Home
 »  Community
 »  Blogs
Doris' Blog

Preparing to Be Uninsured and Beyond - Part Four


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 8, 2009 13:59
  • 1 Comment.
  • Preparing to Be Uninsured and Beyond - Part Four

    Part Four - Final Chapter (Or is it?)

     

    So, Friday July 31st was decision day.  I completed the application and completed the plan name line – HMO Blue $500 deductible.  I felt like I was making an unchangeable life-changing decision.  I was not happy but knew I had made the most practical decision for this moment in time. 

     

    But what does it mean, at least for the short-term?  Is it that big a deal?  To someone like me who very much self-manages their health care and is very picky about seeing caregivers and choosing hospital affiliations, it is a big deal.  

     

    It means I cannot seek assistance out of state.  Have I ever done that before?  Have I needed to?  Yes.  For three years while I lived in Florida, I came back to Massachusetts to see my endocrinologist.  Had I had an HMO back then, I couldn’t have sought the services of the physician I had trusted for years.  Have I ever thought to seek outside services other than Dr. Hudson?  Yes … I would have been down to New York in a heartbeat if Dr. Bernstein was an approved provider but he is not.  I know, for the most part, if I get cancer or have heart disease, I am in the right state.  We have some of the best cancer care facilities and cardiac care units in the country.  Is it possible there is something they couldn’t treat and some other facility could?  Apparently so … just ask Senator Kennedy who sought the services of a brain surgeon at Duke University. 

     

    What else does it mean?  It means that I have to seek permission from my primary care physician to see a specialist.  The methods of referrals are easier these days as they are electronic but nonetheless, I am really dead set against asking permission from anyone about anything regarding my medical care.  In all practicality, with my current primary care physician, it merely means an extra step in the process.  I will still ask for a recommendation if it is appropriate.  I will still research the person on my own.  I will still seek other recommendations.  Then, I will have to call/email Dr. Meyerhardt and ask her and her staff to submit the referral “form.”  They are no longer hardcopy forms I realize.

     

    It may also mean that there are fewer physicians and caregivers on the list.  I chose BC/BS because they are a widely accepted network.  I have not actually tried to diligently compare the two lists to see how different they are since they are also electronic and it is much more difficult to compare than when we had provider books.

     

    I also chose them because I have rarely had trouble getting approvals (short one blood pressure medication).  I chose them because unlike a carrier such as United Health Care, I am not forced to use Merck Medco mail order pharmacy (or any other) to fill 99% of my prescriptions.  I can pay slightly more in copays and use my retail pharmacist (Dan at Big Y) who takes very good care of me and doesn’t try to manage care my prescriptions to death.  Nor does he break HIPAA laws or ship thousands of dollars in medications to somewhere I do not live. 

     

    I also know that this is not the plan under which to need physical therapy.  The annual limits are much smaller than under the PPO.  As it is, physical therapy is very difficult get at the level necessary to properly rehabilitate injuries.  It will be more difficult with a much lower capitated coverage.  For the record, I have needed shoulder surgery for quite a while but I seriously doubt I will be able to “afford” it now anyway. 

     

    Beyond these concerns, I am sure I will find out along the way the differences between the two plans and my sudden loss of freedom.  I know that it will, in the short-term leave me with less debt since office visits are not under the deductible; therefore, I won’t risk alienating Dr. Meyerhardt’s receivables person.  The alienation will be at the lab and hospital levels – blood tests, cat scans, etc.  Physical therapy, etc. is also subject to the deductible.

     

    Massachusetts does mandate certain routine annual physical requirements be covered and NOT subject to a deductible.  I attempted to get a copy of the list prior to completing the application but the sales person said it isn’t available.  He said it might be included in the contract.  My dismay was with his comment that the doctor will know what is covered.  I don’t care if the doctor does know what is covered.  I want to know ahead of time what tests 1) I really need versus 2) what tests are covered and 3) the contract rate cost of those subject to the deductible.  I want that information prior to any office visit so I can have a reasonable give and take conversation with the doctor.  Diabetes require more routine lab tests than non-diabetics (e.g. A1C and creatinine) but they are considered “diagnostic” and therefore, subject to the deductible.  I also have an underactive thyroid, therefore, 2-4 sets of thyroid tests per year are “routine” for me.  So …I will have to work on getting my hands on the list and getting prices for other tests once I get my contract and new member card which should be prior to August 15th – the date coverage begins. 

     

    Can you see how the process has not ended even though I made a decision and completed the application? 

     

    The stress has clearly not ended either.  Though I believe I can keep myself healthy for another week or so and I am not in dire need for any prescription, the stress of being uninsured for any length of time is pretty high.  The stress of knowing I will incur $500 worth of additional debt I sure can not afford (being unemployed) is daunting.  The stress of not knowing how much less service I will get and how much I will have to fight to get what I need is daunting.  As a former employee benefits administrator and a diabetic adept at being my own advocate, I tend to know the rules and who to contact when laws are broken or rules are not abided by.  That does not, however, mean I want to undergo the arguments.  It does not mean less stress. 

     

    However, I have to say I am very fortunate.  I live in a state that has outlawed pre-existing condition clauses, unwarranted cancellation of medical insurance and is forcing carriers to stick with premiums for one-year periods. as opposed to when I had a Florida conversion policy from United Health Care, earlier this decade, that had very hefty premium increases every 3-6 months whether I used the plan or not. 

     

    As far as the “affordability” quest, there really is no good quality insurance coverage I would deem affordable for the average bear.  I do not consider $400-500 per month with or without large deductibles affordable for the average person.  That is more than a car payment – which is why I have not been able to buy a new car in years.  Once you pay the premiums you can not afford to actually go to the doctors with these deductibles and if you get stuck with a prescription deductible, it’s even less affordable.  To get assistance with premiums you must make less than 3x the poverty level.  To get assistance from the patient assistance programs, you must make even less than that.  Some only offer assistance at 1 or 2 x the poverty level.  In this state, you would be covered under one of the “free” insurance options. 

     

    My head spins when I think about all this.  Sometimes (as you can tell) it all goes in circles and still ends up nowhere.  I can not imagine not having an understanding of medical insurance, COBRA and other employee benefits rules and regulations.  Some people will tell you anything thinking if they use an authoritative voice, threats, intimidation and the words “I have to” or the “law says so” you will give in, believe them and give up.  Do not be doing that! 

     

    For those of you who have to go through this process without this experience and understanding, I am so sorry.  I can offer only this … open the window and scream “AAAHHHH”!  Then go get your favorite ice cream cone and savor it.  Diabetic or not, it  is my favorite stress reliever if not problem solver.

     

    Doris J. Dickson

    Comments (1):
    Sort By
  • Add Comment

  • By: FatCatAnna: Aug, 10, 2009 14:01 PM

    Doris - glad that you've done your homework on which medical insurance carrier to go with (I would do the same as you) - in finding the right plan for yourself - that you can "afford" without going into further debt.

    Also, glad to hear the MA protects you from some of the pre-existing condtions clauses, changes in premiums, etc.  I have read in other forums about how from one minute to the next - this can change.  How do these insurance companies expect people to live? Again, as you've stated in the past - it's all about how much money can be made - rather then "are you feeling 100% healthy today Ms. Dickson?".  It's all about the money game - and playing with peoples lives. 

    So sad, for a country such as yours - the United States of America. Perhaps I am saying things wrong here - but this is how many people who are not American see the medical system in your country - and has actually put both myself and my husband from moving to the States for work despite the lower income taxes because of your medical system and the cost of medical coverage. In the end, the higher taxes we pay here in Canada - we come out even in the end with our take home pay and we only hold 1 job each - whereupon other friends I have in the States hold 2-3 jobs - to make ends meet.  You'd have to be like my brother - who lives in the States - but has diplomate coverage - but he still finds living in your country not as rosey as he had expected (though the weather is much better then up North).

    I guess that is one thing with countries that are similar to medical coverage like Canada has.  We would never be placed in this situation. Actually, if you are on welfare - you get many things that if you are just borderline of being a welfare recepient, you will receive over and above the basic medical coverage we have - e.g. free dental care for one thing.  Yes, here in Canada we pay high taxes for the system we have (from 30% to 60% depending on your income tax bracket) - but we don't fall into the state you have found yourself in.



    Tags:
    HMO (1) PPO (1) stress (1) HIPAA (1) benefits (1) tests (1) COBRA (1) medical insurance (1)

    Related posts:

    Flying high and I'm afraid of heights  |  The dreaded "poke 'em doctor" visits  |  Do You Hate Doctors' Visits?  |  Stress, Stress, and more Stress  |  Taking a break from my pump  |  What did I do when I was in Martinique?  |  BC/BS Massachusetts New CGMS Policy  |  Walking on a tight rope!  |  It's the Most Wonderful Time of the Year ... NOT!
  • Previous Blog Post
  • Next Blog Post
  • Longterm Health Risks Part 2
    More Information On Prevention- Long-Term Health Risks
    How to decrease your chances of developing long-term diabetes-related ...
    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: Sep 15, 2019  © 2019 Body1 All rights reserved.