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Although this family paid for health care for their college-age son through the work place, any care had to be pre-approved since this care was in a strict HMO and the college he went to was out of state. The son contracted Lyme disease, for which he was treated with oral antibiotics prescribed by his PCP during a summer break. However, Lyme disease is often difficult to eradicate, and he subsequently developed and arthritic condition related to his infection.
He was now older, taking summer internships away from home and was never in his home state for longer than two weeks at a time. Further examination by a rheumatologist in his home area seen over winter break revealed his Lyme disease in need of further treatment with IV antibiotics, but his HMO disallowed any out of the area treatment for a non-emergency.
His arthritic condition was progressing, and he had now lost 20% motion in one arm.
Solution:
The family purchased the health insurance offered by their son's university for one semester. Treatment was begun at home, and finished in California. The HMO paid for the first part of treatment, and the student insurance paid for the finish. Since he was in the middle of treatment, and he was doubled insured, his university's insurance company is now negotiating with the primary carrier for reimbursement. The disease could not considered a pre-existing condition because he had not been without insurance at any time.
Health Plan Navigator recommended.
Cost: approximately $300 for the second premium.
Saved: $26,000.
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