Tuesday, February 10, 2009

Health Insurance

Health insurance has become a top priority in our life the last 6 months. Some days I sit and think about how we'd manage if we didn't have it. I know Frankie makes too much to qualify for any type of state assistance. We tried to get help for the $160 a month we have to pay a month for insulin & supplies and we were denied. I personally think it's really sad that we're busting our asses to make ends meet and we already pay almost $500 a month just for insurance, not counting co-pays and medications. I wanted assistance for the $160 we have to pay for insulin and diabetes supplies because I didn't want to have to worry about where the money would come from if we happened to come up short. I explained things to the lady and told her without insulin Kacey would die and she looked at me and said "Mam, I really am sorry, but your husband makes too much a month and there is nothing we can do to help you." The system SUCKS! There are people we know that are mooching off the system, lazy bums who don't give a flying flip about their kids, and they go to the doc for every ache & pain and get pain meds and then turn around and sell them for CASH! WTF is wrong with the system?!?! Grrrrr!

OK...so all that being said... I'm in a bit of a dilemma. Frankie's company isn't very stable right now. They've cut his hours to 40hrs a week. He went from working 60hrs a week to 40hrs a week....20hrs of time & a half....CUT! They've told them that NO ONE will get overtime for any reason. This really got me worried. So as things would have it, the job he applied for a few years ago with the city has now opened back up and he was called for an interview. He went for the interview and things look really bright and this would be a stable move for us. My biggest fear was switching insurance. The first thing he asked them was would Kacey have a waiting period for a pre-existing condition. Since we already have insurance then she will NOT :) Our insurance is nearly $500 a month now and we have United Healthcare. We will be getting Anthem and it will be $232 a month....thats HALF of what we are paying now! Right now we pay $20 for reg doc visits and $40 for specialist and with the new insurance it will be $10! So thats another savings. Same with medications...we will pay a significant amount less. Now here's my dilemma...I filled out all the paperwork for Kacey's pump to go through our current insurance which will pay 80%...leaving us paying $1200 or so for the pump. But I'm not sure what Anthem covers for the pump? I've heard 100% and I've heard 80%. If they are going to cover 100% then I'm thinking it will be in our best interest to wait another month or so before filing all the paperwork. I don't have the heart to tell Kacey this because I know how badly she wants the pump and how badly I want it for her. I'm just trying to figure out what our best interest would be to keep us from being stuck with more medical bills. Sometimes we have to think with our brains instead of our hearts and this is one of those times I'm trying to use my brain.

Does anyone have Anthem? How is the coverage?

I'm really scared to make this move but I'm scared if we don't make this move and the company Frankie works for decides to go under then he's without a job and we're without insurance and then we'd REALLY be in trouble. I need some advice here because I'm unsure and stressed over all of this! It's weighing heavy on me right now and I'm torn on what decision we should make.


Rachel said...

Oh Jill I feel for you. I don't have that insurance so I don't know. But I think that before making a decision, you may want to get the answer to your question. Will they cover 100% of the pump. Once you know that, it may be easier to make the right decision.

Does Kacey know when she will get the pump? I don't normally believe in lying but in your case, a little white lie to Kacey may ease your mind. Tell her that it's a long process and there's a lot of paperwork and we just need to be patient.

How secure is the job with the city? Any change of layoffs there? If the city is a more secure position, then I would most likely go for that. It seems like your husband's company is really not doing good with cutting the overtime and everything.

Oh and I do understand your frustration with insurance company. It always seems like it's the people that really need the help that get screwed at the end.

Take your time, get all your answers and really think about what is best for your family. Like you said, it's better to use your head than your heart in this situation.

If you need to talk or just vent, you know where to reach me :)

Jill said...

Our Endo told us that getting the pump is a long process to start with. They said to expect to wait 4-8 weeks for approval and then after that the company sends the pump to us and we have to go for the 3hr training...1 week saline trial...and then back for another 1.5hr training...then we're on our own. Thats why they told us to fill out the paperwork and kinda "forget" about it so it's not something we're thinking about every waking moment. Tell that to an 8yr old thats so excited about getting a pump! LOL!

The job with the city is very secure and he won't be going in at the bottom because of his experience. It will be one step from the top as a Senior Equipment Operator. Next step is Master Operator. So no layoffs there and they have 3 people retiring which is why this position opened up and he was called.

Even if they do pay the 80% ...we're just back to where we are now and thats fine. I just kept thinking if they paid 100% then it would be better to wait and file with them instead. Having a $0 bill vs. $1200+ is a BIG difference!

Rachel said...

I agree with that. Is there any way that you can find the information out from the insurance company?

When should your husband hear back? It sounds to me like it's a great opportunity... I get the feeling that you are leaning that way too... but a little nervous still. Makes changes is always difficult. Making changes when you have a child who has a medical need is extremely difficult.

Just with the information that you gave, it sounds to me like it's a great opportunity! :)

type1mom said...

As a medical insurance billing "specialist" I can tell you that your new coverage would be based on what the employer chooses for coverages. Anthem BCBS doesn't have a set reimbursement, it is based on the employer group selections. It could be 80%, 100%70% etc, depends on what they chose for coverages.

The hard part is you dont really know for sure until you recieve the enrollment information. Hopefully they have multiple choices!

We just switched from UHC paying 80% of DME to BCBS EPO with my husbands new employer only to find they only cover 60%!!!!! SCARY!! Just make sure you read it all in depth!

Karen said...

I have Anthem now, but I think I had regular Blue Cross when I got my pump. Is there a deductible involved that you'd have to meet? When I got my pump, but had to pay about $850 out of pocket because our deductible had not been met yet.

Oh, and with my Anthem, doctors co-pays are $20 / $40. After reading Type1Mom's comments, it makes sense that mine might be different.

The Turner's said...

Jill, we don't have Anthem so I can't help much there. I think that once you find out how much Anthem will cover it will make you choice easier. We were covered at 80% when Nikki got her first pump and the company let us make monthly payments on what insurance didn't cover.

Type 1 is the most expensive chronic illness in the U.S. and doesn't that suck! Our choices are never easy ones, but Kacey sure does have a great mommy in her corner. Whatever you decide, you know you always consider her first and that's really all we can do - even if that might mean waiting a bit longer - don't be too hard on yourself my friend, you're awesome!