Diabetic Canadian Fiance Currently on Disability

[MelissaAndJordan 5]

I sent a letter to Blue Cross/Blue shield stating my husband is a UK citizen and has had NHS his entire life so there should be no issue with proving he has had credible coverage and is therfore not subject to pre ex. They responded stating that in anticipation of a federal mandate they no longer have pre ex for any members. A lot of insurers are mirroring "Obama care". for ex my daughter is 23 and we just found out she can remain in her father's plan until she is 26 in anticipation of the new legislation.

I am assuming he is on a pump? If you get it through a specialty pharmacy vendor it will be less. If you can give me the specifics (model #, number of each supply, your insurance co, PPO network, pharmacy and state I can get pretty accurate estimate)

btw I am a nurse (since 83)and have been working for an insurance company dealing with ERISA/self funded plans for over 10 yrs- feel free to PM me.

Right. Now they aren't denying coverage for preexisting, but instead are increasing premiums and doing waiting periods for preexisting conditions. That blew me out of the water when I got the insurance. I was quoted at $150/mo and then when they looked at it and saw that in an accident 4 years ago I broke my ankle, they bumped it up to $200/mo just in case anything ever goes wrong with it. Well, you best believe that in a couple more months after I am through my 12mo waiting period for preexisting conditions that the metal in my ankle they had to put in which I inevitably seem to hit on the corner of my bed everyday causing the excruciating pinch because its metal my skin then more metal, will be coming out. I am getting my extra $50/mo worth

Right now we order through americandiabeteswholesale.com. They are pretty good, and if his pump supplies aren't covered then we are totally prepared to take on that cost (just really don't to have to)

[MelissaAndJordan 5]

I am type 1 diabetic as well. Having diabetes was no problem in getting my visa. When I got here and was added to my husbands existing insurance (Cigna at the time) they required a letter stating I had received health insurance coverage up to the time immediately prior to being added to my husband's policy or any diabetic expenses I had would not be covered for one year. I had OHIP plus additional insurance that covered prescriptions, dental, vision and such through my employer in Canada. I was actually fortunate because I had enough overtime and holiday time saved up that I was still 'on the payroll' for another month when I moved here, and my health insurance continued for 30 days after my last 'official' day of employment so there was actually an overlap of coverage for me. I obtained a letter verifying my insurance coverage dates from Sun Life and printed out the information about OHIP and submitted that. I was covered immediately and the premium was the same as for adding a family member who wasn't diabetic. When his employer switched plans to BlueCross Blue Shield, Cigna automatically provided me with a letter verifying coverage and I submitted that with my first claim.

So, if there will be a time between when your fiance leaves Canada and his provincial coverage and the time you are able to enroll him on your plan, you might want to investigate purchasing short term 'bridging' health insurance for him so that he is never without some sort of coverage. That will pretty well ensure that your insurance company won't be able to deny him coverage for the one year pre-existing condition clause. He will just need to be able to prove he was covered.

Depending on your plan, you can expect your premium to increase but you will also face additional expenses even with coverage. Diabetes is not a cheap condition and is more expensive in the US than in Canada. (My copays for some of my supplies is virtually the same as the cost of the whole item was back in Canada before reimbursement). He will have deductibles to meet, co-pays and non-covered costs related to his diabetic supplies to cover. These vary between plans so you really do need to talk to your provider - no one else is able to tell you what to expect.

Most insurance companies also have their 'preferred providers/suppliers' which may not be the ones that the doctor wants him to use, which means that he may have higher co-pays for certain medication and supplies. I am not on a pump so have two different types of insulin, one of which is not their preferred insulin - however, it is the one that works -( not all insulins works the same as there are variations in time of action from very quick to very slow.). My test strips are also not the ones my insurance company primarily supports so I pay more for those, however, my glucometer is the best brand on the market and the one my endocrinologist (and I) want me to use due to accuracy and ability to track blood glucose records. The one the insurance company supports is not as accurate or as good and is better suited for those with type 2 who are not doing constant multiple times a day monitoring.

So, you do need to check with your insurance company about what they cover, how much of it they cover, and what their 'preferences' are with regards to brands. Your fiance will also be under the care of an endocrinologist (or should be) and will need, at the very least, quarterly appointments. The co-pay for specialists is usually higher than for regular doctors, and he will have tests done quarterly as well that will have a copay involved (monitoring long term glucose control, metabolic profiles, kidney function, etc.). Some may be covered 100% but most are not so there is the extra costs there as well. He will also need a yearly eye exam..

Most of diabetes is preventative care. Under control it really is not a hardship or a hindrance in life and someone with diabetes can do virtually everything a non-diabetic can do. The bigger problems occur when diabetes isn't controlled and can lead to some very serious complications that can include heart attacks, blindness, amputation and various neuropathies, and even death. While being on a pump is more expensive in terms of supplies, it is also the best way to keep diabetes under control.

Good luck.

Hi kathryn,

Thank you so much for your response. Jordan is very good as it regards preventative care. He does love the pump and won't have it any other way and after having him explain it to me I get it. And he has spent a good amount of time here and we have done all sorts of things. Probably about the only hindrance was when he was down in the summer and we had to time eating with going for a swim. He has also been great about teaching me about it and I have taken the time to learn as much as possible. I do get concerned because he has issues talking about possible complications of the future, but he has gotten better about that. I think the hardest thing for me was to stop worrying. I have gotten much better about not looking over his shoulder every time he tests his blood. I read a post somewhere where they felt that was a bit of an invasion and I totally understood it so now I only ask if I can tell it is spiking or dropping. He too has an insulin he prefers and it is so interesting to hear you say that as well.

And yeah, I have a list of all the types of doctors he needs and when he needs to go. Before he even gets here I am going to research doctors in the area. We are prepared for copays and what have you.

[MelissaAndJordan 5]

Thank you everyone for the feedback! I finally bit the bullet and called my insurance company. I will give specifics in case anyone else ever has a question about this.

Jordan will be covered as soon as he is on American soil using his Visa. Because of the type of policy he will receive, there will be no waiting period for pre-existing conditions.

When he gets here, we will apply to add him to my policy. Because he is insulin-dependent, he will immediately get denied. However, because we are in Virginia, they will offer him what the woman referred to as a back end offer policy. A lower deductible plan will cost $873/mo, higher deductible plan will be $663/mo. His test strips and insulin will be covered under the prescription plan after a $200 deductible. His infusion sets and reservoirs will be covered after the regular deductible.

They are sobering numbers, but I must admit that I had built up a nightmare-ish number in my head and this is way below that so, I think we are prepared.

Over Christmas we were at my Grandma's and she joked that he was just marrying me for the Visa and I replied trust me, he is type 1 diabetic, he would much rather stay in Canada if it weren't for love. I think all we should have to offer for proof of relationship is the insurance quote