My new insurance will be effective starting Monday.
I called today and it all seems good. The deductible kicks in for in-patient stuff and surgeries. However, if my luck lasts, I wont’ need that. I’ll be on the hook for co-pays and, for some reason, I thought the deductible applied to office visits, but they don’t. Yeah!
I will need doctor’s visits, lab work, my pump equipment and prescriptions. I went for the highest end PPO they had. It’s not cheap, but knowing I can go to any specialist I want in the network without a referral is awesome. Blue Shield/Blue Cross has a good network of doctors.
HMOs have gone f#*king nuts with needing a referral for the most minor things. I’m a diabetic. OF COURSE, I need to go to an endo! (Can you tell I’m recovering from the trauma of having to bother my primary care clinic to fax in a referral every few months? Irritating and just bureaucracy. I do wonder how much do HMOs truly save considering all the checks and balances that have to be checked and enforced…anyway.)
It won’t come cheap, but I’m glad to be on it. Now let’s just hope it stays that way!
Congratulations, Regina! I’ve been lucky enough to have a similar BCBS PPO for the last 9 years (yikes, can that be right?!) and I didn’t have to pay any premium! I’m actually going in the other direction from you, switching this coming November to Kaiser HMO. The reason is I’m retired and even though I have no premium, all those 20%'s of lab works, tests not to mention pump supplies add up, so it makes sense for me. I’ve had Kaiser before so I know what you mean, but at least in my area, you can get decent care of you are a good advocate for yourself and pick docs you like.
But I definitely enjoyed the PPO, picking my own docs not to mention having them in walking distance. I felt very grateful to have such great coverage because I know Natalie is right, not every PWD does!
Congratulations! That has to be a huge sigh of relief for you. I hope you won’t ever have to test out the in-patient or surgery part of it!
I like not having to get referrals also. I had to do that with one policy and it was a pain. I had a cut on my foot and had to waste time going to the PCP to get a referral instead of going straight to my podiatrist. Then they sent the referral in for him to look at it. I had to sit in his office and wait until he got permission to treat it after he looked at it. He was really annoyed with them.
I’m a freelancer, so this is being paid for all by me. Not free by any stretch for me, but I’ve been on the other side: uninsured and unable to afford decent coverage. I’ve heard that Kaiser is pretty good now too, so I hope you transition just fine to Kaiser.
I too am lucky enough to have a good health plan through my employer. A couple of years ago they started having us pay a small part of the premium, but the PPO benefits didn’t change. Every year when we renew and the benefits stay the same with BC/BS, I am just as giddy. I completely understand. Congratulations !!
Yeah, for some reason, BC/BS gets a bad rap. I was with them when I was working just out of college. I was a new diabetic and, honestly, I don’t even remember having to deal with a pre-existing condition exclusion. I got a job, enrolled and that was that. Maybe the crap undergrad insurance I had at UCLA counted or, since that was an HMO, there was something else at play. I just remember since I was diagnosed and treated at Cedars-Sinai that I went there for my primary care and almost never saw my endo. I was younger though and my diabetes was real easy to manage.
Anyway, I hope my experience with them stays positive. In the freelancer program I’m in, they were my only choice.
I agree; I think my BC/BS insurance was one of the best compared to other people, at least in the U.S. I retired a month after diagnosis, and someone can tell me if this is incorrect, but I think when you are part of a group through work (and school) that they don’t apply the preexisting diagnosis thing. But it sounds like even with individual insurance you have been able to circumvent the clause.
Zoe,
You are right about not being able to apply the pre-existing clause if you are under the group plan and haven’t let a policy lapse between jobs. My BC/BS policy is wonderful. They authorized my pump, no problem. They authorized my Dexcom, no problem, even though I’m a Type 2. I’ve been really blessed.
sooo aren’t you still paying out of pokcet for your most expensive things on a regular basis? prescriptions i would take to be insulin which of course isn’t generic, pump eqiupment= equals monthly tubing and sets last i checked was around 100 bucks?? a month… and then lab work depending on where is performed varies from 120- 1200(hospital endo’s office) bucks…
i don’t know how much you are paying for things as i am not in your finances, but i am self insured and have the freedom to see any endo or doc i choose without a refrerral as well, i save money on no monthly premiums and use that money in a savings and purchase my diabetic needs through this from which i can tax deduct on my own expenses… and everything you mention i pay for out of pocket as well.
it seems to me that the only upside is surgery and things like that are covered, but if i am not mistaken any type of complication that i may develope will automatiocally get me admitted to a hosptial where the hipocratic oath then takes affect and i would recieve the same care as if i had your insurance(considering your insurance would have to approve decide your best treatment etc etc)
i would be left with bill collectors calling my magic jack line i pay 20 bucks a year for and i never have to hear about it again, is it fair right or moral, no. but i have been wronged more by just trying to be able to purchase my own health insurance since they told me, no. i am sicky. i have found ways to use the system to my advantage, fully understanding that it raises everyone else’s cost but, i can only be concerned for my personal survival just as whomever is opposed to a UHC is doing the same for their own personal needs wants and desires…
while having the label of insurance is always good to have and tote around until the laws take affect in 2014 there is no good health insurance plan for a diabetic on his/her own… you cannot be denied care without insurance and can extremely control your expenditures and not just hand your money over to any insurance company and get no ROI which is essentially what a premium is an investment into someone paying any bills acquired through illness especially major medical bills that one cannot afford on a nominal salary in one’s lifetime, which by idea is fine but so is the marx papers, in action we as diseased toxic assests hold no benefit for a compnay whose sole losses come from paying out claims for sick people…so why give them your money if there is no symbiotic relationship…??
Congratulations! The referral stuff is truly nuts. In my network I can use anyone except a nurse practitioner or podiatrist without a referral. I’d check to make sure you don’t have any similar exclusions.
One thing that confuses the issue also. My doctor was giving me a referral to a specialist and I told him I didn’t need it because my insurance didn’t require it. He said that the specialist required it, which apparently they have the right to do so regardless of insurance rules.
I don’t need a referral to see a specialist with my insurance but I have tried to get in with a couple doctors that did require it. Two of them weren’t worth the hassel so I called someone else but one was someone I wanted to get in with so had to ask my PCP for referral - then he complained because I was seeing someone in Pittsburgh instead of here.
Look I can understand your POV. I don’t like that you have a be a buzz kill though.
I HATE the insurance system in the USA. I don’t see why so many people put up with or why people were so bent when Obama tried to change it. Republicans, Democrats, Libertarians and Independents all get sick and all need care. I lived abroad where they have a capitalist economy but a socialist health care system. Even when I was in school there I could pay out of pocket for most things. I could NEVER afford that in in the USA. Maybe I’ll be able to soon as my business seems to be growing, but if I get sick, that’s it. I am my business as I’m a sole proprietor with no employees.
Anyway, re prescriptions, no. My plan has a $15 co-pay for diabetes supplies. I also made sure that my pump equipment was considered durable medical equipment and it is. In fact, they pointed the $15 co-pay out to me because for other Px stuff the co-pay is higher. I’m not sure if you pump, but that’s EXPENSIVE. I think I would consider alternatives if I weren’t a pumper. But go to the Medtronic site and see how much a month of supplies costs. I won’t say how much my premium is. It’s not cheap, but, I think, for what I get, until the system changes, it’s worth it. I have passed out and have fallen face first before. I was uninsured. I’ve been in the hospital/ER three times before without insurance. Got lucky when my parents were alive as they covered one of those incidents. I had to use the same Hippocratic Oath trick once as a student in law school. It’s a damn shame the system is set up that way. However, I glad my then boyfriend listened to what I told him about me not being insured and where to take me should something go wrong. I’ve had those experiences and, for me, it’s not worth it to be to take that risk now that I can afford comprehensive coverage.
Maybe insurance doesn’t work for you, and, honestly, I do wish my monthly premium was cheaper. However, it is what it is. I went ahead and just paid it in advance yesterday to make sure I always have it paid up. My premium, co-pays and other stuff will be tax deductions too. I’m in business now so I have to start saving all of those receipts.
However, don’t rain on my parade. I’m elated to be insured because I made it through the maze, the pre-existing condition exclusions and have a pretty good policy even in this crappy health care system we’ve got.
@still_young_at_heart - I actually won’t use it too much. I don’t like the doctor’s office. However, I’ve read the fine print. If I get it wrong, I’ll sort it out, but I’m the type to call and to grab that policy and read it. Once I do that, I’ll still get on the phone and double check and take names to verify they’re being consistent.
This is why us self employed buy our insurance as two individual employees of a small group. And we didnt have to have this in order to get it, I think it is a law. Cant remember back that far, because we have had this kind of coverage for a good many years now.
Btw, thanks for the suggestions of seeking financial help with the copay.
The supplier (unfortunately not Animas) is going to take a tax return and some pay stubs (of course, half the time we dont draw any pay because we cant afford to). Then they apply a 100/65 or 33 percent discount if you qualify.
One nurse at the HMO was trying to be helpful and tell me they dont buy pumps until they are broken but that hasnt been the case ever in the past and you can bet if I get assistance I am going to fight for things!
All diabetics should be so lucky!