- 2,584
Hello,
I am in senior market so I don't do individual health. I was asked for help from a 25 year old attorney that I know.
Here is the situation:
Age 25 male just moved to CA from Texas a few months ago, zip 95129 and wants health insurance as he has health net through moms work and is now "out of network". The coverage also ends after age 25 in august according to him.
His health:
He was diagnosed less than 2 months ago w/ lumbar spinal stenosis - a progressive and chronic back condition in which the spinal canal narrows and touches the nerves going into your legs. It causes weakness in the legs (difficulty standing), radiating waves of pain down the legs, chronic stiffness and pain in the lower back. It is not pleasant, to say the least, and eventually can cause difficulty controlling bladder and bowel functions. As for the immediate future, probable treatments will be a series of steroid injections in the area to try and combat the inflammation.
He already had 1 of these a month ago, w/ no results. His doctor in Texas recommends another 1 be done in a different area, but obviously he is in TX, network is in TX, and he is in CA, so for right now all treatments are on hold indefinitely. If the steroid injections fail to provide any relief, the next step, as he understand it, is to go in and install a morphine pump in the affected area.
If that doesn't work, the next option is to go in and cauterize/block off the nerve roots.
If THAT doesn't work, the final step is full-blown back surgery, called a lumbar laminectomy, in which they remove the bone/disc that is pressing against the nerves. He also got some measure of relief from a chiropracter he saw a month ago, and will probably continue to try and seek treatment from a chiropracter.
Medications:
The only prescription he is taking right now is Celebrex, a pricy anti-inflammatory drug. His current insurance plan pays 100% of generics but 0% for name--brand drugs, so his family has been paying for it out-of-pocket. The only other potential medications that he is likely to take in the future are painkillers like hydrocodone, oxycodone, or morphine. These are all generics, though and pretty cheap according to him.
1. What are his options if anything?
2. I am assuming he would need some sort of guarantee issue if that exists and qualified?
Thanks!
I am in senior market so I don't do individual health. I was asked for help from a 25 year old attorney that I know.
Here is the situation:
Age 25 male just moved to CA from Texas a few months ago, zip 95129 and wants health insurance as he has health net through moms work and is now "out of network". The coverage also ends after age 25 in august according to him.
His health:
He was diagnosed less than 2 months ago w/ lumbar spinal stenosis - a progressive and chronic back condition in which the spinal canal narrows and touches the nerves going into your legs. It causes weakness in the legs (difficulty standing), radiating waves of pain down the legs, chronic stiffness and pain in the lower back. It is not pleasant, to say the least, and eventually can cause difficulty controlling bladder and bowel functions. As for the immediate future, probable treatments will be a series of steroid injections in the area to try and combat the inflammation.
He already had 1 of these a month ago, w/ no results. His doctor in Texas recommends another 1 be done in a different area, but obviously he is in TX, network is in TX, and he is in CA, so for right now all treatments are on hold indefinitely. If the steroid injections fail to provide any relief, the next step, as he understand it, is to go in and install a morphine pump in the affected area.
If that doesn't work, the next option is to go in and cauterize/block off the nerve roots.
If THAT doesn't work, the final step is full-blown back surgery, called a lumbar laminectomy, in which they remove the bone/disc that is pressing against the nerves. He also got some measure of relief from a chiropracter he saw a month ago, and will probably continue to try and seek treatment from a chiropracter.
Medications:
The only prescription he is taking right now is Celebrex, a pricy anti-inflammatory drug. His current insurance plan pays 100% of generics but 0% for name--brand drugs, so his family has been paying for it out-of-pocket. The only other potential medications that he is likely to take in the future are painkillers like hydrocodone, oxycodone, or morphine. These are all generics, though and pretty cheap according to him.
1. What are his options if anything?
2. I am assuming he would need some sort of guarantee issue if that exists and qualified?
Thanks!
Last edited:
