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Possible new job, ins, Tec, employer, pre-exist condition, obamacare, privacy

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    Possible new job, ins, Tec, employer, pre-exist condition, obamacare, privacy

    Hi
    I'm up for a new tenure-track prof job obviously with health insurance. I am lucky to have a what is mild (or benign, though I know that is a phrase that many say is not accurate) MS diagnosis.

    I am currently on some sliding scale and assistance programs, both for Tec and at a public health facility.

    With my understanding that Obamacare saying no one can be denied due to pre-exist condition, if I get this job, I can't be denied health insurance, right?

    Also, I read another post here on this issue, and want to be sure. I'm going to have to disclose MS and needing Tecficera (50k year) to the health ins. company. That paperwork is not seen by employer, right? I send it direct to the health company and they are only one that see it?

    Again, according to another post here, the company is going to be able to see the claim for 50k for Tec, right? Do they see the date? Will they be able to tell it was me who was hired in August? Or how much info can they see?

    I understand it's illegal for jobs to fire based on med condition, but as another poster said if job is only 5 people, they could say any excuse if they didn't want premiums to go up. But this is a medium sized university. Will they be able to pinpoint it and use as reason for not giving me tenure?

    #2
    With my understanding that Obamacare saying no one can be denied due to pre-exist condition, if I get this job, I can't be denied health insurance, right?

    If the employer sponsors a group health insurance plan, you can't be denied coverage under the plan due to a pre-existing condition. ACA eliminates the HIPAA required Certificate of Credible Coverage that passed back in 1996?. The DOL link below explains CCC updates to HIPAA since passage of ACA:

    http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

    Also, I read another post here on this issue, and want to be sure. I'm going to have to disclose MS and needing Tecficera (50k year) to the health ins. company. That paperwork is not seen by employer, right? I send it direct to the health company and they are only one that see it?

    Group Health Plans don't usually include an insurance application form. Group Health Plans usually consist of an enrollment form to participate in the Group Health Plan, but no personal info about a participant's medical history. No need to worry about disclosing to your employer inadvertently via participation in the health plan, or even the insurance company until claims are actually submitted by a medical provider to the insurance company for payment.

    Before limitations for pre-existing conditions were imposed by HIPAA in 1996, and revised recently by ACA, a Group Health Plan would deny payment of an actual claim if the claim was determined to be for pre-existing condition. Passage of HIPAA regulations in 1996 limited the pre-existing condition exclusion for group health plans to no more than 6 months or less if the employee presented a Certificate of Credible (prior) Coverage.

    Employee's don't usually submit claims for payment to the insurance, via the employer, any longer due to manage care and electronic payments. That process of submitting claims via the employer has been eliminated since the shift to Managed Care system of providing health insurance coverage. Managed Care involves medical care providers partnering with the insurance company, with claims for payment typically sent by the doc/medical care provider directly to the insurance company electronically.

    Patient confidentially rules have always guided docs/medical care providers when it involves a patient's private medical info. HIPAA clarified privacy rules when it involves your employer and the insurance company. An employer should never have access to private medical info about an employee.

    Insurance company's are prohibited from sharing identifiable info about an employee's cost for medical care to the employer/health plan sponsor.

    Again, according to another post here, the company is going to be able to see the claim for 50k for Tec, right?

    No. Unless you give your employer access to your claim or medical info, your employer should not be involved in specific info about your medical claims or medical history. Medical info should be shared between you, your doc and the insurer, only.

    The only info the insurer can share with your employer is cost info about premiums, payroll deduction info to pay premiums, determine who participates in the plan and cost of claims, but nothing that would identify a specific employee's medical claim history.

    Employees who use FLMA, for instance, are protected from termination of employment for up to 12 weeks for medical leave annually. Once FLMA protected medical leave is exhausted by the employee, the employer is under no obligation to retain the employee for employment purposes.

    On the other hand, FMLA leave request form must be signed by a treating physician, with a dx for the relative condition. That does not mean that MS is necessarily the disabiling condition. Disability could be due to 'cognitive' impairments, and other sx's that don't necessarily disclose a dx of MS.

    It's not impossible for employers to infer a dx of MS if the physician submitting FMLA forms to your employer is a MS Specialist. Your employer could extrapolate from non-identifiable claim info that you might be on a DMT. But that can't be the basis for termination, there are federal laws to protect your employment status.

    Comment


      #3
      Originally posted by MSW1963 View Post
      [
      On the other hand, FMLA leave request form must be signed by a treating physician, with a dx for the relative condition. That does not mean that MS is necessarily the disabiling condition. Disability could be due to 'cognitive' impairments, and other sx's that don't necessarily disclose a dx of MS.

      It's not impossible for employers to infer a dx of MS if the physician submitting FMLA forms to your employer is a MS Specialist. Your employer could extrapolate from non-identifiable claim info that you might be on a DMT. But that can't be the basis for termination, there are federal laws to protect your employment status.
      I'm guessing it is a moot point trying to hide if MS has progressed to the point where we need FMLA? Although I'm definitely not telling sooner I do plan do disclose when the time comes that I need accommodations or extended time off. If nothing else to squash speculation and be considerate to my team-mates who will be likely picking up my slack.

      The other thing I always think about is that since I have to get employer physicals prior to being hired, I work in health care, and I disclose my MS at that point there is a chance, HIPAA or not, that the information will leak out.
      He is your friend, your partner, your defender, your dog. You are his life, his love, his leader. He will be yours, faithful and true to the last beat of his heart. You owe it to him to be worthy of such devotion.
      Anonymous

      Comment


        #4
        I appreciate the responses here. It's really relieving. Also I apologize for the double post. I think my title header spooked maybe too many to read it. I'll be more brief in future.

        I do understand that the employer cannot see my specific med files. But I was somewhat surprised to learn they can see a generalized list of claims, if I am understanding correctly. And would at least know, someone out there is on a 50k, med, is that right? They do at least find that out even if they don't know who? If I am understanding that correctly (and I never thought employers would know that kind of specificity) then that still kind of unnerves me.

        I thought employers just knew overall big number cost of insurance, not a specific breakdown, even if they don't know employers' specific info.

        This job thing is a bit nervewracking since it's the first time I'm going through it since being dx'ed, however mildly I've been told my dx is, but still, it feels weird to know these things.

        I'm grateful to the "work crew" here for helping me with this info. I didn't know most of it.

        Comment


          #5
          Be the best, most conscientious employee you possibly can. Kill them with kindness, and you've conqoured 90% of any obstacle the cost of your DMT might represent.

          In any pool of +300 insured individuals, there will likely be a few MSrs' taking DMT drugs. A few non-MS'ers taking expensive medical treatments as well. It's the nature of our health care system. The more serious the condition, better the meds, the higher the cost.

          Cantankerous, disgruntled and unreliable employees who also represent high claims have a lot more to worry about. Try your best to not be 'that' employee.

          There may come a time when your MS will change, but for now if your disease is well managed, concentrate on enjoying your new job and your benefits too. Save for whatever the future brings.

          Be kind to others, it will make you feel good and could come back to you in spades one day when you really need it.

          Be discreet, relax and best of luck.

          Comment


            #6
            jules, I'm not sure it's a moot point. But I'm with you, I'm not telling either!

            Comment


              #7
              I spent some time training as a young academic before switching careers. It's not fair, but I think you are right to think about this.

              The rule I learned was, if you wanted to get tenure, you needed to be viewed as an asset, not a liability to the school.

              Not sure what to suggest. I wouldn't sacrifice ms treatment. But if it were me, I would not disclose my condition until after I had tenure.

              Comment


                #8
                thanks everyone. this is very heartening to read. i'm trying to focus on being positive. honestly i didn't even think of anything about this and started scrolling back through this board and this entire website and kinda got freaked out and maybe overthought things. still, it led me to learn to be a bit more conscious of things.

                i do agree with the previous poster, absolutely not to disclose anything, and if then not until after tenure. but i don't even know about that unless i hit a time when i need obvious accommodations related to ms.

                my interview is next week, i'll try to remember to report back here. it's a phone interview no less so i have to use my caption phone to read the captions even though i can't hear through my aid.

                wish me luck! trying to anticipate the q's they will ask a hope to be assist prof!

                Comment


                  #9
                  Don't forget that most employer health plans cover a lot of dependents (family members) as well as employees, so it is not just an employee who might cause a high claim. Very expensive medications are used for a variety of auto-immune diseases and cancer, among many others.

                  As far as pre-employment physical exams, those usually are done after you have been offered the job. If you are physically able to do the job, but the offer is rescinded after your physical exam, that is highly suspicious for discrimination based on disability. In that situation, I'd hold onto my copy of the job offer letter and call my lawyer.

                  Comment


                    #10
                    But will I really be asked for an employ physical for a professor job? I've worked in nonprofits for years and never was asked for such a thing. This is making me nervous. I absolutely do not want to disclose MS on a form that goes to my employer.

                    am I understanding correctly or is this really for more physical jobs?

                    Comment


                      #11
                      Since the passage of ADA=Americans with Disabilities Act, pre employment 'testing' is limited to testing directly related to physical ability to perform a job and skills testing.

                      Employers are prohibited from asking questions related to medical history or 'physical aliments' during a job interview. The one exception is if during the job interview, the applicant discloses information about physical limitations or medical history, which would open the door for the employer to persue info further. I'm not sure what limitations apply if any, when an applicant discloses.

                      During the typical corporate job interview, questions are limited to applicant's ability to 'lift a 40lbs? box of printer/photo copy paper' or 'sitting at a desk for up to 9hrs a day', etc.

                      I worked for a company that had a MD and nurse on site, state of the art medical facility including a lab, in a high end corporate location, before passage of ADA. As a job applicant I underwent a full physical exam, labs, etc., with no problems, although it was about 10 years before my MS dx. The medical facility and doc were eliminated after ADA.

                      Comment


                        #12
                        Ok, this response makes me feel less nervous. It sounds like I will probably not be asked for a pre-employ physical for this type of job that would entail any type of me having to reveal MS.

                        On a side note, and someone did mention something earlier about not disclosing my hearing loss potential accommodation need until *after* hiring - but what about if I'm asked to do a class presentation/class for the job? If I feel I need CART (real time captioning which is expensive 150/hr) is it not a good idea to ask for that for the job interview process?

                        And if I do get the job, should I wait until I am fully hired to possibly ask for CART or will that make me seem like a liability? It all depends on room, acoustics, etc. I don't want to NOT get tenure due to being seen as expensive. I do have methods to work with it but am up for a job for more seminar style classes that will render my current lecture type class a bit not applicable with the tools and techniques I use.

                        Any advice welcome from this group here since you all are so knowledgeable about this with MS and accommodations. My cover letter does mention I have a hearing loss and they are Equal Opp employer and mention an interest in disability studies in my humanities field that I am applying in. CART makes a big difference but I don't want to jeopardize my chances. Even if they say we don't discriminate and want diversity etc.

                        Comment


                          #13
                          Sorry, I can't help you with CART, hearing loss and any type of accomodation needed in 'a class presentation/class for the job'. My instinct is it shouldn't present a problem based on my perception of hiring practices in the medical field and university hiring that tend to be more welcoming to individuals with physical limitations.

                          Someone should be along soon with a reply.

                          Comment


                            #14
                            OrangeMetal, you may get more responses if you post your hearing, CART and job interview question in the General Questions forum, or post a new thread here at Employment and MS with a title specific to your question.

                            Very best of luck to you and post an update.

                            Comment


                              #15
                              Also on market

                              Orange -

                              First, congratulations on getting to the phone interview stage. It's been rough out there this year. I'm also on the market in Humanities.

                              My alma mater just hired someone at the career services office who advises students (and alumni) on issues of disability in the job search. He himself has visual impairment that is not always an issue - so he understood the issues of an invisible disability. I'll tell you a couple of interesting suggestions he had, but maybe also include things from my own experience.

                              I've had accommodations under the ADA for my current visiting position, as well as my last two part-time lecturer positions. Nobody knew why I needed accommodations (though I think an official diagnosis is handed in to the disabilities/EEO office). I never told anyone what the diagnosis was - just that I received accommodations for heat sensitivity due to a medical condition. So no fears there. I'm not sure how insurance deals with the medication because I've always gotten meds through a co-pay assistance program, but they do go through my insurance somehow. If it's a large institution, nobody has time to deal with the details of how much your medication is costing. Even if it's a SLAC, they probably don't. And there probably won't even be someone on campus to liase with the insurance company beyond those who deal with the institution's taxes. So I wouldn't worry about that, other than being guarded about what information you volunteer to others.

                              Oh - and you will NOT have to take a physical. Think of how many of your professors would've failed if that were the case!

                              Regarding the interview: I would ask for accommodations, but don't make it a big deal. You want to be sure you are putting your best foot forward in the interview. Especially with hearing issues, you'd rather be seen as having a disability that can be accommodated than being seen as someone who is slow or inattentive. One of my elderly relatives is too vain to wear his hearing aids, so he constantly gives the impression of being stupid or uncaring because he didn't hear what was said. That would be a bad move in an academic setting.

                              If you don't need to use the accommodations on that day, you can choose not to. But if they aren't in place and your performance suffers for something that you have a right to under the ADA, you'll be upset. Just contact the person designated for that, and tell them exactly what you need. If it comes up with any of the people on the search committee, gauge their reaction, and add something like, "As you can tell from my C.V. (resumé), my performance is not affected by my disability/condition if given these simple accommodations." Bring it back to your record of achievement, because clearly they thought you were superb or they wouldn't have invited you.

                              The disabilities/career services guy I spoke to also pointed out something I knew from experience with previous positions: most people you will speak with are afraid of the ADA because they don't know what's actually in it. They are afraid of doing something illegal, so they will bend over backward to be kind, or avoid the topic, or whatever. Know your own rights under the law, and use their fear to your advantage. Adding sentences like the one I mentioned above should end any conversation because they know they can't ask certain questions (much like those under other labor law - you can't ask about family situation, for instance, but a candidate can volunteer the information), and so they will probably just change the subject.

                              If I have to say anything, I usually use terms like "medical condition" rather than "disease" to avoid questions of it being contagious (which they can't ask, but might think), and to avoid any question in others' minds about things like progression. It's none of their business.

                              On a recent campus visit, one of the search committee members pointed out that they were also auditioning for me. It might not seem like that, especially in the current market, but they have chosen you at this point - and it is as much about whether you choose them back, just like dating.

                              You have one other advantage in the whole thing: you can plan out what you are going to say and how you are going to say it. There needn't be any surprises. You might go to the disabilities office or career services office t your graduate school to get a little more advice. The person you've dealt with about accommodations during graduate school can at the least explain the ADA to you, and what a committee can and cannot say or ask. They can tell you how they deal with students or job candidates at your graduate institution. They have no way of leaking the information to the place you are interviewing - and it would be illegal, anyway. Plus, it is in your graduate institution's best interest to assist you in preparing for an interview in this way. Every unemployed graduate is a mark against them, so they want to see you succeed.

                              Good luck with the phone interview! Keep us posted!

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