As I face changes in my health care coverage, this is a question I ask often. The following is an oldie but a goodie that I just had to share once again. Hope it makes you smile:
It’s that time of the year when scary things happen. I’m not talking about Halloween. I’m talking about open enrollment into insurance and Medicare plans. Read more on RheumatoidArthritis.com here: https://rheumatoidarthritis.net/living/two-scary-words-open-enrollment/
Thanks for checking in.
I wrote about this subject a while back when I discovered my insurance company had listed all my lab/test results for the two-year period I had been covered with them on their website where I could refer to them. https://carlascorner.wordpress.com/2011/04/13/privacy-what-privacy/ And I also assume that the several thousand people who do customer service work for the insurance company could see them as well. I questioned (as I still do) the insurance company’s right to the information (and when/where I gave it to them) and certainly their right to publish it in such an open forum.
Let me just say that I am and will eternally grateful for insurance companies. Without them, my health and quality of life, which is dependent upon affordable health care, would be in a far different state than it is today. I further highly respect their fiscal responsibility to try to control health care costs. But I tend to think the boundary line needs to be drawn at approving procedures and medications, not being privy to personal test results. Or giving medical advice (which is the doctor’s job).
pissed me off come up again because I just received a letter from my current insurance company. It’s actually entitled a “Care Consideration” that’s an alert about something that might be improved. In this instance, they’re recommending that I get a Hepatitis B vaccination. I’m not exactly sure why they think this — they didn’t say. I suspect that it’s because one of my liver enzyme tests is slightly elevated and has been for some time. Between being a bit overweight (which translates into fat in the liver) and taking some very strong RA drugs that can affect the liver, you can pretty much anticipate things to be a lot more out of whack than they are. My gastroenterologist, my rheumatologist, and my primary care physician (PCP) have all weighed in on my liver enzymes and I’m monitored with lab work every four weeks. NONE of my doctors have said a word about getting the Hepatitis B vaccine. So where does the friggin’ insurance company come off giving me medical advice?
And then I kind of laughed because I immediately wondered if they would even cover it, even though they recommended it.
As it turns out I have an appointment with my PCP next week for the medical clearance for my upcoming ankle surgery. Being the good patient I am, I am taking the “Care Consideration” letter along with me. The discussion will no doubt cause my blood pressure numbers to go through the roof. I wonder what my insurance company will say about that?
I hope whatever care consideration there are in your life bring you a smile. Thanks for checking in.
So if you don’t want to read a long, whiney post, just keep on scrolling. I posted something earlier today that’s a whole lot more uplifting.
I officially left the workforce in November. From an insurance standpoint, this means that I was covered by employer’s policy through the end of the November. In December, I was able to continue that coverage under COBRA which simply meant that I paid 100% of the premium instead of the company paying a portion. As I had met 100% of deductibles, out-of-pocket, etc. and everything (including prescriptions) was being paid, it was a good deal. It took some diligence to make sure everything was in place and that coverage didn’t lapse. The Thanksgiving holiday slowed some progress, but everything worked out.
Now last year, through December, medical coverage was through Insurance Company A. My ex-employer switched insurance providers starting January 1 to Insurance Company B. In order for me to continue coverage, I had to pay my December premium to Company A. Once I paid for December, my information was to be transferred to Company B for coverage under the new policy starting in January. I then had to pay my January premium by a certain point in December. With some hand wringing and tooth gnashing on my part, all of that happened but we got down to December 28 and I had no confirmation (even though I paid the premium) that I actually had health insurance coverage starting January 1. This was important because the first two weeks of January, I have scheduled two sets of labs, one X-Ray, three doctors’ appointments, my Actemra infusion, three prescription refills, and four physical therapy sessions — all of which had to be verified with the new Insurance Company B. But finally on December 28 I was able to print out a temporary insurance card and start providing the pertinent numbers to those various people who needed it.
So I’m feeling pretty good. I start January with a sense of accomplishment that even though I had been treading some pretty treacherous waters, I had successfully transitioned from group coverage to COBRA and then to a new insurance provider.
I guess being smug is the same thing as pride because I was feeling smug and there was definitely a fall in my future.
I was on Insurance Company B’s website checking to make sure that my dentist (with whom I have an upcoming appointment) was in network. But the weird thing was that I didn’t see any dental insurance coverage listed.
I contacted my old HR department. We went around the mulberry bush a few times (metaphorically speaking) before we figured out what happened. In addition to the health insurance election I made back in December, I was to have also made elections (if I wanted) for continuation of dental and vision insurance. But guess what? Those were never transmitted to me, so I had no opportunity to make the elections. So my dental and vision coverages had actually lapsed in December and therefore had not been transferred to the new provider to begin coverage in January. I didn’t know they weren’t bundled altogether, so I didn’t raise a flag at the time. I selected the only thing that was made available, which looked like this (whatever those codes mean):
The “fix” was to go back to Insurance Company A, turn on those elections and pay the December premiums. Theoretically this would then automatically flow through to Insurance Company B where I could then pay the January premiums and once again have my eyes and teeth covered. Oh, and it’s now the first week of January and I only have until January 14 to make all this happen or I lose eligibility. Previously, it took more than two weeks for each step of the process for medical coverage.
So I immediately thought to myself, “Self: It’s still open enrollment. You can just find an individual dental policy and sign up for it and skip all that trauma.” So while I had my old HR department chasing down how to “turn on” the original elections that should have been available to me two months ago, I start on a multiple-hour investigative journey into the land of dental policies to see if I can find a reasonable replacement on my own.
I’m sitting there after a few hours, my desk littered with printouts of policies, trying to sort out which are affordable, which have my dentist in-network, which are insurance companies I’ve actually heard of, and my phone rings.
It’s my physical therapy provider. They can’t verify health insurance benefits for my PT appointment the following morning. It appears that Insurance Company B has my birthdate wrong. Since my provider has the correct birthdate, it doesn’t match what the insurance company (incorrectly) has and they won’t verify that I’m covered.
So this is the first Monday of the new year, right? Insurance companies are getting slammed by people with questions. Insurance Company B’s website has crashed. It won’t even load. (They eventually put up an error message.) I call the customer service number. I am on hold for 46 minutes until I finally get a representative. (Thank you, Sprint for unlimited minutes …) She immediately asks me to verify my birthdate. You can only imagine how that conversation goes.
It doesn’t get much better after that, compounded by the fact that English is obviously not her first language. But she tries to be helpful and eventually, after about 17 security questions, decides she’s actually speaking to me and tries to fix my birthdate. She can’t do it. It’s one of those protected fields that only authorized users can change and she obviously isn’t authorized enough. She says she’s sent the request to “operations” but it may take three to five days for it to be corrected. I explain that’s not good enough and ask if there is a supervisor or someone else who might be able to help. She puts me on hold. Comes back. Puts me on hold again. She finally comes back and tells me that no one is answering — she is rolling directly to voicemail. So after more than an hour, I’m not really any closer to getting the situation fixed than when I started. She did, however, tell me the issue with my birthdate. The last four digits of my Social Security number (which actually form a valid date) got input as my birth year. (I am momentarily elated as this makes me much, much younger than I actually am …) She also told me that my old company should be able to correct this issue on their administrator screens.
So I go back to my old company’s HR department (who is still trying to work on my dental and vision elections) and explain the new problem. No, they can’t fix it on their screens. But they did send in an urgent request to their Insurance Company representative.
Deflated, but not yet defeated, I return to my quest for dental coverage. It turns out the best policy I can find will cost about 20% more than what coverage would be through my old employer. That’s actually not a lot of money as dental premiums are not that expensive for one person. The problem is, that since my dental coverage actually lapsed (through no fault of my own), I was looking at a six- to 12-month waiting period for any kind of dental procedure other than a simple clean and check. I have not one, but two crowns that need to be replaced, so that issue made my finding my own, separate dental policy a really bad idea.
The next morning there is an email for me from the company HR department. They say the birthdate issue on the health insurance is now corrected. Sure enough, when I arrive at the PT appointment, they are able to verify coverage and my pharmacy has also been able to process my prescription refills.
I call Insurance Company A and ask them what the December premiums will be for dental and vision insurance. Even though neither the elections nor the premiums are showing up yet on the website, I make a payment online. As soon as the premium notice shows up, I need to have the payment waiting for it. Because it still has to be processed then transmitted to Insurance Company B in order for me to pay the January premium.
So things aren’t perfect (yet). But the truly large issue of health insurance has, at least, been addressed for the moment. I have people helping me work the issue of the dental and the vision coverage. True these are, no doubt, the same people who caused the screw up in the first place, but who better motivated to correct the situation?
It’s now the third work day of the new year. I hope this week is not a harbinger of the rest of the year. But I do hope your 2016 is not only starting well but will be filled with both health and happiness.
Thanks for checking in.
So last week and this have been filled with doctors. As posted earlier, I have a good bill of health from my neurosurgeon who did my recent back surgery and also had a fairly rewarding conversation with my PCP’s PA about weight loss.
I had a regular follow-up with the orthopedic surgeon who did my hip and knee replacements. The good news is he says both replacements are looking great, which is really positive news considering the hip replacement is now seven years old. Most joint replacements need revisions or replacing after 10-12 years so I’m encouraged. The bad news is that he’s making noises that we might be replacing the right knee sooner rather than later. 😦
Today I had my regular rheumatologist’s appointment. With the surgery and trying to get caught up with stuff at work, I really haven’t had time to think about it. I’ve just been taking my Actemra once a week and going on about my business. I told her that taking the Actemra injection was like taking a 5 mg or 10 mg prednisone tablet. It helped for a day or two, but then wore off. She has suggested that we try to get the insurance to approve Actemra infusions where she can modify the dosage to see if we can’t get a better result. She also wants to be a bit more aggressive with pain management so she has prescribed some hydrocodone. At this point, it’s just one tablet at night to help me sleep. I’m really not much of a fan of hydrocodone but I keep having doctors insist on prescribing it for me. I should be grateful. There are a lot of people who really need it that, because of the new regulations, are having trouble obtaining it.
I got my lab results back prior to my rheumy appointment and they, for the most part, looked good. All my labs have always looked great. The one result that was out of line was one of my liver enzymes (again). But it was just slightly high and is probably because I’m still on Lyrica after the surgery to help with some diminishing but continued numbness in my right thigh.
The big news is that I formally gave my notice to my company effective mid-November. I am in the midst of a major project and I don’t want to leave them hanging, so I’m going to wrap that up before I leave. One of the benefits offered at the company is disability insurance (both short-term and long-term), so I have applied for benefits. If awarded, I will receive a large percentage of my current salary up until my full retirement age. I’m not sure what they’ll say about RA being a pre-existing condition, etc. but I guess we’ll see. So in the midst of everything else, I’ve been scrambling trying to get my doctors to fill out the (really stupid) forms and get them in so we can get a determination. I never really actually thought I’d be retiring early due to health reasons — I more kept the insurance so I’d have income during surgery recovery if I needed it. But the point is I’ve been paying the premiums all this time so there’s no reason not to apply for the benefits. All they can say is no and I already have that.
The good news is that I discussed this decision with all my doctors that I’ve seen recently and they fully support my decision to step out of the corporate world. That’s a bit sobering. It’s almost like I’m seeing myself through their eyes for the first time. Not one of them said anything like, “Are you sure you’re ready for that?” In fact one of them said they have been amazed that I’ve worked for as long as I have.
Of course this will play havoc with my insurance. I’ll be covered by company insurance in November. Then in December, I’ll still be covered, but I’ll be paying for it through COBRA. Then in January, I’ll still be on COBRA, but they’re switching insurance companies. Am I nervous making three major changes in my insurance coverage in three months? You bet.
In other news, Dallas is set for a major rain event. We had enough rain in May that a significant part of our area finally came out of the five-year drought we’ve been enduring. But it’s barely rained since. In fact, October, which is one of our wettest months, has not logged more than a trace of rain all month. With highs in the 80’s and 90’s, it might as well be early summer. But all this sunny weather has lulled me into a false sense of security. Rain and stormy weather on the other hand, send my joints into a tail spin. So with four days and 3″ to 6″ of rain in the forecast, I may be glad that I’ve got that new prescription for pain medication.
Overall none of this is really bad news and some of it is actually quite good. I think I’m just tired with dealing with it all. I’m tired of not feeling well. I can’t remember the last time I actually felt good. I’m tired of the stupid back brace and I’ve got two more months to go on my three-month sentence. I’m tired of doctors and needles and insurance claims. The thing that keeps me going at the moment that this time next month, much of this will behind me. I’ll be officially “retired”, the determination on the infused Actemra will be in, and the determination of the disability will be in. My biggest problem should be finding something new to whine about.
Thanks so much for “listening” to me whine and thanks for checking in.
December brings a lot of milestones including the Christmas and Hanukah holidays, the Winter Solstice, and New Year’s Eve with its endless “Best Of” lists and unrealistic resolutions for the coming year. Equally ubiquitous are deadlines for making commitments for the coming year’s health insurance. Whether you’re covered by your company’s insurance (I’m not), purchasing health insurance on your own (that’s me), or by Medicare, you have to make important decisions that will impact both your health and your pocketbook for the next 12 months.
Read the rest of the post here: http://rheumatoidarthritis.net/living/insurance-trap/.
The first of the year is a busy “doctor time” for me. A week or so ago I had my annual mammogram and retina check (not the same doctor) followed a few days later by my every-four-month visit with my internist. This week I have my annual dermatology exam, meeting with the spine guy about the issues with my back and follow-up with my knee guy about the potential Hyalgan injection treatment for my left knee. In the upcoming couple of weeks I also have my regular rheumy check up along with the follow-up with my shoulder surgeon. And of course, there is the monthly run to the pharmacy that, between my prescriptions and my husband’s, runs me about $300 after insurance.
You see that’s the rub. It appears that there’s been yet another clerical error and not only am I not covered by insurance at the moment, I haven’t been since January 1. You’ll recall this happened earlier when I changed from employee insurance to COBRA at the end of November. This time it has to do with the annual open enrollment at the end of the year. The HR people are working on the issue, but I found out about this when I had to shell out $$$ for prescriptions this weekend. Going back to the claims statement, it appears that my earlier doctors appointments haven’t been covered, either. I am just hopeful that they will resubmit the claim and, when they do, this mess will be straightened out. With the cash flow hemorrhaging I’m doing on the house renovation, I really don’t need to be paying full price for specialist visits.
The good news is that the house is moving along. After some issues, we’re finally getting the floors finished. I need an extra coat of paint in one room, then the painting is done. The kitchen cabinets are being installed even as we speak. We have countertops, tile, and clean up to finish, then hopefully the end of next week we can move home. (There’s a potential disastrous delay on the countertops in the works, but that’s another story.)
This weekend I decided that I would clean the kitchen tile well before the cabinets were installed. It’s not a very big area, but by the time I was done with a mop and a rinse, I could really tell the toll that RA has taken on me. What would have been a quick, painless job just a couple of years ago turned into an arduous adventure. My hands hurt, my back hurt, my knees hurt, my feet hurt.
But again, good news. With all this stress and extra physical activity, I haven’t had a flare. (Fingers crossed.) I guess the meds are actually helping keep things under a level of control.
So that’s my life at the moment. Hope yours is rolling along smoothly. 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.
I love online access to information and services. I research (everything) online, I shop online, I bank/pay bills on line, I connect to family and friends on line. When my Internet goes out, my whole life stops.
One of the things I really appreciate is the information I can get from the insurance company about claims and benefits. I’m old enough to remember when you had to submit paper forms (yourself) along with copies of the doctors bills. It might be months before you found out what they paid and months later to straighten out an error.
I was poking around my insurance website the other day to see if the charges for my MRI had been filed yet (as I normally get a refund) and I stumbled across an area about “my health records”. It had several tabs including one that listed all my health care providers I’d seen and their contact phone numbers (cool), along with how many times I’d seen them. Then there was another list of all the procedures I’d had done. I decided that was okay, too, since I’m asking the insurance company to pay for said procedures, you’d assume they’d be told what those procedures were.
What I didn’t expect to find (thank you very much) was a list of all my test results. Yep, that’s right. Every test result for the two years that I’ve been covered by the insurance company is listed right there online. Not only do I have access to it, I’m assuming that the several thousand employees of said insurance company have access to this information as well.
I’m sure I signed something somewhere that gave my doctors the ability to share treatment information with the insurance company, but I was expecting information about the treatment PROCEDURES to be shared, not the treatment RESULTS.
I actually found this section of the site because on my personal home page there was an alert telling me I could click on a link to find out ways to help keep my triglycerides low. My immediate response was how did they know about that? And what kind of insidious system do they have that scans all the results for abnormal reports and builds automatic links on people’s login pages? I think we’re sharing a little TMI.
George Orwell is alive and well and working in the insurance industry.
Hope that whatever Big Brother sees you doing today brings you peace and happiness. Thanks for checking in.
I’ve decided that money is just like air: it’s not important unless you don’t have any.
I’m very fortunate in that I have a job that I like and it pays well. The benefits are good — they support my $1800/mo. Simponi habit. My husband owns his own architectural firm and while he’s not Frank Lloyd Wright, it has had consistent business over the years. We’re a long way from being rich (particularly based on Dallas standards), but our income supports our relatively modest lifestyle and allows us to indulge our passion for travel on a fairly regular basis.
I grew up [really] poor, and I’ve worked hard starting at a very young age to get to where I am today. The last 15 years or so I had my own consulting business, which takes an enormous amount of hard work and long hours if you don’t want to starve. I closed my consulting firm and ran for cover under the corporate umbrella about a year ago when I saw the economic handwriting on the wall.
What I would really like to do, what I’ve never had the opportunity to do, is to either stop working or cut way back — perhaps do some project work at home. I love keeping house and cooking. I’d like to be able to seriously work on my second novel — which has been gathering dust for over a year. I’d like to be able take exercise classes in the middle of the day — instead of missing them because I’m working late (again). I’d like to indulge those days when I don’t feel well without worrying if I have enough time off accrued.
And while our lifestyle would become even more modest, and travel become less frequent, we could manage on my husband’s income alone. The other night when I got home after a particularly grueling day, my husband even told me that if that’s what I really wanted to do, that he’s right there behind me all the way.
It sounds good until I look back just a few months ago when my husband had his triple-bypass surgery. What if he had not survived or had not been able to return to work? What if that had happened and I had already quit my job? It made me realize that as comfortable as our lifestyle is today, we, like many people, are one major health event from potential financial disaster.
We just applied (and were finally approved) for long-term health care insurance. This was right after my husband’s heart surgery. It seemed to take a while for things to move through and yesterday I spoke with our agent. It seems the hold up was not my husband’s health, but my RA. In fact, my RA disqualified me for one of the benefits we applied for (a waiver for the waiting period for home health care), and put me in a sub-prime group, which increased the premium on my policy. My policy has less benefits and costs more than my husband’s who has had open-heart surgery.
I tell people that I don’t necessarily believe the phrase, “If you have your health, you have everything,” but I’m a firm believer that if you don’t have your health, it impacts everything.
I’ve also decided that health, like money, is a lot like air. When you’re young, healthy, and invincible, you don’t pay attention to it because whatever you’re doing is working, right? But when you’re health becomes an issue, it’s like getting that after-Christmas credit card bill in the mail.
So take care of your health budget. Put some nutrition, exercise, and rest in the savings bank, and they’ll pay dividends well into the future.
Thanks for checking in.