Insurance Maximum?

[Donald A E Spencer]

Hi all, just a statement and question.
My factor provider told me in March that they were being told by my
insurance company that I had met my lifetime max. When I called to get some
info, none of the service persons at the Ins. Co. knew anything about it.
After calling every contact I was referred to, I finally talked to someone
who promised to look into it for me. In May I got a letter stating that as
of 1/01/07, I had gotten to my lifetime max of $1,000,000.
This had been employer sponsored ins. and had been in effect initially from
05/04 to 11/05, where I was the insured and with spouse. As of 12/05 to
present, my wife was the insured with me as spouse. I called the person who
had signed the letter and asked which policy had I maxed-out, to she replied
"both". [I read the fine print, always] She proceeded to tell me that I had
maxed-out as a member, across both policies. [Fine print had said policy]
So I asked what about the 'Premiums' still being deducted from my wife's
wages. No answer, but......, in August, my portability letter showed-up,
and...... it stated that my coverage ran from way back then, to MAY, 2007.
First question: Why was I not notified before I started my inquiries?
Next question: I know I should fight this somehow, but I'm so angry I may
not be thinking straight; any words of wisdom?
Other question: I had factor and oral meds shipped in January and February
that have not yet been payed for; don't I hold them responsible?
Last question: What do you Think/Know?

Just applied for and received assistance from Baxter!
:)

[someone on the internet]

I think its about time to start looking for a new job, those
assistance programs don't last long.
A lot of states have what are known as high risk pools, which usually
also have a lifetime max (so there is only so much money there)
although a lot of them have pre-existing conditions clauses of a long
time (in Texas, its a year), so if your insurance has lapsed you are
probably screwed there, though if you still technically have insurance
you may not be bound by the pre-existing condition clause it will most
assuredly have.
Regarding meds that have shipped that might not be covered by
insurance, I would set up a payment plan of 1$ per month, usually the
carriers don't bother to collect and even if they do send it to a
collection agency it won't hit your credit very hard (most people
don't look at medical bills since they're so insane these days).

Since your using so much factor, and I'm betting its on your knee's,
I'd suggest looking into getting a radio nucleotide synovectomy at
some point. I also find that keeping my knee's cool cuts down on
bleeds quite a bit.

As to why they didn't notify you about you capping your lifetime max,
its not something that happens all that often, and most companies only
have the appearance that they have there act together.