Friday, August 20, 2010

Insurance and the New Health Bill Part 1 - BadgerCare

Insurance has been one of the biggest issues in our life ever since Bill lost his job in April 2008. The majority of my fibro medical bills were covered by the accident settlement until January 2008 and then were picked up by our health insurance until he was let go. After that I had a chance of a snowball in hell of getting any insurance to cover me with two pre-existing conditions, the fibro and diabetes. I was told that even if I did get insurance those two conditions would be exempt from coverage, for anywhere from 12 months to 18 months. So based upon our income last year we applied for the BadgerCare Core Plan run by the State of Wisconsin. It was a new program that had just been implemented for people without children. The program had always existed for people with children but now it seemed the state was trying to make things more fair for those of us who had chosen not to further overpopulate the world.

At first the plan seemed like it would be something that would be workable -- until we decided to leave the state for employment that is. BadgerCare is only good in the State of Wisconsin and it is only good for certain procedures and certain medications -- no exceptions and no appeals. For example, I could really use the Lidoderm patch as a pain drug that would take the place of some of my pain meds now. Nope. Another program will cover Cymbalta, Lyrica and Byetta for my diabetes but at only about 35% off the regular price. I would LOVE it if there were a generic version of those three drugs but as of right now there isn't and there are no other drugs that are their equivalent in generic form either. It will only pay for my meds in Wisconsin so every month I need to go through the "gauntlet" so to speak. I call the pharmacy that I need my meds refilled.  As three of them are controlled substances my doctor will only renew on a monthly basis and I have a signed pain contract with her. This pain contract gets sent to the pharmacies and emergency rooms around Crandon. That makes a lot of sense as I am nowhere near Crandon but rules are rules! The pharmacy then faxes my doctor. Within a few days or so the doctor faxes them a new script which they then fill. Then Carol, my neighbor, goes into Crandon to pick up the meds and sends them in our next batch of mail. So a good two weeks can pass between the start of the gauntlet to me finally receiving my meds. Good thing I am anal and do things ahead of time. How much easier would it be if I could just pick up my meds at a local Walmart and have them paid by BadgerCare which IS in reality Medicaid, a federal program? Too easy obviously.

Then comes the renewal for BadgerCare by August 31st. I log into the website and attempt the renewal. As it so happens we are now making about $600 too much per month to qualify which is fine -- the problem arose with the amount the denial letter came up with as our monthly income. I entered Bill's income in various forms -- weekly, biweekly and monthly and it still said we were making $7500 a month! I wish! So I call the 800 number and they say I need to make an appointment to speak with someone. The someone calls me at 9:30am this morning and proceeds to tell me that the $7500 amount doesn't mean anything to the state high risk pool.  Uh aren't telling me that bunch of bull. I have been burned too many times by some piece of information being left as is and it coming back to bite me in the rear later on. So then she says that if I want a denial letter that does not state an income amount I need to pay a $60 application fee just for them to tell me that we don't qualify which I already know! I then demand to speak with a supervisor who proceeds to go over the same info with me. I tell her that my next call will be to my state representative as my tax dollars are just not working if their website cannot even add up two income amounts correctly. All of a sudden she is able to access the application and look at the numbers. It seems there was like $4000 in extra income from somewhere that was included in our total but I had not been able to access that information online. All in all, we still do not qualify for the BadgerCare any longer, which I am fine with. But at least now the erroneous income will not be anywhere included in any information when we turn around an apply for the Wisconsin High Risk Pool Insurance sometime next week.

No comments:

Post a Comment