Disease-specific insurance coverage?

June 27, 2005 3:33 PM

I work for a small business and they told me I can pick my own insurance plan. I'm really having trouble narrowing the field. Is there a method for determining which insurance plan would provide the best coverage for certain diseases?

I have nothing to go by here except for the price. The plan has to be somewhere in the vicinity of $100-200/month. (It can be higher, but I will have to pay the difference myself.) I've looked at various sites and I am thoroughly overwhelmed.

Info: I am 25, no kids, and live in Missouri. So if any Missourians would like to recommend a plan or provider, that would be extremely helpful.

Mostly I need prescription drug coverage. But for the near future, I will probably need TMJ treatment and I am hoping to have ETS surgery. Both of these are treatments that insurance companies do NOT like to pay for. I found this, however it wasn't very useful because there is no mention of Missouri and some of the plans are from 2003. How can I pick an insurance plan that will be most likely to provide coverage for TMJ and ETS? Has anyone had particular luck in having these conditions treated? (The TMJ treatment might fall under the realm of dental insurance, therefore recommendations for plans that include dental or recommendations for separate dental plans would also be valuable.)

I know this question is fairly convoluted and far-reaching, thus any advice at all would be truly appreciated.

posted by anonymous to Health & Fitness (2 answers total)

I don't have much help for you but a quick google search brought me these:

Call your insurance company and ask these questions:

* Do you cover diagnostic services for TM Joint disorders? If so what services are covered?
* Do You cover TMJ treatment? If so, does that coverage include the "Treatment Orthotic"?
* If you cover some services, but not others, which services ARE covered, and which are NOT covered?
* Is there a Benefit Limit? If so, what is the limit?


and -

http://www.tmjoints.org/policy/policy.html TMJ Health Insurance Coverage Policies

and -
http://www.sweathelp.org/treatment/Insurance.asp

or

http://www.sweaty-palms.com/forum/archive/index.php/f-1.html


I would suggest calling each insurance company you are considering and asking specific questions and also posting to forums to inquire which insurance companies covered the surgeries.

Btw, I found these by typing tmj or ets + insuranance coverage. Good luck!
posted by LadyBonita at 5:38 PM on June 27, 2005

One thing to consider is signing up for higher-deductible plans (you pay for small things, or at least more for small things; the insurance company pays for higher-cost/catastrophic things). At least you should consider that if you expect ETS surgery to be expensive, and if you're sure that you can get a doctor to convince the insurance company that this is medically necessary.
posted by WestCoaster at 7:33 PM on June 27, 2005