Saturday, August 21, 2010

Insurance and the New Health Bill Part 2 - Blue Cross/Blue Shield of GA

We received some information from Bill's company about the health insurance that is offered to some of the employees. I hesitate to even call it health insurance at all as it is basically only good for health catastrophes. This insurance for the eligible employees would go into effect on September 1 although the benefit year runs with the calendar. So basically there would only be three months in which to try and make the deductible for 2010.

To start it off the cost for an employee and spouse would be $714.18 monthly or $164.81 per week. The real kicker is that there is a $9,000 deductible! Now I can understand one OR the other....high premium and low deductible or low premium and high deductible but this plan is HIGH premium and HIGH deductible! It is almost not doable for most people.

Then to add insult to injury if you have not had insurance for the 63 days leading up to September 1st there is a 12 month pre-existing condition clause which says that any illness or injury that has been treated in the 6 months prior to September 1st will not be covered until the member has had the insurance for a year. So in some cases people will be paying this huge premium, have a huge deductible and not have anything covered for the most pressing needs -- the illnesses or injuries that they already have. Granted medications are not included in the exclusion but with the Walmart $4 prescriptions many of the associated costs of taking meds have dropped significantly especially if the meds are generic.

So to put it into real numbers here is what it would cost us to get insurance from the company.

$714.18 x 12 = $8,570.16  Yearly Premium
                          $9,000       Deductible

                         $17, 570.16 Total Baseline Out of Pocket

                         $9,000        Maximum Out of Pocket From 80/20 Coinsurance

                         $26, 570.16  Total Out of Pocket Until Insurance Covers 100%

THIS is why the health reform bill did not go far enough. These costs are ridiculous.

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.

Medical Personnel/Locations Friendly to RVers

I am starting this post which will be added to each and every time I find a caregiver who is friendly to the RV lifestyle or fibro/pain sufferers. I am going to start listing them by state and see how that works and adjust if needed.



Chiropractic Arts Center - visited numerous times in November/December 2009

  • Dr. Clarke Bumgarner
  • 620-251-2970
  • 509 Maple Street Coffeyville KS 67337
  • No x rays or prior office notes needed, $20 per visit by cash or check.
  • I visited this location every other week for the two months we were in Coffeyville. It was a very busy, almost assembly line type office but they were always able to get me in when needed and on short notice. Dr. Bumgarner did only activator adjustments but they did use an electric massager before which helped.


Topeka Therapeutic Massage - visited once in August 2010

  •  Nancy Weigand
  • 785-213-7361
  • 1170 SW Mission Ave Topeka KS 66604 - lower level of Studio 1 Salon
  • After calling quite a few chiropractors in the Topeka area and getting prices in the $100 and up range, I decided to try some massage again as Nancy charges $35 for 30 minutes, $60 an hour, $75 for 75 minutes and $90 for 90 minutes. At the office she only accepts cash and checks but she accepts credit card payments through PayPal ahead of time.
  • Nancy is really easy to talk to and does a great massage if you are looking for a light, relaxing type massage which unfortunately does not work for me. I need a deeper, harder, more like Rolfing type massage to have it work for me.



Healthwise Chiropractic Clinic - visited twice in June/July 2010

  • Dr. John Kleptach
  • 330-494-7158

  • 1170 S Main Street North Canton OH 44720

  • No x rays or prior office notes needed, $30 per visit by cash or credit card

  • I finally broke down and decided to find a chiropractor as my hips and lower back were indescribably painful. I lucked out this time on the first call and reached the receptionist,Barb, who is very cheerful and great to talk to! They were actually able to get me in for an appointment within 20 minutes. Dr. John used warm heat and electric muscle stimulation before treatment. He does both manual and activator adjustments.



First Choice Chiropractic - North Office

  • 5510 Wallwood Road Knoxville TN 37912
  • 865-686-4994
  • No x rays or prior office notes needed, $30 per visit by cash check or credit
  • I did not have a chance to visit this location as I was "ok" while we were in Knoxville but I am listing them as they were reasonably priced and willing to work with the lack of x rays.
Provo Chiropractic Care and Massage Therapy - visited once in September 2010

  • Dr. Marc Bowers
  • 777 N 500 West Suite 205 Provo UT 84601
  • 801-377-0898
  • No x rays or prior office notes needed. $45 per visit by cash, check or credit.
  • I actually was able to try a new (to me) chiropractic method with Dr. Bowers called flexion/distraction. I can't believe that in 25 years of prior chiropractic I had never run into this method. It is where your ankles are strapped on a special table and and the chirpractor sort of "stretches" everything to, in a nutshell, make more room between the vertebrae. For a better definition see here - The doctor also manually adjusted many areas of my back and neck but did them opposite of what I am used to. For example, he adjusted my back while I was lying on it.