We’re back from vacation (of course) and Christmas is over (double of course), and I am back to work this week (balls).
Can I complain about my health insurance for a minute?
I pay about $200 each pay period for health insurance, that is $400 a month to cover myself, Dave and the two kids. Then, every time we go to the doctor, it costs a $15-20 co-pay for the office visit and if there is any medical procedure that needs to be performed, that isn’t covered until we satisfy the annual deductible (which is $1500 per person or $4500 for the family if we go to doctors that are in their network. If we go to doctors that are out of the network then the deductible goes up to $2500 and $7500). Beyond that, prescription coverage is really hard to figure out because they have this really complicated chart that divides drugs into “tiers” and then assigns the percentage of coverage based on the tier the drug falls into and also takes into account if there is a generic version available. If there is a generic, you have to get that or they won’t cover it at all.
I think our plan is considered to be one of the better plans. I work for a large global corporation and I think the payroll deduction is also on the lower end of things.
Thankfully, we are a pretty healthy family. But just to give you a taste, Dave had a little cyst that had to be removed and biopsied this year. He was at the doctor’s office a total of approximately 30 minutes. The actual procedure took about 10 minutes from the time they numbed it to the time they stitched it. That cost me over $300 because I had to pay the doctor for the procedure, the office visit co-pay and then I had to pay for the lab to perform the biopsy.
As I said, we are, thankfully, a pretty healthy family, so the doctor’s visits are pretty minimal. We really don’t go to the doctor much (like probably 1-2 visits each per year and those are mostly well visits). However, I’m sure I have mentioned before that I am a lifetime insomniac. I have tried everything from meditation to medication for this and it has always been a struggle. And with the stress work has been giving me, it has gotten so much worse. I have a hard time falling asleep (if I fall asleep an hour after I get in bed, that is pretty good) and when I do fall asleep I wake up about every hour to hour and a half. I have tried a couple of different medications and they work for a while and then stop. Until I started taking Ambien CR. That has worked consistently for a couple years now. I only take it during the week, and I don’t abuse it. I have never taken more than one pill in a 24 hour period. I fall asleep when I get in bed and usually stay asleep until at least 3am, sometimes even later. It is the best I have slept in years and it costs me about $40-50 a month for the prescription. That is a 30 day supply and I can stretch it to last me at least 6 weeks or more.
So can I live without Ambien? Yes. But it sure has taken one stress out of my life.
My company held their open enrollment in October (where you choose your health plan for the next year). This is also the time when you can decide if you want to contribute to the health care spending account (money held from your paycheck pre-taxed that you can use for health care related expenses). I opted not to use the spending account this year because, as I said, we don’t go to the dr much and it is a pain to track.
So last week I got a letter from the insurance company that they are no longer covering Ambien CR. There is no generic version so if I want to continue taking it, I have to pay cash. I looked around and I don’t think I can get a 30 day supply for less than $160ish. Kiss my ass.
So I pay every paycheck for my health insurance that I pretty much never have a claim against and then the one thing I do use it for and they decide they just aren’t going to cover it anymore. It really pisses me off. If I had known they were going to do that, I would have looked in the changing to a high deductible plan because we really just need to be covered if something catastrophic happens, I’m paying out of my pocket for everything else anyway. Or, I would have at least put some money in the spending account for it, but it is too late now.
Don’t get me wrong, I appreciate that I have insurance and will be covered if one of us gets really sick, but gees, what if one of us does get really sick and then the insurance company decides that they don’t want to cover the prescribed treatment? I guess that is their choice and they can do whatever they want.
Other things they don’t cover: Fertility treatments of any sort and counseling. So basically anything I might want to utilize.
But hey, if I gain 150 lbs, become a diabetic and start abusing alcohol and drugs, well, all those treatments are covered. So I guess I just have the wrong ailments.
4 comments:
I don't know Mel... that sounds pretty messed up. But then again, I haven't worked in corporate world in a very long time, so maybe that is par for the course.
You could try contacting the company that makes Ambien. Many companies are offering discounts on medications or are giving coupons. You also should ask your physician for free samples... believe me... they should have a bazillion free samples of different things.
It sounds fairly messed up. My mom sent out propaganda to stir the pot the other day on this health care reform. It took all I had to not reply back to her about her smoking, unhealthy weight, and poor lifestyle that costs the insurance companies TONS of money. This whole thing is so messed up.
Healthy lifestyles SHOULD be rewarded by the insurance companies. :)
That is SO messed up but unfortunately it's typical. What I think is complete BS is that you have to choose your plan at a certain time, but the insurance co. can make changes to your coverage all year 'round. What's up with that?? I think you can appeal some of those things on a case-by-case basis. And since the cost for Ambien is very low (for the ins. co.) they might be willing to work with you if your doctor writes a letter. Call the customer service number and see what they say, and find out who a letter should be sent to.
好好充實內在，空袋子是站不起來的。..................................................
That is so ridiculous. And trust me I feel your pain. I paid for 8 years for health insurance from my large corporate employer, as a married person no kids I paid about $40/month less than the person with 7 kids. Kraig and I also are very healthy people which I am grateful for but I did resent that I had to pay nearly as much for my health care. BUT I will say that when I adopted Julia - I was given a million excuses by BCBS as to why they wouldn't pay her hospital bill, they left it unpaid for 2 years. For 2 years, each month I got the pleasure of having my heart ripped open as the statement arrived. By the time BCBS completed their investigation and paid the claim they had to pay the hospital $20,000 in interest for late payment. Again though I am grateful that we had health care insurance because that bill would have ruined us financially.
And then don't even get me started on fertility treatments. I will say that you would be wise to use the FSA even though it's a pain - it's free money cuz you're spending it anyway, why not spend it tax free?? Remember that you can deduct even contact lens solution from the FSA account too.
On the Ambien - I think calling to see if they will work with you is a good idea. My experience has taught me that in dealing with insurance companies the person who is willing to jump through the most amount of hoops wins.
It's messed up for sure, it's just that the proposals to "fix" it don't seem instill much confidence either.
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