Getting the axe from my job waiting to go under the knife
March 21, 2024 9:13 PM Subscribe
I've been approved for jaw surgery to take place in around 8 months after orthodontic treatment. I'm wondering what happens to my Kaiser HMO coverage if I am laid off before then and what my options are (if any).
I'm reviewing financial worst case scenarios after being approved for Double Jaw Surgery with Kaiser HMO.
The surgery will take place in around 8 months after I've had orthodontic treatment (again but I won't get into that, thanks previous orthodontist!) to move my teeth into the correct position. The orthodontics I will be paying out of pocket with some reimbursement from my work dental insurance.
The jaw surgery will be covered by Kaiser HMO with the usual deductions.
My predicament is that once the ortho starts then I have to follow through with the complete treatment. This combined with layoffs at work, being on a non-immigrant work visa and a not-so-great job market in the tech industry make me nervous that I will be facing a huge bill should I get laid off before the surgery takes place.
Should I delay the surgery until my situation is more stable? Either from an immigration or employment perspective.
I've heard of COBRA which kicks in when you lose your job but will that cover scheduled surgery?
I'm reviewing financial worst case scenarios after being approved for Double Jaw Surgery with Kaiser HMO.
The surgery will take place in around 8 months after I've had orthodontic treatment (again but I won't get into that, thanks previous orthodontist!) to move my teeth into the correct position. The orthodontics I will be paying out of pocket with some reimbursement from my work dental insurance.
The jaw surgery will be covered by Kaiser HMO with the usual deductions.
My predicament is that once the ortho starts then I have to follow through with the complete treatment. This combined with layoffs at work, being on a non-immigrant work visa and a not-so-great job market in the tech industry make me nervous that I will be facing a huge bill should I get laid off before the surgery takes place.
Should I delay the surgery until my situation is more stable? Either from an immigration or employment perspective.
I've heard of COBRA which kicks in when you lose your job but will that cover scheduled surgery?
Also please note it doesn't "kick in" you have to actively elect it, and then remember to pay for it every single month. I've had this conversation with four separate employees just in the past month so I guess it bears repeating.
posted by phunniemee at 9:26 PM on March 21, 2024 [3 favorites]
posted by phunniemee at 9:26 PM on March 21, 2024 [3 favorites]
Best answer: Two other options would be to purchase private insurance or explore the healthcare marketplace. One or more Kaiser Permanente HMO options will most likely be offered in places where Kaiser is present (which it obviously is, if you are getting it through your employer).
If you lose your employment that is a qualifying event for switching to marketplace coverage. That means there will be no pre-existing conditions & the same things covered now should be covered.
Now whether your prior authorization would transfer over to a different plan within the same company is a somewhat complicated question. You could call the company and ask them. But they are supposedly offering the same coverage so in theory if they approved it under your current plan it should be approved under a different Kaiser HMO plan because it is all generally the same providers, same rules, and such.
I'm pointing this out just because COBRA insurance is super expensive, about the most expensive way to purchase insurance, and there is the possibility you could save a whole boatload of money by switching to a marketplace plan, if Kaiser HMO is available in the marketplace in your area. Depending on your income etc etc maybe you won't save any money. But maybe you will save a lot and it isn't that hard to find out.
Just for example you can scope out plans on the California Marketplace here. About two minutes of poking around shows me that Kaiser HMO is one of the options.
Point is, it's worth checking out as a possible option.
posted by flug at 10:19 PM on March 21, 2024
If you lose your employment that is a qualifying event for switching to marketplace coverage. That means there will be no pre-existing conditions & the same things covered now should be covered.
Now whether your prior authorization would transfer over to a different plan within the same company is a somewhat complicated question. You could call the company and ask them. But they are supposedly offering the same coverage so in theory if they approved it under your current plan it should be approved under a different Kaiser HMO plan because it is all generally the same providers, same rules, and such.
I'm pointing this out just because COBRA insurance is super expensive, about the most expensive way to purchase insurance, and there is the possibility you could save a whole boatload of money by switching to a marketplace plan, if Kaiser HMO is available in the marketplace in your area. Depending on your income etc etc maybe you won't save any money. But maybe you will save a lot and it isn't that hard to find out.
Just for example you can scope out plans on the California Marketplace here. About two minutes of poking around shows me that Kaiser HMO is one of the options.
Point is, it's worth checking out as a possible option.
posted by flug at 10:19 PM on March 21, 2024
A bit tangential, but I was talking with a friend last night who was laid off last year while in the middle of a medical treatment plan. She was able to negotiate a longer period of coverage as part of her severance package. It might be worth having a conversation with HR if you are laid off, before you sign anything.
posted by Sweetie Darling at 2:37 AM on March 22, 2024 [7 favorites]
posted by Sweetie Darling at 2:37 AM on March 22, 2024 [7 favorites]
Best answer: COBRA is indeed a way to continue your health insurance if you are laid off. Also, some COBRA plans will let you continue JUST the dental coverage. That's what I did when I was laid off and I was facing similar dental surgery (I am still midway through the process of a dental implant, and my first of 3 appointments was one week before I was laid off myself). Buying insurance on the marketplace now might also be an option.
However - take a very close look at what the insurance actually covers first. I learned a bit too late that the dental coverage I continued through COBRA does NOT cover the very implant surgery I kept my dental insurance FOR, and I am going to have to pay $6K out of pocket. Fortunately I will be able to deal with that, but it was still an unpleasant surprise. (Oh well, at least I could keep my cleanings up between jobs.)
My point is that this may not be an insurance issue after all - apparently a lot of dental insurance plans don't cover major work like this (which is STUPID to me, but hey). So it may not matter whether you get laid off since the plan may not cover the surgery anyway; that's something you may want to look into now. That way, a) you can start saving up for the costs now if your insurance doesn't cover it so you're ready in 8 months, and b) if you do get laid off, you'll know whether the insurance coverage is or isn't an issue anyway.
posted by EmpressCallipygos at 4:38 AM on March 22, 2024 [2 favorites]
However - take a very close look at what the insurance actually covers first. I learned a bit too late that the dental coverage I continued through COBRA does NOT cover the very implant surgery I kept my dental insurance FOR, and I am going to have to pay $6K out of pocket. Fortunately I will be able to deal with that, but it was still an unpleasant surprise. (Oh well, at least I could keep my cleanings up between jobs.)
My point is that this may not be an insurance issue after all - apparently a lot of dental insurance plans don't cover major work like this (which is STUPID to me, but hey). So it may not matter whether you get laid off since the plan may not cover the surgery anyway; that's something you may want to look into now. That way, a) you can start saving up for the costs now if your insurance doesn't cover it so you're ready in 8 months, and b) if you do get laid off, you'll know whether the insurance coverage is or isn't an issue anyway.
posted by EmpressCallipygos at 4:38 AM on March 22, 2024 [2 favorites]
My partner literally just went through this; luckily he was able to negotiate continued insurance coverage with his severance package so that the coverage is uninterrupted through the length of his severance. However for the week that that was in question, he had been coming up with contingency plans with his doctors and they had suggested that COBRA would be the surest bet, but yes, terrifically, insanely expensive.
His doctors/hospital were more than willing to work with him though; they want to get you cared for and they want to get you covered so just be transparent with everyone about things and they will try to make it all work!
posted by We put our faith in Blast Hardcheese at 8:40 AM on March 22, 2024
His doctors/hospital were more than willing to work with him though; they want to get you cared for and they want to get you covered so just be transparent with everyone about things and they will try to make it all work!
posted by We put our faith in Blast Hardcheese at 8:40 AM on March 22, 2024
Best answer: COBRA coverage is month to month and there will likely be a limited length of time it is available to you. When I took COBRA in Pennsylvania, I had an 18 month limit I think. Not sure if it was a state, federal or employer mandate, so not sure what limit might apply to you. Your coverage will be seamless and function as though you were still employed and insured. For a complex high-dollar procedure it is probably worth it to continue this if at all possible. To a new insurer the fact that Kaiser approved the procedure will be irrelevant, and they will have to approve it all over again for them to cover it.
My son had jaw surgery performed by an oral and maxillofacial surgeon (someone who was a fully-qualified oral surgeon as well as an MD surgeon) and it took some effort and time to have the procedure approved, not to mention the months waiting for an initial appointment for this sub-specialist. If you start the orthodontia and have your surgeon on board, delaying the surgery while you deal with a new insurer (and potentially new oral and maxillofacial surgeon who takes your new insurance) might be a real problem.
The dental insurance I carried did not cover the surgery - it was 100% medical insurance. His before and after braces were partially covered by dental/orthodontia insurance, but it sounds like you are already dealing with the orthodontia.
posted by citygirl at 9:43 AM on March 22, 2024
My son had jaw surgery performed by an oral and maxillofacial surgeon (someone who was a fully-qualified oral surgeon as well as an MD surgeon) and it took some effort and time to have the procedure approved, not to mention the months waiting for an initial appointment for this sub-specialist. If you start the orthodontia and have your surgeon on board, delaying the surgery while you deal with a new insurer (and potentially new oral and maxillofacial surgeon who takes your new insurance) might be a real problem.
The dental insurance I carried did not cover the surgery - it was 100% medical insurance. His before and after braces were partially covered by dental/orthodontia insurance, but it sounds like you are already dealing with the orthodontia.
posted by citygirl at 9:43 AM on March 22, 2024
Anecdata: I had surgery while on COBRA (but not dental surgery).
posted by kbuxton at 10:21 AM on March 22, 2024
posted by kbuxton at 10:21 AM on March 22, 2024
Best answer: Anecdata: I had surgery while on COBRA (but not dental surgery).
Yeah, adding the clarifying re-direct that many employers' health plans have separate insurance policies for medical, dental, and vision. And each plan may handle things differently when it comes to surgeries. So your medical insurance may cover surgery on your knee or your hand, but your dental insurance may not cover surgery on your teeth. And if you're thinking "but that's stupid", I agree.
All the more reason to take another look at your existing insurance to see what it would and would not cover, so that you can plan accordingly. Many companies now have a "benefits concierge" as part of their benefits - someone you can call and ask "I have this really complicated question about how I can cover this thing", and they can help you figure out what to do. It's possible your medical insurance would cover jaw surgery, but that's something you'd have to look into and confirm. I just know that it's not guaranteed your dental insurance would.
posted by EmpressCallipygos at 12:11 PM on March 22, 2024
Yeah, adding the clarifying re-direct that many employers' health plans have separate insurance policies for medical, dental, and vision. And each plan may handle things differently when it comes to surgeries. So your medical insurance may cover surgery on your knee or your hand, but your dental insurance may not cover surgery on your teeth. And if you're thinking "but that's stupid", I agree.
All the more reason to take another look at your existing insurance to see what it would and would not cover, so that you can plan accordingly. Many companies now have a "benefits concierge" as part of their benefits - someone you can call and ask "I have this really complicated question about how I can cover this thing", and they can help you figure out what to do. It's possible your medical insurance would cover jaw surgery, but that's something you'd have to look into and confirm. I just know that it's not guaranteed your dental insurance would.
posted by EmpressCallipygos at 12:11 PM on March 22, 2024
"COBRA coverage is month to month"
Yes, though note if you're still unemployed when you drop coverage, you'll probably want to move to a marketplace plan, and that's something you can't do any month--you need to do it either during the annual open enrollment period, or have special circumstances that trigger a special enrollment period: https://www.healthcare.gov/unemployed/cobra-coverage/
posted by bfields at 8:16 AM on March 24, 2024
Yes, though note if you're still unemployed when you drop coverage, you'll probably want to move to a marketplace plan, and that's something you can't do any month--you need to do it either during the annual open enrollment period, or have special circumstances that trigger a special enrollment period: https://www.healthcare.gov/unemployed/cobra-coverage/
posted by bfields at 8:16 AM on March 24, 2024
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To the insurer, at least in my experience, there's no difference between an employee on a plan and a COBRA continuant on the same plan.
It's very common for people to hold onto their coverage with COBRA just to finish out a pre-approved treatment plan.
posted by phunniemee at 9:25 PM on March 21, 2024 [8 favorites]