You know that one of my favorite topics is healthcare. This time it's a doozie, if we can ever begin to define doozie.
For those of you following at home, my new insurance has a $5,000 deductible, plus over $500 per month in premiums. I shopped Obamacare and found that my choices were very similar, so I went with a work plan.
I had to pick up a prescription the other day. This was at the only pharmacy chain I was permitted to use. The lovely lady behind the counter, flush with cleavage (moreso than most customer service people) rang the medicine up and hesitated, backing away from the register. This was a subtle sign that I chose to file away in the almost not-noticed category.
She asked if I knew I had a copay. Of course I had a copay, this was Obamacare. This is when I made my second mistake: "Hit me," I said.
Thirteen hundred and forty seven dollars.
I forgot all about her cleavage, which is something I cannot normally avoid and asked her to repeat it, in case I had stuck an icepick in my ear or had a lapse in my ability to comprehend numbers.
Thirteen hundred and forty seven dollars.
Thirteen hundred and forty seven dollars?
Thirteen hundred and forty seven dollars.
For medicine?
Thirteen hundred and forty seven dollars.
For an old, generic medicine I have to refill monthly.
Thirteen hundred and forty seven dollars.
Jesus tap-dancing Christ, to quote South Park. What have we come to? This is a negotiated preferred price. I cannot afford that now, no less monthly.
What exactly were the criminal Obama and criminal Congress thinking? Oh yeah, gifts for the insurers and Big Pharma<tm>. How are (semi-)normal people supposed to afford healthcare? I have bloodwork scheduled and I'm wondering if I should mortgage the house in preparation. HOW IS THIS INSURANCE?
My doctor recommended a few online sites. Friends recommended Canada. I wound up at goodrx.com. This is a coupon-based site that negotiates deals. It even works with insurance. You can only go to certain places but they are chains, like Walmart. According to the website, my thirteen hundred and forty seven dollar prescription would cost me thirty seven dollars. Really - thirty seven dollars. Gee, that's a bit of a discount.
Off to Walmart. The medicine was six hundred dollars cash. With the coupon, it was only about three hundred and fifty dollars. Even the most math-impaired among us will recognize that the discount price was about ten times the advertised price. The kind gentleman behind the counter, completely without cleavage, informed me that the 'discount' price from the website was usually incorrect, even to the ten times figure.
A call to the site yielded the fact that although there were seven options, none of them led to a human (even after yelling the F-word, which sometimes gets you what passes for a human). Each option recommended performing that action online. Emailing would take twenty four hours, which I did not wish to spend wandering around Walmart, even considering this was a twenty four hour Walmart.
My very patient doctor prescribed something else, which was ready in ten minutes, at about sixty bucks with coupon from goodrx. When I suggested strangling the people who voted for Obamacare, the doc said it was actually Big Pharma<tm>. That's a lot of strangling. The situation is so bad that the doctor didn't have health insurance. Digest that for a moment.
Contact your Congressperson and demand a workable solution. This can mean torture and/or starving for people who need healthcare. You think gun-related violence is bad now? Wait til people can't get their psych meds.
With concern and respect,
-lefty
Showing posts with label copay. Show all posts
Showing posts with label copay. Show all posts
Wednesday, March 16, 2016
Sunday, December 21, 2014
Health Insurance or Let's Make Your Head Explode
Now that I'm sorta almost nearly employed, it's time to deal with the Evil Empire (no, not Comcast) - health insurance. For those of you who think Obama did wonders for the uninsured, it's time to crawl back under whatever rock from which you emerged.
I objected to government-run healthcare and I caught a ton of crap for it. I objected because nothing run by the government is a good idea or works correctly: look at Medicare and Social Security. The objection from the other side was that at least people would be insured.
The long and short of it, dear readers/plodders, is that Obamacare is a gift to insurance companies. You must have an Obama-approved plan or pay a fine. After some research, a fine would actually be better in some cases.
If you have an employer-sponsored plan, do the research. You'll probably find that it's cheaper with your employer. You will also avoid the dreaded Donut Hole [more later].
My previous employer (where the yellow brick road meets the duck pond) had good coverage at ridiculous rates. My new employer offers so-so coverage at ridiculous Obamacare rates. It makes my head spin.
So off I went, to healthcare.gov, to do my own research. Now I know insurance, from being in the field, being a consumer and being married to a Frequent Flyer. With all of my cumulative years of insurance dealings, after doing the research and going over the numbers, my head exploded. There are bits of cranium, red stuff and something that looks vaguely like cauliflour all over the ceiling. Have you ever tried to clean this stuff off a ceiling? With or without a ladder? In the dead of winter? Without so much as a pole?
The people who champion Obamacare will tell you that millions more people now have healthcare than before. What they don't tell you is that in most cases, this is subsidized by everyone else. And they can have up to six thousand dollar deductibles. For all of you playing along at home, this means that the insured have to pay up to six thousand dollars before their insurance kicks in (twelve thousand for couples). People who have never had insurance before are getting the shock of their lives because they don't know what a deductible is. Yes, they are technically covered but most won't even make their deductible (unless they have a hospital trip in their future). So that's a monthly premium plus a deductible. You are paying for the right to pay your deductible (or pay a fine).
To be fair, one of my loyal readers is overjoyed with their plan. I must admit that it's a great deal and really helps my reader out. There may also be a difference between states that have their own plans and states that default to the federal plan (mine).
Are you ready? [drum roll]
I did some ridiculously complex spreadsheet projections to see what plan benefits us most. This was rather a shame, as I am completely incapable of ridiculously complex spreadsheet projections. One has to take into account the premium, deductible, copay for office visits (primary and specialist) and drug copay. Add a headache to your already-spinning head.
For a single guy about my age, the cheapest plan is about four hundred dollars per month, with a sixteen hundred dollar deductible. In the end, I will have put out an additional thirty eight hundred dollars on top of the premium and deductible (plus donut hole). I am by no means a large user of medical services. This kind of plan is good for younger, healthy folks or me.
But wait...
Now stop waiting. You can select plans with escalating monthly premiums. For a premium of four hundred thirty eight dollars and a four thousand dollar deductible, I would put out two thousand one hundred fifty six additional dollars. Plus donut hole.
There are a few other plans with cheaper monthly premiums and deductible so high that insurance would never kick in.
And if you think this is bad, try adding your spouse to the plan. It comes out over double the premium for a single person. And if you think this is bad, I won't even mention the family plan.
And now your head has exploded, like mine, and your relatives/cohabitants/roommates are left to try to remove the stains from the ceiling.
WHO REALLY WANTS TO DO THIS?
I have a thing about being interrupted - it agitates me. The more interruptions, the more agitated I get.
So I'm starting my Grand Analysis and my wife jumps up to have a cigarette. I continue then ask for the cost of her meds. She leaps from the couch and starts watering a plant.
At this point, I'm getting the idea that she does not want to deal with this. I asked. She asked why I asked. I told her that it's important we do this and the fact that she keeps leaving the general area seems to indicate that she wants no part of this process.
Attempting to listen to my point, she sits down and her leg starts jumping around of its own accord. In her family, leg jumping indicates agitation and anger. When Dad's leg was moving, she needed to make herself scarce. I pointed at her leg, which she hadn't noticed. Even when she noticed it, it would not stop moving. I have to admit it was pretty funny watching her trying to stop it (and failing).
Further into calculating numbers, my darling picks up her phone and starts reviewing the calls. At this point, I'm quite agitated due to the constant interruptions (although neither of my legs is moving about on its own). Finally I had to pull out the Big Guns and ask if playing with the phone was more important than deciding on healthcare. She finally admitted that she didn't want to do this.
Funny, neither did I. And I pity folks who have little knowledge of healthcare and insurance.
DONUT HOLES
Far from being a tasty treat, donut holes are poisonous entities, otherwise known as gifts to insurance companies, installed by Congress as a Screw You to the populace. And don't forget - Congress does not have to use this wreck they created; they have their own special plan that covers what ours doesn't.
Donut holes come with drug plans that aren't from an employer, for instance, all Obamacare plans. Your drugs are covered up to a certain dollar amount, then you fall into the donut hole, when the plan pays a paltry percentage for your meds. Another few thousand dollars later, you are again covered under the catastrophic portion of the plan. If you are prescribed a lot of medicines, especially expensive ones, you are beyond screwed. It's cat food for you (which would be just fine with my dog but not me).
My parents hit their donut hole in October. My wife hit her donut hole in forty five days. And this magic carpet ride starts all over again in January.
OLD FOLKS
The Medicare set, along with the Disability set, gets Medicare insurance. This is a good insurance but it does not cover the entire medical expense. It also does not cover drugs. For example, let's say the doctor charges you one hundred dollars for your visit. In the Olde Days<tm>, Medicare would pay eighty dollars (after deductible) and your additional Medigap policy would cover the extra twenty. But since this is most definitely not the Olde Days<tm>, it no longer works that way. Out of one hundred dollars, Medicate pays eighty (after a larger deductible) and Medigap, depending on plan, might pay ten, with the extra ten to come directly from your pocket. So you need Medicare hospital and doctor (Plans A+B), supplemental/Medigap (Plan C) and meds (Plan D, after deductible, with possible pre-existing conditions). There are also Medicare replacements, which encompass Plans A,B,C and D and have exclusions and weird HMO regulations.
There is also a late filing fee for people who don't get their insurance during Normal Signup Time. Normal Signup Time is a few days in December, between the hours of ten and eleven, at the Normal Registration Place, around the corner, in the sub-basement, in the secret room you must go on a trek to locate the key for. Hint: beware of the anteaters; they're out to get you.
By the time my wife has navigated this mess, her plans cost two hundred dollars per month with a five hundred dollar deductible and an additional six thousand dollars out of pocket. This estimate does not include some meds, hidden deductibles, hidden costs, late fees, and a one thousand dollar mandatory tribute to the President and architects of this Insurance Wonder.
If you're wondering why I was unemployed so long, let me do the math for you.... I need to make approximately two hundred thousand dollars per year to pay for all of this. And this is before anyone runs into my car (with its five hundred dollar deductible).
I have to go now. My insurance only covers one cranial explosion per year, plus the ceiling cleanup is not covered by anybody but me.
I objected to government-run healthcare and I caught a ton of crap for it. I objected because nothing run by the government is a good idea or works correctly: look at Medicare and Social Security. The objection from the other side was that at least people would be insured.
The long and short of it, dear readers/plodders, is that Obamacare is a gift to insurance companies. You must have an Obama-approved plan or pay a fine. After some research, a fine would actually be better in some cases.
If you have an employer-sponsored plan, do the research. You'll probably find that it's cheaper with your employer. You will also avoid the dreaded Donut Hole [more later].
My previous employer (where the yellow brick road meets the duck pond) had good coverage at ridiculous rates. My new employer offers so-so coverage at ridiculous Obamacare rates. It makes my head spin.
So off I went, to healthcare.gov, to do my own research. Now I know insurance, from being in the field, being a consumer and being married to a Frequent Flyer. With all of my cumulative years of insurance dealings, after doing the research and going over the numbers, my head exploded. There are bits of cranium, red stuff and something that looks vaguely like cauliflour all over the ceiling. Have you ever tried to clean this stuff off a ceiling? With or without a ladder? In the dead of winter? Without so much as a pole?
The people who champion Obamacare will tell you that millions more people now have healthcare than before. What they don't tell you is that in most cases, this is subsidized by everyone else. And they can have up to six thousand dollar deductibles. For all of you playing along at home, this means that the insured have to pay up to six thousand dollars before their insurance kicks in (twelve thousand for couples). People who have never had insurance before are getting the shock of their lives because they don't know what a deductible is. Yes, they are technically covered but most won't even make their deductible (unless they have a hospital trip in their future). So that's a monthly premium plus a deductible. You are paying for the right to pay your deductible (or pay a fine).
To be fair, one of my loyal readers is overjoyed with their plan. I must admit that it's a great deal and really helps my reader out. There may also be a difference between states that have their own plans and states that default to the federal plan (mine).
Are you ready? [drum roll]
I did some ridiculously complex spreadsheet projections to see what plan benefits us most. This was rather a shame, as I am completely incapable of ridiculously complex spreadsheet projections. One has to take into account the premium, deductible, copay for office visits (primary and specialist) and drug copay. Add a headache to your already-spinning head.
For a single guy about my age, the cheapest plan is about four hundred dollars per month, with a sixteen hundred dollar deductible. In the end, I will have put out an additional thirty eight hundred dollars on top of the premium and deductible (plus donut hole). I am by no means a large user of medical services. This kind of plan is good for younger, healthy folks or me.
But wait...
Now stop waiting. You can select plans with escalating monthly premiums. For a premium of four hundred thirty eight dollars and a four thousand dollar deductible, I would put out two thousand one hundred fifty six additional dollars. Plus donut hole.
There are a few other plans with cheaper monthly premiums and deductible so high that insurance would never kick in.
And if you think this is bad, try adding your spouse to the plan. It comes out over double the premium for a single person. And if you think this is bad, I won't even mention the family plan.
And now your head has exploded, like mine, and your relatives/cohabitants/roommates are left to try to remove the stains from the ceiling.
WHO REALLY WANTS TO DO THIS?
I have a thing about being interrupted - it agitates me. The more interruptions, the more agitated I get.
So I'm starting my Grand Analysis and my wife jumps up to have a cigarette. I continue then ask for the cost of her meds. She leaps from the couch and starts watering a plant.
At this point, I'm getting the idea that she does not want to deal with this. I asked. She asked why I asked. I told her that it's important we do this and the fact that she keeps leaving the general area seems to indicate that she wants no part of this process.
Attempting to listen to my point, she sits down and her leg starts jumping around of its own accord. In her family, leg jumping indicates agitation and anger. When Dad's leg was moving, she needed to make herself scarce. I pointed at her leg, which she hadn't noticed. Even when she noticed it, it would not stop moving. I have to admit it was pretty funny watching her trying to stop it (and failing).
Further into calculating numbers, my darling picks up her phone and starts reviewing the calls. At this point, I'm quite agitated due to the constant interruptions (although neither of my legs is moving about on its own). Finally I had to pull out the Big Guns and ask if playing with the phone was more important than deciding on healthcare. She finally admitted that she didn't want to do this.
Funny, neither did I. And I pity folks who have little knowledge of healthcare and insurance.
DONUT HOLES
Far from being a tasty treat, donut holes are poisonous entities, otherwise known as gifts to insurance companies, installed by Congress as a Screw You to the populace. And don't forget - Congress does not have to use this wreck they created; they have their own special plan that covers what ours doesn't.
Donut holes come with drug plans that aren't from an employer, for instance, all Obamacare plans. Your drugs are covered up to a certain dollar amount, then you fall into the donut hole, when the plan pays a paltry percentage for your meds. Another few thousand dollars later, you are again covered under the catastrophic portion of the plan. If you are prescribed a lot of medicines, especially expensive ones, you are beyond screwed. It's cat food for you (which would be just fine with my dog but not me).
My parents hit their donut hole in October. My wife hit her donut hole in forty five days. And this magic carpet ride starts all over again in January.
OLD FOLKS
The Medicare set, along with the Disability set, gets Medicare insurance. This is a good insurance but it does not cover the entire medical expense. It also does not cover drugs. For example, let's say the doctor charges you one hundred dollars for your visit. In the Olde Days<tm>, Medicare would pay eighty dollars (after deductible) and your additional Medigap policy would cover the extra twenty. But since this is most definitely not the Olde Days<tm>, it no longer works that way. Out of one hundred dollars, Medicate pays eighty (after a larger deductible) and Medigap, depending on plan, might pay ten, with the extra ten to come directly from your pocket. So you need Medicare hospital and doctor (Plans A+B), supplemental/Medigap (Plan C) and meds (Plan D, after deductible, with possible pre-existing conditions). There are also Medicare replacements, which encompass Plans A,B,C and D and have exclusions and weird HMO regulations.
There is also a late filing fee for people who don't get their insurance during Normal Signup Time. Normal Signup Time is a few days in December, between the hours of ten and eleven, at the Normal Registration Place, around the corner, in the sub-basement, in the secret room you must go on a trek to locate the key for. Hint: beware of the anteaters; they're out to get you.
By the time my wife has navigated this mess, her plans cost two hundred dollars per month with a five hundred dollar deductible and an additional six thousand dollars out of pocket. This estimate does not include some meds, hidden deductibles, hidden costs, late fees, and a one thousand dollar mandatory tribute to the President and architects of this Insurance Wonder.
If you're wondering why I was unemployed so long, let me do the math for you.... I need to make approximately two hundred thousand dollars per year to pay for all of this. And this is before anyone runs into my car (with its five hundred dollar deductible).
I have to go now. My insurance only covers one cranial explosion per year, plus the ceiling cleanup is not covered by anybody but me.
Tuesday, January 3, 2012
It's a Gallbladder!
Yes, at approximately 12:35pm today, my wife gave birth to a gallbladder. Mother is sore but well, father is much better because he didn't have to watch.
Everybody was really surprised, as the entire routine took about four hours, house to house. Apparently this type of thing used to require an overnight stay and a lot of grief.
Having worked in the field, I don't like doctors and I like hospitals less. But I have to say that the experience was not bad, all things considered. The hospital ran like a well-oiled machine, the surgeon was on time and visited me immediately after, and the staff was competent and really personable.
For those of you familiar with gallbladders, this was apparently an interesting case. Initial symptoms looked a lot more like gastritis than gallbladder. The diagnosis was a bit of a surprise but we trust the diagnostician. The tests barely showed anything wrong. The surgeon said he only operated because of the family history. He was shocked to find the bladder was bogged, whatever that means. Apparently it was much worse than any of the indicators. He said the timing was right because it might have burst in the next two weeks.
We'll take those odds.
Once again we had a reminder that you have to be up on your condition and your meds before and after the procedure. In spite of getting about five doctors together on pain meds, the staff still questioned my wife about the meds. She actually brings a list of her meds with reason, dose, and prescribing doctor noted in case there are any questions. In spite of this, they still tried to give her narcotics for pain (her pain meds are non-narcotic).
In short, don't go along for the medical ride. Question everything and go no further until you're satisfied with the answers. The life you save may be your own.
Everybody was really surprised, as the entire routine took about four hours, house to house. Apparently this type of thing used to require an overnight stay and a lot of grief.
Having worked in the field, I don't like doctors and I like hospitals less. But I have to say that the experience was not bad, all things considered. The hospital ran like a well-oiled machine, the surgeon was on time and visited me immediately after, and the staff was competent and really personable.
For those of you familiar with gallbladders, this was apparently an interesting case. Initial symptoms looked a lot more like gastritis than gallbladder. The diagnosis was a bit of a surprise but we trust the diagnostician. The tests barely showed anything wrong. The surgeon said he only operated because of the family history. He was shocked to find the bladder was bogged, whatever that means. Apparently it was much worse than any of the indicators. He said the timing was right because it might have burst in the next two weeks.
We'll take those odds.
Once again we had a reminder that you have to be up on your condition and your meds before and after the procedure. In spite of getting about five doctors together on pain meds, the staff still questioned my wife about the meds. She actually brings a list of her meds with reason, dose, and prescribing doctor noted in case there are any questions. In spite of this, they still tried to give her narcotics for pain (her pain meds are non-narcotic).
In short, don't go along for the medical ride. Question everything and go no further until you're satisfied with the answers. The life you save may be your own.
==========================
You know for a fact that absolutely no outing could possibly proceed without grief (hence this blog), so allow me to let loose.....
Since when do you need to show up at the hospital with two hundred dollars before you have a procedure? Answer: since we got HMOs and since my coworkers are apparently crack addicts.
Follow this logic (if you can): too many people were using emergency rooms as their primary care, so the insurance slapped on a fifty dollar fee for using the emergency room; waived if you got admitted. Then it went to one hundred dollars. I get the point- you were being penalized for using the emergency room.
I recently discovered that if admitted, there is now a five hundred dollar fee! So now we're being penalized for being admitted, as opposed to being penalized for just appearing in the emergency room.
When I complained to my benefits people about the fees, they told me those fees got raised so they didn't have to raise other fees.
And that helps me how?
============================
So I'm minding my own business in the waiting room, which is an impressive feat. Today was especially cold, perhaps out of spite. The hospital doors opened right into the waiting room, dumping large amounts of arctic air into the area.
There was a very large flat-screen television mounted in the corner of the room. You could see it from outside. But even if you couldn't see it, you could hear it. There was no apparent way to turn down the thunderous aural assault. To make matters worse, there was no apparent way to change the damn channel either.
I cannot afford a flat-screen television that large. Strangely enough, I cannot afford two hundred dollars copay for the procedure either, yet there I sat, traumatized by both.
There were several signs on the wall that I truly appreciated. They told everyone to be courteous to your neighbors by not talking loudly, especially on cell phones.
Personally I thought it was a violation of the Geneva Convention to force anyone in a confined area to watch The View. Perhaps this hospital never got the memo. Next up, possibly to rhyme, possibly just to annoy, came The Chew.
I know this in spite of never having looked at the screen. I was trying to check email and amuse myself in other ways.
It was at about this point that I got company in the waiting room. There was one fellow closer to the television but by the look on his face, I think he was incoherent long before he sat down. To my right was the television, to my left were two yentas. Yenta is a Yiddish word meaning chatterbox or ratchetjaw. So here were the perfect pair of negative Jewish stereotypes for my amusement.
But amusement is not really accurate. Nor bemusement. Perhaps something a bit closer to Two Hour Trip to Hell. When I die, I figure I'm going south anyway. If it's every bit as bad as its press indicates, hell will be eternity at Chuck E. Cheese's.
You have to understand my plight... thunderous bad tv on my right and two loud yentas to my left. There was simply nowhere to go. The phrase stereo assholes most accurately depicts my dilemma.
The Chew is apparently some sort of cooking show. I would place it squarely in the Annoying Cooking Show category in spite of not watching many cooking shows. Suffice it to say Jacques Pepin it wasn't. What made the show more intolerable was the color commentary from the yentas....
tv: ...we start with olive oil
yenta #1: ooh, I don't use olive oil.
yenta #2: yeah, it's too expensive.
yenta #1: right.
I'm still trying to read something on my phone.
tv: we'll be right back.
yenta #1: there are too many commercials
yenta #2: yes there are
yenta #1: I wish they wouldn't have so many commercials
Now I'm trying to read a book. And failing.
yenta #1: where do we check the status?
yenta #2: I don't know - go to the desk.
yenta #1: there's nobody there
yenta #2: isn't that just perfect. Nobody's home.
yenta #1: there should be somebody there
yenta #2: yes there should. They're absolutely horrible.
yenta #1: horrible.
I'm reading the signs up on the wall, which state to be courteous to your neighbors by not talking loudly, especially on cell phones. I was thinking of repeatedly pointing to the signs but I had no way of knowing if either of them could read. And by this point the other guy was looking even more glazed over than before. I'm not positive but I think he killed himself rather than having to listen to the yentas for another minute.
And I felt a sudden pang of jealousy.
yenta #1: oh my God, it was eight minutes.
yenta #2: eight minutes?
yenta #1: eight minutes before they went to commercial! I timed it.
yenta #2: so you need to pick up his prescription?
yenta #1: yes, on the way home.
yenta #2: [groan] how long will it take?
yenta #1: i don't know.
yenta #2: you know you can't just take a prescription in and expect it to be filled on the spot. It doesn't work like that.
I noticed I was reading the same paragraph over and over again.
yenta #2: is he done yet?
yenta #1: wait, let me look at the board... it says he's in ABC1.
yenta #2: what does that mean?
yenta #1: wait, let me look again. Maybe he goes to ABC2 after.
yenta #2: go find someone and ask. Sheesh.
yenta #1: there's nobody there.
yenta #2: still? This is terrible. You'd think it was their job!
And if I shoot them, I will be the bad guy.
yenta #1: it's very cold out.
yenta #2: yeah, well, they shouldn't put the door so close. Am I taking you to the pharmacy? Maybe you can tell them it's an emergency for the sick patient in the car. Because if I have to wait, you're walking home. They should have told you this up front.
yenta #1: they did tell me. They gave me prescriptions. Oh no - another commercial. I forgot to time it this time. So many commercials.
Some argue religion. Some argue supreme beings or deities. I am here to tell you that angels exist, ladies and gentlemen. I saw my first one today. Yes, she was dressed in scrubs so you couldn't see her wings but she was an angel all the same. She stepped into the waiting room and asked if the yentas were there to pick up Steve. The yentas said yes and stood. It was at this precise moment that I could see her halo and golden light filled the room as the yentas prepared to get the )$*# out of my waiting room.
It saddens me that I shall never again see a sight as beautiful.
At that point, all I had to do was wait. And listen to soap operas in my right ear.
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