Let me just state right up front that I am exceptionally grateful for insurance companies and for the fact that I can afford fairly good health insurance that puts a great medical team and some very expensive drugs within my financial reach. I know that it’s an incredibly difficult business, particularly with the shifting landscape of recent health insurance legislation. It has to be a very tricky balance of containing costs while meeting their fiduciary responsibility to those who are insured.
I get it.
All that aside, it makes me a bit crazy when it appears that insurance companies cross the line and actually start practicing medicine.
Read the rest of this post here: https://rheumatoidarthritis.net/living/when-insurance-companies-play-doctor/
I have a good friend who happens to be an accomplished writer. She has, on more than one occasion, commented that writing is like using the toilet. It should be done in private and you should wash your hands afterward.
In addition to researching insurance policies for my husband’s company, I’ve been looking for my own coverage. Having been laid off last year, I have been covered under COBRA through my previous employer’s plan. My COBRA coverage extends through May next year, so technically I can stay on that plan for a few more months. However, I will have to switch plans when COBRA expires, meaning that I will have to start all over again on paying against deductibles, out-of-pocket, etc. with the new policy.
And while I could join my husband’s company policy as a covered spouse, there are similar reasons why that won’t necessarily work either.
Texas is one of the states that uses the national health exchange (www.healthcare.gov) rather than establishing its own. If you live in the US, you can’t have avoided all the news concerning the difficulty the site has had due to the overload of people trying to log in. While waiting for the logjam to clear so I could log in, I visited the individual sites for the insurance companies that seem to be common to my plethora of doctors: Blue Cross Blue Shield, Cigna, and Aetna.
Here’s what I’ve found:
- If you are eligible for tax credits/discounts because of low income, you should visit the national health care exchange www.healthcare.gov to verify your eligibility. If your state has a health care exchange, you may also be able to do that there.
- The individual insurance company sites are easier to access and easier to navigate than the national exchange. The quotes for the same plan are exactly the same on the national exchange as are offered through the insurance companies’ sites. Therefore, if you’re not claiming a discount/credit against health insurance costs, it’s probably easier for you just to go directly to the insurance companies’ sites.
- Both the national exchange site and the individual company sites let you “save” and “compare” various policies. You can further filter the policies by such things as premium cost, HMO vs. PPO, etc. This helps narrow down the field to policies which might better fit your needs.
- The good news is that plans starting January 1 cannot take into account prior medical history or existing conditions. This is a good thing for those of us with RA (and joint replacements, and high blood pressure, and high cholesterol, and/or other chronic conditions). So if you can wait until January 1 to start your coverage, it might be a good thing.
- If you’re 30 years old and a non-smoker, you can find pretty good coverage for around $200 – $250/month. While a non-smoker, I’m no longer 30 years old, and the policies I’m considering are around $750 to $900 per month.
- Be sure and consider all your medical costs when looking at a health policy. Because I have somewhere between 15 and 20 doctors appointments a year and I have about a dozen prescription medicines I take, I have to look at the cost of office visits and drugs as well as premiums — particularly since I take expensive drugs like Orencia which run about $2000/mo. It turns out that some of the higher-monthly-premium plans are actually more cost effective because they pay a higher percentage of drug costs and have lower office visit co-pays.
- If you’ve been trying to get into www.healthcare.gov and have had issues, keep trying. I was able to log in and set up my account on a Wednesday evening a week or so after the exchange opened on October 1. I suspect that some of the initial rush is over and the government has been working to improve access.
- You have until December 15 to sign up for insurance starting January 1.
- The national site only handles policies that start January 1 when the new health care laws become effective. If you need insurance before then, you should visit individual company sites, or a private marketplace like http://www.ehealthinsurance.com.
At this point, I don’t know which plan I’ll choose, but at least I’ve got the information I need to make an informed decision. I’m appalled at the premium cost, but with my health, I know that the premiums are a small pittance against what I would be paying (or would be able to afford to pay) for my health care needs.
I hope that your insurance requirements are a simple matter. Thanks for checking in.
We’ve all seen those movies where the person backs up one step too many and finds themselves falling over the balcony, or the cliff, or the edge of the building. Or perhaps they hear the crack of the ice before they fall in or the click of the trigger of the land mine they’ve just stepped on.
I’ve always imagined that would be the most horrible feeling — knowing that your life was suddenly and completely in danger and utterly out of your control.
That’s how I felt Tuesday night.
My husband and I had gone to have a nice dinner and, as the restaurant was close to the pharmacy, I asked that we stop on the way back to pick up a prescription refill that I’d called in. It wasn’t one of those “urgent” prescriptions, so I had not taken the time to pick it up for a couple of days.
The pharmacy aide who knows me by sight, was reaching for my prescription even as I approached the counter. Then he kind of looked at me odd, lowered his voice and asked, “Have you had a change in your insurance? When we ran this through, it came back that your insurance was terminated.”
Crack. Click. Fall.
Now I can’t disclose the particulars of my severance agreement with my past company, but I will say (to their credit) there was a great deal of understanding about my health issues and I had been assured that the transition from insurance to COBRA coverage would be seamless.
It was a relatively inexpensive prescription, so I just paid for it knowing that when all of this got straightened out I could file for a reimbursement. However this was also the night before my rheumatologi$t’$ appointment and I really didn’t want to pay that out-of-pocket, particularly since I thought she might be injecting a joint or two.
Next-morning calls to the benefit supplier indicated that they had sent the notification to the insurance company concerning my coverage. Calls to the insurance company revealed that if they had received the notification, it hadn’t trickled through their system as yet because my coverage was, indeed, terminated as of November 30.
This story has a happy ending for me. Frantic emails to my old HR team worked magic and by the time I got to my rheumy appointment, the insurance system was once again agreeing that I was covered.
I can’t forget, however, the horrible feeling of suddenly finding myself uninsured and the great relief that I hadn’t been in a car accident or serious fall for the previous week. And as I look toward this joyous holiday season, I can only send up a prayer for those who, unlike me, haven’t had happy endings to their employer-sponsored insurance plans and who face the future with families and chronic diseases, but without insurance.
When I count my blessings, insurance is surely near the top of the list.
The friends I’ve made through this blog are right there at the top as well. Thanks for checking in.