February 1st our new insurance will take affect through Josh's new employer! Hallelujah! We have paid $5,000 for COBRA insurance over the past 6 months to cover just Maddison and I. How sickening is that? As much as I am excited to be done paying such a horrid amount each month to have our medical coverage, I am terrified at the same time. What if I missed something in the new benefit elections? You know, one of those "minor" details. I guess being that medical insurance is my background specialty for over 12 years, I am a step ahead in understanding our certificate of coverage. The problem is, insurance is evil. I know their dirty game. I'm worried that COBRA and our new BCBS coverage will try and say there is a lapse of coverage from the day COBRA ends to the day BCBS begins. Could you imagine? I'm just hoping for a smooth transition so I don't have to bring out the big guns on them!
Our new insurance is quite more expensive than what we were paying previously, but of course with coverage always decreasing and premiums increasing, I expected some increase of cost but not this much. I'm just thankful at this point to have "affordable" health insurance honestly.
Here are some details of the plan I decided on:
BCBS EPO plan Base RX
$300 family deductible (we never previously had a deductible)
DME coverage is only 60% compared to our previous 80% coverage. Paying 20% more for pump supplies is somewhere around an additional $1,800 per year! OUCH!
Copays are now $40 to see our Endocrinologist instead of $25
PCP copays are now $30 instead of the $15 we used to pay.....that's double!
Hospitalization is much better for our new plan though at 100%....we used to pay 20% of Inpatient stays......it took us over a year to pay off Maddison's 3 day stay when she was diagnosed! (lets just hope we don't need to use this great benefit!)
Rx for generic is only $10
Rx for name brand is $70!!!!!!
What happens though when insulin doesn't come as generic? I never thought of that!? Overall I am pretty happy with the insurance plans we had to choose from. Life insurance coverage is great for Josh, we upped it as high as possible at a reasonable $10 per month. HOWEVER....not so great for the SPOUSE with FRICKIN DIABETES!! $3 per month buys me base life insurance at $10,000 of coverage. Any more than that required me to fill out the health questionnaire. Well, I did, but I might as well forget it! I can already see the denial now....
"WE REGRET TO INFORM YOU THAT WE ARE UNABLE TO PROVIDE ANY ADDITONAL LIFE INSURANCE COVERAGE FOR KELLY L AT THIS TIME. IT SEEMS YOU HAVE A PLASTIC PANCREAS. YOUR LAST 6.0% A1C IS INSIGNIFICANT. WE KNOW YOU WORKED YOUR ASS OFF TO REACH THAT GOAL, BUT BEING CLOSE TO HEALTHY DOESN'T MEAN ANYTHING WHEN INSURANCE IS CONCERNED. AT THIS TIME YOU DO NOT "QUALIFY" FOR ANYTHING BUT A BIG, FAT LABEL OF UN-INSURABLE. SO SORRY TO INFORM YOU THAT HAVING DIABETES MEANS YOU ARE FOREVER SCREWED WHEN IT COMES TO MEDICAL OR LIFE INSURANCE. HAVE A NICE DAY.
So, what does this new policy cost us a month? $360 which is DOUBLE what we paid with Josh's previous employer. I realize $360 is REALLY good in comparison to what alot of other families fork out each month, but it will still hurt our budget since we are used to paying half that.
So....before our insurance changes and we have lower coverage for DME, I am thinking I am going to ask Maddison's Endo to write us an RX for the CGMS. Convieniently, Maddison goes in to see her Endo next Friday. Funny thing, I don't plan on using the CGMS for Maddison. Last year all I needed was to say the word and Medtronic was going to ship out our Minilink. Actually, I did give the go ahead and then I chickened out and called them back to cancel within a few hours. Why? I just couldn't stand the thought of another gadget to learn. Another device to make Maddison feel even more robotic. Her last A1c was 7.2% so for now I would never even go there for her. Nope, I certainly didn't plan to have Maddison wear it, I planned on wearing it myself. My Endo was pretty much set against a pump, so I wouldn't even think about asking her to write a script for a CGM. She would probably laugh in my face! Our insurance approved the Minilink (or so they say until they get the actual claim!) with minimal paperwork. It couldn't have been easier. Our COBRA covers 80% which would leave us with a small portion that is totally do-able. So my plan is this: I am hoping that we spend the money now for the device since our out of pocket cost would be less on he current insurance plan. I might choose to use it, I might not (depends on what my next a1c is with all these basal canges!) but the point is to save money now and have the expense reimbursed at the higher rate before we loose our chance and end up having to pay 40% instead of 20% for the CGMS. We then pay for the "upgrade" program and whenever a newer, better device becomes available, we upgrade at minimal cost. This was just a split second idea, I have to look into it quickly! GOOD RIDDANCE TO COBRA!!
Moving my blog again
7 years ago