is a PRE EXISTING CONDITION. It took a couple months to get them to agree I WAS covered and thus they HAD to cover me!
FURTHER, the US is another government so they might not allow the drugs you want/need also.
FURTHER, and don't ask me why, drugs may go by ALIASES, so even if the drug IS here you may have trouble finding someone that knows what it is. |
My insurance company (blue cross, blue shield) claimed I never sent in the paper with the doctor's signature saying it was a pre-existing condition. Said it was accidentally left out of the envelope. Umm, how about the fact that it went into the envelope immediately upon the doctor signing it, and I didn't seal the envelope until I could hold it open and see the doctor's signature is I closed the flap.
To make it worse, because of their losing the paper, my ambulance ride was not counted as part of my deductible, other bills were. This cost me $500 that I wouldn't have had to pay had they done their end of the job and counted the ambulance into the deductible as it should have been, being as it was the first claim I had.
In addition, since they had the dates of my epilepsy prior to any claims being filed there wasn't one valid reason for them to deny the ambulance ride or some other treatments on the basis of pre-existing conditions (I even got the lady to admit that on the phone) |
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