Insurance Woes and Understanding Coverage

The last few months have been pure HELL! So much is going on and I'm exhausted, depressed and maybe even a little bitchy! (Alright...A LOT BITCHY...SO THERE!) My blood pressure has been a roller coaster. I had this cyst on my cheek that has come and gone for years and the doctor at MD Anderson just throws antibiotics (Bactrim) at it which tears up my stomach. It finally blew up last week and my face looks horrid. I've been trying to grow out my hair to donate it to Locks of Love but I CAN'T STAND THE LONG HAIR...adding to my misery. I now have a new health insurance plan and frankly with all my research I'm still a little worried about. I had to drop my private health insurance when the premiums reached over $800 a month and I'm still paying MD Anderson for last year's medical bills! Oh...and there might be a little stress involved here.

During this time I had a roof leak and I was told it was not covered on my homeowners insurance, but the damage to the interior is, subject to my deductible. So I paid the full cost of the roof repair while they have issued a payment for interior damage that is about $1,400 shy of the estimates and nobody will return emails or phone calls from the insurance company! I could affect repairs with the money given if I do the paint myself, but that's not why I have insurance and I'm not really well enough to do all that. AND if you remember last time I climbed a latter I fell and spent over 6 weeks in bed recovering from a pulled groin muscle and had to use a walker for several weeks after, but then that was with a chainsaw not a paint brush. Dare I??? Hum...The whole thing just sucks!

After realizing I might be a bit under insured, I called my homeowners insurance to increase parts of my coverage. I was told, "You have an open claim. We cannot make changes to your policy with an open claim. Would you like to close that claim out?" Ah...NO! Not until somebody calls me back to discuss the inadequate payment that was made for those damages!!! The rep told me she would forward the message to the adjuster and his supervisor so someone would call me back...TWO MONTHS...NADA!

Now let's talk Health Insurance! I know many of you have had trouble attaining or maintaining your health coverage and there are so many options out there if you are well, but it's harder at the moment if you end up with a preexisting condition. I don't want to get too detailed here because there are so many variables that affect your choices and availabilities. You need to do plenty of research before you decide to drop or modify your coverage.

You might have coverage from your employer or continue to pay your own privately. Perhaps you are disabled or over 65 and on Medicare. With Medicare comes many choices. If you are healthy you can get a supplemental plan (at an added cost to you) to cover things Medicare doesn't pay for. I had this setup for my mother after General Motors canceled health benefits to all retired salaried employees. It worked out well with the exception of having to enroll her in Medicare Part D (prescription drug coverage) which left her to payout thousands of dollars after hitting the infamous "donut hole" after her first order of scripts.

Some only have the option of staying solely on "traditional" Medicare or choosing a Medicare "Advantage" plan (Part C.) Some of these plans throw in the Medicare Part D drug coverage while you must continue to pay your Part B. This can get very complicated and expensive if you are a cancer patient taking a lot of medications, but remember some medications might be covered under your Part  B. For a better understanding of Medicare Part D from the American Cancer Society click (HERE)

One thing you cannot do is have a supplemental plan with the Advantage plan, that's only reserved for tradition Medicare. Advantage plans try to keep you "in network" allowing lower co-pays for using doctors or hospitals that accept this plan. These plans also put a cap on your yearly out of pocket whereas with traditional Medicare you are subject to a 20% co-pay on almost all services. Have your eyes glazed over yet from trying to comprehend this little bit of information? There are a few different Advantage HMO. PPO, POS, and Regional plans offered making it even more confusing and if you get an agent involve to try and help you, they will most likely guide you towards a company they get a referral fee from.

Just hit up AARP and they will fit you into a United Health Group plan that might lead you to believe you are fully covered. But that wasn't the case when in 2008 Lisa Kelly walked into MD Anderson in Houston (my understanding is, they are "out of network" or don't accept this plan at all) for treatment of leukemia and she was told she was grossly under insured and they asked for $45,000 up front to care for her. Full Story HERE

READ and understand everything about any changes to your policies as they seem to change yearly and you only have a short window of opportunity to exchange plans or go back to traditional Medicare. There are many companies out there offering these plans and they all seemed to be different yet still labeled "Medicare Advantage." Also make sure your doctor's and hospitals accept your plan BEFORE signing up for it. Providers can leave the network even if you still carry the plan, so stay on top of that and review everything each October when you have the chance to change plans.

What seems to make this even more complicated is that even the providers don't seem to know the differences. I went to a new doctor last week, one I waited months to see and researched extensively. He quit and walked out days before my appointment leaving me with a new, new doctor I know nothing about (that's a whole other story! AND NO, it wasn't my fault...I had nothing to do with it!!!)

I was charged $40 for the office visit and since this was the very first time using my new insurance I didn't think much of it. Then I read I was entitled to one free yearly "wellness visit." So I called the insurance company to ask exactly what that was, mostly because the doctor wanted to see me again for a full physical since I was a new patient. In conversation I learned that a standard office visit is subject to a $10 co-pay if the provider is "in network." Since they were in network, I realized the doctor's office overcharged me by $30.

At this point I have to give major credit to my health insurance rep on the phone who has promised to call the doctor's office and straighten it all out and inform them my next visit should be classified as my yearly wellness visit and there should be no charge. We'll see how it goes. Pardon me if I think it won't be as simple as all that.

Dealing with insurance companies (or people for that matter) has never been more difficult due to how complicated the policies are. I think they should limit ALL available plans to THREE: Bronze, for young and healthy, Silver for people with some reoccurring problems, and Gold of the disabled, over 65, or severely ill. Make it that simple! I think it's criminal to make this so complicated!!!

Peace B

***THIS IS NOT A RECOMMENDATION OF ANY KIND! I AM NOT AN EXPERT AND SOME OF THE INFORMATION REPORTED HERE I STILL DON'T FULLY UNDERSTAND AS I FURTHER IMMERSE MYSELF INTO THIS NEW WORLD. PLEASE UNDERSTAND YOUR OWN POLICIES! I CANNOT EXPRESS THIS ENOUGH! THIS IS ONLY A CONDENSED VERSION OF WHAT I HAVE LEARNED SO FAR AND IT'S MAD COMPLICATED!