So my wife was unfortunately diagnosed with MS about two weeks ago. We went through a few doctors to finally get her diagnosis but feel super lucky to have gotten a proper diagnosis and that she got in with a well renowned doctor who specializes in MS and runs a large clinic who is on the cutting edge of treatments, etc. When her work (school district in MO) learned of the diagnosis they told her “for individuals who are expected to have claims that will exceed $35,000 or more in a year, our District plan summary states that expenses related to a chronic condition or specific course of treatment exceeding that amount may be denied”. They are trying to get her to switch to ACP plan which they said they would pay for. The problem is the carrier for that plan is different and her doctor would no longer be covered. Which would mean we would have to start all over. We are extremely stressed and worried about her diagnosis and fighting insurance wasn’t something we were hoping to have to do. Any suggestions or tips on how to go forward would be greatly appreciated. Do we have a choice? Or do we basically have to switch if we don’t want to go bankrupt trying to pay for her medicine out of pocket. Thanks in advance!
submitted by /u/mbsob
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So my wife was unfortunately diagnosed with MS about two weeks ago. We went through a few doctors to finally get her diagnosis but feel super lucky to have gotten a proper diagnosis and that she got in with a well renowned doctor who specializes in MS and runs a large clinic who is on the cutting edge of treatments, etc. When her work (school district in MO) learned of the diagnosis they told her “for individuals who are expected to have claims that will exceed $35,000 or more in a year, our District plan summary states that expenses related to a chronic condition or specific course of treatment exceeding that amount may be denied”. They are trying to get her to switch to ACP plan which they said they would pay for. The problem is the carrier for that plan is different and her doctor would no longer be covered. Which would mean we would have to start all over. We are extremely stressed and worried about her diagnosis and fighting insurance wasn’t something we were hoping to have to do. Any suggestions or tips on how to go forward would be greatly appreciated. Do we have a choice? Or do we basically have to switch if we don’t want to go bankrupt trying to pay for her medicine out of pocket. Thanks in advance!
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