Tag Archives: health insurance

Again and Again (really)?

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The great health insurance debacle continues.

I received a letter 2 days ago dated 12/16 (last day of open enrollment for coverage starting 1/1), that my health insurance application was rejected due to the form being “old”.  Yep.  I had questioned the insurance broker in reference to the date on the application and if there was a newer one (there was a discrepancy in one of the plan codes although not mine).  It’s a long story involving many emails and phone calls but I was assured by the broker that the MY plan name and number were the same so the application would still be processed.  Nope.  After cry-panicking, sending an angry email on Saturday night, followed by more crying, I had to pull myself together for a FaceTime call with one of my nephews.

My nephew started by asking me, “What’s happening?” so I scaled it back but explained that I was in a bit of a mess with health insurance and how crazy things were.  He repeated back to me “crazy”.  Indeed, crazy. I spoke of how the options I had were not even close to what I wanted and all were worse than my current coverage but now another wrench was thrown into the mix.  He said something I didn’t quite understand, mentioned Lightning McQueen and talked about things that are “great”.  I told him the situation is tricky and he kept saying “tricky” back to me.  He then said my name, followed by “Rocky run”, put his hands above his head and started running in circles.  Next he dropped to the floor and did his version of Rocky Balboa push-ups (looked more like an impression of a seal).  Did I mention my nephew is 2 years old?  And it made me laugh and then think.  I have the privilege from time to time to speak to people about the evolution of T1D care and technologies, about progress and research, and the most important part… advocacy, I have spoken about the JDRF Ride program and why it is so very dear to me. I get to talk and talk and even tie things into some of my own personal philosophies and parallels with Rocky Balboa.  Eye of the Tiger, baby.

Freedom Fog

Freedom fog all around

My nephew’s advice was solid.  This insurance mess is a mess for sure, but I need to keep fighting.  This was another round, not the full fight.  It’s like athletic training.  You keep going and when you hit obstacles, you use your mind and experience to figure out multiple solutions.

I moved on to Plan B yesterday when I’d exhausted everything I could do in this debacle (it was Sunday), I took advantage of this Miami-esque weather we’re having in the North East, put air in the Pinata bike tires, dressed in a costume of Spandex and started pedaling.  I worked on Plan E (I already had a rough outline of C and D before I reached the West Side.  There were so many tourists near the WTC memorial and most walking in the bike lane.  “ON YOUR RIGHT,” was unsuccessful with most people who were not speaking English and I may have sounded like the teacher from Peanuts, “Wha-waaa-whhhha-WAAAAHH” so I decided to take side streets back across the city.  What a gift.  I saw beautiful graffiti from some of my favorite street artists, cleared my head a bit, smiled.

Wonder woman

Pinata Bike on a mission

Mr Robot Pinata

Hello Mr Robot

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LOVE

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Wheatpaste girl

This morning I started my follow-up calls to my health insurance broker after a night of emails and networking my D plan.  My “kill them with kindness rule” had to be shelved for a bit.  Emails unanswered, voicemail messages unreturned, cell phone calls and texts done (repeatedly).  Couldn’t get my hands on a carrier pigeon (damn those birds are fast). I called the broker company’s main number and then kept dialing extensions of everyone else in that department.  Oops.  I’m sorry I dialed the wrong extension, I haven’t been able to get through, can you transfer me, I don’t mind waiting, thanks so much for your help.  I finished signing all the appropriate forms a few minutes later.  Will this situation resolve itself in enough time?  I don’t know.  Plan C is so close now I could lick it.

Patient advocacy starts with us.  Always.  Now stick your hands in the air and Rocky Run.

xo

I’ve Been Here Before, Right? (for the USA)

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In the past 2+ years I have had to change health insurance plans (and carriers), 3 times.  The process is simply mind boggling.  New doctors, new procedures, new pharmacies, new bills, moving mountains to make things “work”.  Many people are going through the same thing right now (Health Republic Insurance of New York went out of business recently and although not my insurer, it certainly contributes to the madness with open enrollment ending in 4 days and less options for individual coverage plans in my state).  This process is nothing short of torturous, as trying to find specifics on both On and Off Market plans is a game of “How many questions can you ask and how few answers can you get?”.

My situation is complicated (isn’t everyone’s?) but as I have read through contracts on the coverages (these prescription drug tiers… where are all the other meds?), any decision I make involves risk. The premiums are less ($) than what I was previously paying BUT the coverage is MUCH less (“coinsurance” is not a nice word).  The feelings of “Which decision is the least bad” combined with “OMFG how much is this REALLY going to cost me?” and my new favorite, “What do you mean the insulin I’ve been on for years and have had good results isn’t covered… AT ALL anymore” (<- that’s really happening. Novolog.  See photo).  I will figure it out.  There will be more 4am bolting awake nights (well mornings), and there will be tears but, as I have learned, you just do (and use your brain and maybe kick some shins along the way).

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So, I’m sharing this fiasco (OK, story), because there is a link that is INCREDIBLY valuable and even if you are one happy yellow smiley face sticker with all things health insurance related (oh how I envy you and wonder if you’ll marry me… I have little to offer in return… I seriously can not think of anything except free wifi, a ridiculous amount of gold glitter and I *may* dance and rap in the shower… yikes…?), I hope you will bookmark this link.  It is a post from Christel at The Perfect D (and updated recently).  Need Help With US Diabetes Supplies and Medications? UPDATED! 

Look at ALL that information.  Thanks Christel for allowing me to share this and more importably THANK YOU for doing all this work for all of us!

Information is power.  Go be powerful. xo

 

Fear? Cowabunga Dude

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IMPORTANT: WE WILL NOT OFFER YOUR HEALTH INSURANCE POLICY NEXT YEAR.

That sentence (and the letter it was attached to) has been on my list of life fears for years and years and years.  Due to a rather complicated (ok, weird) work situation over the past 12 years, I have joked (read: definitely NOT joked) that I would marry for health insurance.  New York State (and NY City) have some health insurance laws (not to mention premiums) that seem to be “different” than many other states.

This “NOT OFFER” is not taking effect right away.  I have a few months.  I will slam my face repeatedly into a window if I have another conversation with my “advisor” at Fill-in-the-Blank Insurance because:

1. He has a name that is only fitting for a child.

2.  He sounds like he just hopped off his skateboard to take my call.

3.  When he told me about the other plan available to me, he explained that other people with my “old timer” plan switched last time they had open enrollment and they all, “REALLY LIKE THEIR NEW PLAN”.  (God I wish I could say his name but I’m afraid someone who reads this has a kid with a cute bowl cut named —- and will be eternally offended).  Really —-?  EveryONE who switched plans likes their new plan?  That’s amazing!  So, how exactly does this “everyone” measurement work?

“Well, no one in my territories has called to complain.”

Seriously, no one has called you, —-, to complain so therefore EVERYONE likes their new plan?  Holy shit, this is my advisor?  (Note: I took Logic in college to fill a core requirement.  I did not do well.  I am sure I beat —- in that class).

4.  When I ask about durable medical equipment coverage, I actually want an answer about durable medical equipment.  Crazy, I know.

5.  When I’m finally told (by someone else) that the plans we are talking about are subject to change in October, before the enrollment period, and I ask —- about this, here’s what I don’t want to hear, “I think you’ll really like the plan everyone else switched to and there will probably be a plan like-that in October”.

6. That phone call required many quarters.  Many.  I would smack —- across the face with his skateboard if I could.

7.  My favorite part was when I said, “So you’re basically telling me I have options that sound like cheaper premiums but less coverage and more expensive costs in almost every other area, but you can’t confirm any of this because the official insurance plans don’t come out until October?  And now I can feel like I’m going to throw-up every day worrying about this for 2 months?  Well at least I’ll be really skinny and sleep is over-rated anyway right?.”  The response, “You really are funny.”  Ugh

Here’s the thing and hey maybe it’s because I’m just a laugh-a-minute, or because it was a day where other huge fears (job related) also happened to come true (oh the timing!), but I’m just not freaking out.  I am so oddly calm, I’m wondering if someone is drugging my coffee.  HUGE fear….happening… not freaking out.  Who am I???  I almost feel guilty that I’m not freaking out, but when you are juggling, more than you ever thought you could realistically juggle, does one more ball in the air change everything?  I dunno, I don’t actually know how to juggle, I find most clowns annoying (unless they make balloon sculptures… balloons change it up completely), and my athleticism doesn’t always lend itself to eye-hand coordination, so I have no one to ask about my juggling theory.

I’ll deal with it (while I attempt to stockpile the eff out of every supply I can get my hands on).*

*I’ve decided “eff” doesn’t count as cursing.

tmnt

 

 

 

 

Share and Don’t Share – Monday 5/13/1

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Last year I wrote my first, real Surfacefine blog post during Diabetes Blog Week 2012.  I am thrilled to be able to participate again this year as well.  For more information on the 4th Annual Diabetes Blog Week (and be prepared to read some really fantastic posts from a variety of perspectives, Check this out http://www.bittersweetdiabetes.com/2013/05/diabetes-blog-week.html :

D blog week

Here’s today’s topic:

Often our health care team only sees us for about 15 minutes several times a year, and they might not have a sense of what our lives are really like. Today, let’s pretend our medical team is reading our blogs. What do you wish they could see about your and/or your loved one’s daily life with diabetes? On the other hand, what do you hope they don’t see?  (Thanks to Melissa Lee of Sweetly Voiced for this topic suggestion.)

Wait a second!  Does the blog reading cut into our 15 minutes of seeing our medical team?  If so, I’ll just copy the bullet points I read off my phone during my appointments and make those questions into my next blog post!

Alright this is serious, so here goes: My Endo is a T1D.  She has been diabetic longer than I have (I was diagnosed in 1979).  She is married and has two kids.  I knew her long before all of that.  I’m pretty sure as a fellow T1D, there would be nothing shocking or even surprising about my blog (well actually that I crack jokes when I write but I don’t have time for that when I see her) Although I have joked in the past that meeting with my endo is like this:

http://www.youtube.com/watch?v=NeK5ZjtpO-M

I appreciate that my endo is a T1D too.  When I was kid and had been a T1D for a few years, my family switched pediatricians.  Yep, we switched to a pediatrician who was a T1D too (what’s up Dr. Selig?).  Guess what else?  My podriatrist is a T1D too.  Do you sense a theme here?

I don’t have anything huge that I would want my doctors to see or not see if they read my blog, BUT if the question were about my health insurance company, then yes, I have a strong opinion on this one:

Dear Health Insurance Company Who I Will Not Name Because As Much As I Fight You, I Also Fear You,

Do you remember last year when you sent me a letter about how I should be getting regular A1Cs and then explained what an HbA1c is?  Do you recall how the letter pointed out that I am missing items/tests for “good” diabetic care?  Do you also remember that I chose to ignore it instead of confront you on how insulting it was?  I did that because you scare the hell out of me.  You and I both know  I am on a private plan since although I work in a partnership, I am the only one who needs health insurance (as in: others have spousal health insurance or Medicare).  We also probably both know that I have found alternative plans over the years but what I would save in premiums would be spent covering deductibles, so here we are.

We started together for a few reasons, but the most important one was my opthomologist had switched plans and I had to scramble.  I hope to never know how low I would sink to keep seeing my opthomologist (his group treats a celebrity with diabetes. If that doesn’t matter to you, great.  It is a HUGE vote of confidence to me).  My primary care physician is also part of your plan and she’s got a great working relationship with my endo so that’s an added bonus.  You know who doesn’t participate with your plan?  My Endo!  Crazy right?  Especially because she DID participate with your plan, left her hospital, went into pharma sales, came back to another hospital about 30 blocks away and I am happily back under her care, but she isn’t one of your plan’s endos.

At one point I saw 3 endos in your plan.  1 is my current endo.  Another was a very young doctor who although “nice” she seemed to want to be my friend more than my doctor.  I stuck with her for awhile although I questioned her T1D experience.  She left for a pharma job too.  I even had an appointment with her replacement.  It became very clear that not only did I know more than he did, BUT that he couldn’t answer ANY of my questions.

So Insurance Company, I have given you the benefit of the doubt with that letter of yours about what I’m doing wrong with my diabetes care.  I pay out-of-pocket to my endo.  I am beyond lucky to be able to do that.  I get all blood work done a week before my appointments, with a prescription, at one of your labs.  I don’t get any labs at all done in her office like her other patients.  For all you know, I do not see an endocrinologist at all… EXCEPT you pay for my blood work at your labs.  You pay for my HbA1c and microalbumin tests.  The prescription for the tests and the results come from and go to that very doctor who is not part of your plan.   You can continue acting like I don’t see an endo.  You can pay for my Dexcom which had all the proper paperwork for medical necessity as did my pump.  You can keep covering my ACE Inhibitor under my prescription plan too.  You can keep seeing these prescriptions come through my endo’s office and you can remain clueless when I tell you I wave my right to have YOUR on staff nurse (with no specialty in diabetes) review my case to perhaps give me some pointers and recommendations.

Getting back to the question above, my dear health insurance company, you can raise my rate $100 a month EVERY year for 4 years running, and I will work harder to make more money too.  I don’t want you to ever see I have a blog.  I don’t want to be anything more that a code number to you.  I don’t want you to know about my challenges and victories as a diabetic.  I will fight you over billing errors, but I don’t want to ever be on your radar.  I will spend hours trying to figure out how to work with you and when or if that doesn’t pan out, I will spend those same hours working around you.  I’ll keep signing the checks, and take care of myself.  You keep making your “suggestions” so I’ll mock you in my blog.

xoxo,

Surfacefine or perhaps Diabetes Batman would be a little more secretive.