Thursday, August 21, 2008

No Endo visit!!

On Tuesday afternoon Maddison's Endo office called to see if we received our COBRA policy number yet, and needed to know if we showed any eligibility for her appointment scheduled today. I explained that although I paid the initial $1400 (!!!!!!) we haven't yet received any notification of "eligibility." First, let me say I understand nothing in life is "free." I understand a Physician's office is a business first these days and they cannot allow every sad story to influence their receivables. (after all I have to deny my own patients every day too!) BUT, when I explained our hardship I honestly thought they would waive the required up front payment. After all, we have two with Diabetes in our house and I was certain they would trust that we had no choice but to maintain our insurance coverage through the evil COBRA.

Not so. I never even got a response from the office manager. It probably isn't a good idea for me to see (or hear) Maddison's A1c right now anyway after a month of pure hell chasing highs. I would probably have a nervous break down in the office and go postal. So, Maddison missed her appointment today because we honestly did not have the money to cover the office visit since payday isn't until Friday. Oh, and don't forget the HUGE check I was forced to write out to COBRA that demolished my money tree! I will probably remember writing that check for the rest of my life. Being forced into paying outrageous premiums because two of us have Diabetes is a very emotional thing. But I guess everything that is Diabetes related is emotional to me isn't it? As I was writing that check I thought, geez! How wrong is health care in America? Yet, I realized I am lucky to have the insurance coverage at all. What if I didn't have any insurance for me or Maddison when we were diagnosed? We would NEVER in our lifetime be financially able to maintain a higher standard of caring for our disease without good insurance. We HAD good insurance and the expense was still tremendous! State health care funding will not pay for insulin pumps. If we were doomed to state health insurance we would never be given the option to pump or not. The insulin pump is classified as "not medically necessary" because you know, injecting yourself 10 times a day without precise pump amounts is considered managing just fine. What a bunch of crap!

Then there were the emotions that wanted to tear up the damn check and scream like a child. Why? Why is our life so complicated now with medical expenses? My husband wanted to pursue a better career elsewhere and it is going to cost us $4,200 over the next 3 months to get there? Well let me mention something else that just is flat out wrong. When you take your new job you aren't necessarily sure what benefit elections are available. Well, we just found out what the new job elections are. From 3 care levels to choose we now will be paying $20 more per month for insurance and we are stuck with DME craziness. DME is Durable Medical Equipment. DME is also the account I work at my PT job. So, I am well versed on what this craziness means for us with a new policy that starts in 90 days.....DME coverage is also what is needed for pump supplies. Our new plan will pay 80% and will max at $700 per year....HOLY SHIT PEOPLE! YOU HAVE GOT TO BE KIDDING ME! ONE MONTH of supplies max's out that $700 "benefit"!!!!

Let's do the math......at $700 per shipment (every 3 months for us both combined) the pump "sets" will pay $560 from insurance. We pay the other 20%.......Then there is the "Reservoirs" that hold the insulin inside the pump and are disposable every 3 days as well. We are billed $300 (every 3 months for us both)insurance pays $240.00 and we pay the remainder. Looks like we already maxed out that $700 benefit limit for DME in the first damn shipment! We still have 3 shipments for the year that we will have to pay for. Out of our own pocket. Thanks for the $700 you srewed up insurance plan! Is this a better career move for our family? Not really. So, although Josh will make more money at his new job, we won't see alot of it because we again are FORCED into covering remaining medical expenses for a lame insurance plan that D.C.S. (DOESN'T COVER SHIT!!)That's another $250 per month we will now have to front on top of all our other medical expenses. I can think of alot more things to do with $250 a month than jabbing myself in the ass with a huge pump site needle! Funny that I just said that, now every time I change my pump site I will see the "ch-ching" of dollar signs and think of what I would rather do with that money every month!

Financial assistance? Um, no. We make about $20,000 more than allowed for financial assistance. Hmmmm. Maybe I should quit my part time job! Maybe then they would help us with the $4000 a year for medical expenses. Probably not a good idea to quit my job right now. At least I am starting to see this as comical. Insurance is a funny thing isn't it?

3 comments:

Scott K. Johnson said...

Very, very frustrating.

Kris said...

Oh no! They wouldn't see you? I am SO sorry. Insurance problems are a horrible kind of stress. I really hope things get better for you guys soon. (((HUGS)))

Harmony said...

How horribly frustrating!!!