![](templates/SoftBlue/images/border_1_2.gif) |
|
![](templates/SoftBlue/images/border_3_2.gif) |
![](templates/SoftBlue/images/border_4_2.gif) |
|
Forum
-> Parenting our children
-> Our Challenging Children (gifted, ADHD, sensitive, defiant)
Cmon be nice
↓
![](./images/ranks/rank5.png)
![](images/avatars/default_avatar.png)
|
Thu, Aug 08 2024, 2:21 pm
Hi maybe somebody here can help me to what is probably a common issue. DS needs therapy and his school needs him to have a private insurance plan with out of network benefits in New Jersey. W're currently on Jersey care, which doesnt cover it. Does anybody have any ideas of how we can get on a plan? Ive posted under my SN in case someone wants to PM me. Thanks
| |
|
Back to top |
0
0
|
amother
Chestnut
![](images/avatars/40.jpg)
|
Thu, Aug 08 2024, 2:38 pm
I was told by Cosmo Insurance that you can't buy private insurance with out of network coverage. the only way is through an employer plan.
| |
|
Back to top |
0
0
|
↑
Cmon be nice
↓
![](./images/ranks/rank5.png)
![](images/avatars/default_avatar.png)
|
Thu, Aug 08 2024, 2:53 pm
amother Chestnut wrote: | I was told by Cosmo Insurance that you can't buy private insurance with out of network coverage. the only way is through an employer plan. |
Right. So DH actually has a small corporation, and we were wondering if we could just get on a insurance plan
| |
|
Back to top |
0
0
|
amother
![](images/avatars/40.jpg)
|
Thu, Aug 08 2024, 8:49 pm
Cmon be nice wrote: | Right. So DH actually has a small corporation, and we were wondering if we could just get on a insurance plan |
Does he have one employee who could join the plan?
In New Jersey you CANT have an owners only group, does he have an employee who can enroll?
ETA To fix a typo
| |
|
Back to top |
0
0
|
amother
Denim
![](images/avatars/40.jpg)
|
Thu, Aug 08 2024, 9:00 pm
A plan like that could cost you $30k a year in premiums plus deductibles, copays or coinsurance. You’d have to figure out if the increased cost over whatever you’re paying now is going to cost less or more than what you’d pay out of pocket for therapies.
| |
|
Back to top |
0
0
|
↑
Cmon be nice
↓
![](./images/ranks/rank5.png)
![](images/avatars/default_avatar.png)
|
Thu, Aug 08 2024, 9:41 pm
amother Banana wrote: | Does he have one employee who could join the plan?
In New Jersey you CANT have an owners only group, does he have an employee who can enroll?
ETA To fix a typo |
Not really, which I know is a problem 😕
| |
|
Back to top |
0
0
|
amother
![](images/avatars/40.jpg)
|
Thu, Aug 08 2024, 9:44 pm
There are no therapy agencies that are in-network that can help?
| |
|
Back to top |
0
0
|
amother
![](images/avatars/40.jpg)
|
Thu, Aug 08 2024, 9:47 pm
Some agencies work with horizon Omnia gold. Is that an option?
(Anyone can purchase that but you might need to wait for open enrollment)
| |
|
Back to top |
0
0
|
amother
Leaf
![](images/avatars/40.jpg)
|
Thu, Aug 08 2024, 9:53 pm
Why is the school dealing with health insurance? They should not be demanding you see a specific therapist or health care provider. Sounds like a kickback scheme....
There are no providers where you live that accept your insurance?
| |
|
Back to top |
0
2
|
amother
Strawberry
![](images/avatars/40.jpg)
|
Thu, Aug 08 2024, 9:56 pm
You can purchase insurance during Open Enrollment for coverage beginning 2005
However I am not sure you understand what out of network means.
You currently have a form of Medicaid which is generally accepted by a small group of providers because reimbursement is lower than from other health insurance.
Almost every plan you would purchase has a network. Some plans that are a PPO have benefits that for using a provider who isn't in the network. However, these cost more - the co-payment is higher, deductible could be higher and out of pocket expenses are higher.
Also you can be balanced billed as insurance will only compensate a rate that consider to be customary and usual.
Example
Go to a doctor in a network - doctor has agreed to accept the negotiate rate with insurance company so you are responsible for co-insurance and/or co-payment after meeting the deductible.
Go to a doctor out of network - Doctor charges $500. Insurance only believes the reasonable charge should be $250. You will be reimbursed for the $250 in accordance with the plan and responsible for the additional $250
Keep in mind that the cost after premiums, co-insurance, co-payments could be more than just paying a doctor out of pocket.
Also billing can be complicated when you have Medicaid and another insurance plan.
| |
|
Back to top |
0
0
|
amother
![](images/avatars/40.jpg)
|
Thu, Aug 08 2024, 10:01 pm
amother Marigold wrote: | Some agencies work with horizon Omnia gold. Is that an option?
(Anyone can purchase that but you might need to wait for open enrollment) |
Connect plus takes Omnia Silver which is cheaper.
| |
|
Back to top |
0
0
|
amother
![](images/avatars/40.jpg)
|
Thu, Aug 08 2024, 10:10 pm
They take Omni’s silver but that only covers Aba. For ot/speech also you need the gold plan
| |
|
Back to top |
0
0
|
↑
Cmon be nice
![](./images/ranks/rank5.png)
![](images/avatars/default_avatar.png)
|
Thu, Aug 08 2024, 10:29 pm
amother Leaf wrote: | Why is the school dealing with health insurance? They should not be demanding you see a specific therapist or health care provider. Sounds like a kickback scheme....
There are no providers where you live that accept your insurance? |
Don't worry, not a kickback scheme.
| |
|
Back to top |
0
0
|
amother
![](images/avatars/40.jpg)
|
Thu, Aug 08 2024, 11:11 pm
Out of network deductibles and oop maximums can be astronomical. It may not be worth your while even if you can get on a plan with oon coverage
You really need to know your numbers- How much you spend in oon providers.
| |
|
Back to top |
0
0
|
Related Topics |
Replies |
Last Post |
|
|
Asd benefits
|
7 |
Sat, Sep 07 2024, 8:50 pm ![View last post View last post](templates/SoftBlue/images/icon_latest_reply.gif) |
|
|
Aba-what insurance.
|
6 |
Thu, Sep 05 2024, 10:33 pm ![View last post View last post](templates/SoftBlue/images/icon_latest_reply.gif) |
|
|
Bituach Leumi Benefits Autism Diagnosis
|
14 |
Tue, Sep 03 2024, 10:34 am ![View last post View last post](templates/SoftBlue/images/icon_latest_reply.gif) |
|
|
Snap benefits
|
1 |
Sun, Sep 01 2024, 9:57 pm ![View last post View last post](templates/SoftBlue/images/icon_latest_reply.gif) |
|
|
Wic benefits in bp/flatbush
|
1 |
Sun, Sep 01 2024, 9:21 am ![View last post View last post](templates/SoftBlue/images/icon_latest_reply.gif) |
|
|
Imamother may earn commission when you use our links to make a purchase.
© 2024 Imamother.com - All rights reserved
| ![](templates/SoftBlue/images/border_5_2.gif) |
![](templates/SoftBlue/images/border_6_2.gif) |
|
![](templates/SoftBlue/images/border_8_2.gif) |
|
|