Home
 »  Community
 »  Blogs
Doris' Blog

Preparing to be Uninsured and Beyond - Part Three


Doris' Blog
By: dorisjdickson


<< August 2009 >>
SunMonTueWedThuFriSat
            1
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28 29
30 31

 Blog Entries
Islet Cells Generation - Cure? I Think Not! - Oct 01
This article in Diabetes Health discusses yet another new potential "cure."  However, yet again, it requires immunosuppressants which are not an option to me.  ...
more
Cholesterol Conundrum - Sep 21
I recently wrote about Red Yeast Rice as an alternative to statins and the fact that it actually IS a statin since they contain the same active ingredients.  You just ...
more
Red Yeast Rice - It is a Statin - Do I Take It? - Sep 10
I receive Dr. Mercola's newsletter regularly.  I don't, however, regularly read it.  My concern is the amount of "stuff" sold on the website.  However, this ...
more
Diabetic ketoacidosis at onset of type 1 diabetes remains frequent in children - Sep 08
This article in yesterday's edition of Endocrine Today makes me scratch my head.  First and foremost, had this study been conducted in 1976 in the US and not in Germany, ...
more
Inaccurate Monitors and Strips - Sep 02
Some of you may have read about the FDA's recent warning about the inaccuracy of certain test strips while taking certain medications.  Honestly, I didn't pay much attention ...
more
Posted: Aug 4, 2009 13:28
  • 0 Comments.
  • Preparing to be Uninsured and Beyond - Part Three

    Part Three

     

    I spent several months not knowing when my COBRA was going to run out.  I thought it was the end of May or June but was not sure.  Every time I went to the pharmacy, my insurance was still active and they were able to fill my test strip prescription.  Why rock the boat?  They were cashing the checks, which is a binding contract and could not by law demand I reimburse them for claims paid.  I did not receive any information from the employer, third-party COBRA administrator or BC/BS until Friday, July 21st. 

     

    The letter came from BC/BS and was dated July 17, 2009.  It stated that my COBRA was about to run out or had run out and gave me an 800 number to call for information about new plans.  Therefore, I called the 800 number and chose the individual plan option.  I spoke to Matt and, honestly, was in a particularly negative mood about what I anticipated being told.

     

    First, I asked about the letter I had received.  I was annoyed that the insurer was the player in the game to adviser me of the cancellation.  I was even more annoyed when he said they received notification on July 17th to retroactively cancel my insurance back to June 1st! 

     

    Later that day, I was even more annoyed to find out the third-party administrator had cashed the June payment on July 24th.  I was then infuriated the employer refused to do their job (as the customer of the 3rd party vendor) and inquire as to when I would be reimbursed the $445 payment that never should have been cashed in the first place and HAD been cashed AFTER the insurance had been cancelled retroactively.

     

    Back to the discussion with Matt at BC/BS - we discussed the variety of plans available as an individual and if there was any price/plan difference if I chose the self-employed option.  There were no differences.  We discussed my needs as a diabetic who is strong-willed at making medical decisions without “permission” from a primary care physician.  We discussed the cost replicating the recently terminated plan.  The premium would be $774 per month for the PPO I had with the deductibles I had.  Ouch. That was currently out of the question.

     

    So on to the other options.  Based on our detailed conversation he suggested and emailed proposals for two options:  HMO with a deductible of $500 and PPO with a deductible of $1,000.  The costs, based on zip code and age, are $452 and $435, respectively.  The contract term is one-year. 

     

    The major differences between the HMO and the PPO, other than deductible are:  HMOs require referrals (but it is a much easier process these days), the inability to seek non-Massachusetts medical care (for example if you get a particular form of cancer that Massachusetts physicians are ill-equipped to treat) and services under the deductible differ.  Under the HMO option, office visits are NOT subject to the deductible. 

     

    I decided to call back and ask a few more questions including what the cost of the HMO with the $1,000 deductible is.  It is $405.  Mathematically, it is more beneficial to not expose myself to the additional $500 deductible with either the HMO or the PPO.  Even the HMO premium difference of $45 (x 12) is only $540 total (just slightly more than the difference in deductible), which I would prefer to pay monthly, rather than owing medical providers.  There is no question one doctor’s visit will cause me to blow right through the $500. 

     

    Therefore, after laboriously researching several sources of individual and self-employed plans, including the Small Business Administration, the Commonwealth Connector, and Blue Cross/Blue Shield Massachusetts Direct Pay, I had to make a decision.  Fortunately, I live in Massachusetts and do not face pre-existing conditions clauses.  Therefore, the fact that the employer and third-party vendor blew by the notification of termination of coverage and thus, the 63 days of continuation of coverage mandates required by HIPAA were not going to be an issue.  My deadline was July 31st in order to have coverage for August 15th (the start date of all plans under BC/BS Massachusetts Direct Bill).

     

    The biggest question was HMO or PPO.  I absolutely do not like the concept of HMO’s and managed care.  I do not like large deductibles in conjunction with such high premiums.  Something suffers along the way.  At least with these plans, there is no prescription deductible, limited prescription formulary or limited physician list.  Most physicians take HMO Blue. 

     

    Therefore, I begrudgingly and with much apprehension called Matt at 8:30 Friday morning and faxed the application having chosen … HMO Blue $500 deductible.  My thought process is changing back to a PPO once I find full-time work.  In the mean time, it is important that I have prescription coverage (stock piled insulin or not) and that I can see a physician. 

     

    But is the process complete … not really.  Stay tuned for Part Four to find out what else this choice means and how this stressful this entire process has been.

    Comments (0):
  • Add Comment


  • Tags:

    Related posts:

  • Previous Blog Post
  • Next Blog Post
  • Problem Solving Part 7
    Special Ocasions/Holidays- Diabetes Problem Solving
    Tips for managing your diabetes on special occasions, holidays, and parties...
    more more Featured Videos
    Cost Savings Tool
    Do you know the annual cost of managing your diabetes? Would you like to find ways to reduce your costs? Calculate your total budget and identify ways to save money. You can do this in just a few minutes by entering facts about the products you use. This quick analysis will provide you with a comprehensive overview of both spending and potential savings.

    Cost Savings Tool
    Monitor Comparison Tools
    Blood glucose monitors offer an easy way to test your blood sugar at home or on the go. Use this comparison tool as a guide to learn more about the features and benefits of your current monitor or to find a new one.
    Handheld Monitor Comparison
    Continuous Glucose Monitor Comparison
    Advanced BMI Calculator
    Ever wonder if you are at a healthy weight? Then enter your height and weight in our advanced Body Mass Index (BMI) calculator. This tool provides you with two important numbers reflecting the estimated impact of your present body weight and shape upon your overall health.
    Advanced BMI Calculator
    more Care Tools
    Home | About Us | Press | Make a Suggestion | Content Syndication | Terms of Service | Editorial Policy | Privacy Policy
    Last updated: Feb 28, 2020  © 2020 Body1 All rights reserved.