After last week's "OMG! The Prescription costs HOW much?!?!" Moment I sat down to take on the onerous chore of figuring out the who's and what's of our new medical coverage.
Since I am a "frequent flyer" maintenance medical coverage user with various doctors, tests, medications and appointments throughout the year, changing our medical coverage because of our children has given me the added pleasure of having to try to sort out what the new coverage actually covers as far as me. Now we have an "in network/out of network" situation so I have to find out which of my doctors I can still keep, without having to pay an arm and a leg for the great pleasure.
I also have to find out if the lab where I have my frequent coagulation tests done is in-network or not.
This was jolly good fun this morning attempting to get this settled. Seems the new insurance has 2 national lab chains I can use that charge $2.85 per for this PROtime test I need done. Of course both locations are in cities nearby but there is no facility local to me.
Great.
So after 30 min. on the phone with the insurance CS person, wherein she called the hospital who bills for the facility I use, and the actual lab/clinic as well, to see if this lab is in the network, and after 2 different calls it's as clear as MUD.....nobody would answer this question directly, they just danced around it, so we still don't know if I will have to pay 10% or 30% OOP. And in addition I get to call the hospital's billing dept. to see what they actually charge for this test. I predict I will end up in a phone tree hell for my trouble.
The alternative is to go to one of the labs the insurance wants me to use.....except that to do this and have this test(which I need next Tuesday), I first would have to make an appointment with my primary physician, see him and get an order for this test, then call the insurance endorsed lab and make an appointment and take the new order to the lab whenever the appt. it made for and pay them $2.85.
That doesn't count the $128 dr. visit fee I would incur to get the order for the test, so it would probably more expensive than just going to the lab I do now.
At least for this one time.
I have a standing dr. office visit in Feb. so I'll get any orders and such I need then. No point paying $128 now and then another $128(or more)next month, right?
And then we got to go through all this again concerning the Durable Medical Goods company I get my BiPAP machine from. The new insurance has a "Sleep Management" Team and I have to be preauthorized in order for them to pay for any of the DMGs I use. So now I get to go collect the original Dr's orders and the sleep study and dump it off for them to go over and see if they will cover me. Meanwhile I will have to pay OOP for DMGs beginning Jan.1st to the supplier I was using/am using now since they can't bill my old insurance carrier after Dec. 31st.
Good times.
I will also be transferring ALL of my prescriptions to Walmart, as all of them, except for that one "gold level" $291 drug are $4 per fill there. And I'll talk to the dr. next month about how I am not made of money and can I go back on the old medication that was $4 a fill instead of this "make the pharmaceutical bosses rich" drug he put me on. That $4 med has the same effect/used to treat the same illness as the fancy pants drug anyway.
Sorry Rite-Aid......I just can't stomach paying through the nose for these drugs if I don't have to!
I need to go take something for a headache now and stop thinking about this crap before my blood pressure shoots up again.
Dealing with the insurance and medical systems long enough is likely to kill a person!
Or at least drive you crazy.....but wait!, you'll need a preauthorization for that!!
Sluggy
Since I am a "frequent flyer" maintenance medical coverage user with various doctors, tests, medications and appointments throughout the year, changing our medical coverage because of our children has given me the added pleasure of having to try to sort out what the new coverage actually covers as far as me. Now we have an "in network/out of network" situation so I have to find out which of my doctors I can still keep, without having to pay an arm and a leg for the great pleasure.
I also have to find out if the lab where I have my frequent coagulation tests done is in-network or not.
This was jolly good fun this morning attempting to get this settled. Seems the new insurance has 2 national lab chains I can use that charge $2.85 per for this PROtime test I need done. Of course both locations are in cities nearby but there is no facility local to me.
Great.
So after 30 min. on the phone with the insurance CS person, wherein she called the hospital who bills for the facility I use, and the actual lab/clinic as well, to see if this lab is in the network, and after 2 different calls it's as clear as MUD.....nobody would answer this question directly, they just danced around it, so we still don't know if I will have to pay 10% or 30% OOP. And in addition I get to call the hospital's billing dept. to see what they actually charge for this test. I predict I will end up in a phone tree hell for my trouble.
The alternative is to go to one of the labs the insurance wants me to use.....except that to do this and have this test(which I need next Tuesday), I first would have to make an appointment with my primary physician, see him and get an order for this test, then call the insurance endorsed lab and make an appointment and take the new order to the lab whenever the appt. it made for and pay them $2.85.
That doesn't count the $128 dr. visit fee I would incur to get the order for the test, so it would probably more expensive than just going to the lab I do now.
At least for this one time.
I have a standing dr. office visit in Feb. so I'll get any orders and such I need then. No point paying $128 now and then another $128(or more)next month, right?
And then we got to go through all this again concerning the Durable Medical Goods company I get my BiPAP machine from. The new insurance has a "Sleep Management" Team and I have to be preauthorized in order for them to pay for any of the DMGs I use. So now I get to go collect the original Dr's orders and the sleep study and dump it off for them to go over and see if they will cover me. Meanwhile I will have to pay OOP for DMGs beginning Jan.1st to the supplier I was using/am using now since they can't bill my old insurance carrier after Dec. 31st.
Good times.
I will also be transferring ALL of my prescriptions to Walmart, as all of them, except for that one "gold level" $291 drug are $4 per fill there. And I'll talk to the dr. next month about how I am not made of money and can I go back on the old medication that was $4 a fill instead of this "make the pharmaceutical bosses rich" drug he put me on. That $4 med has the same effect/used to treat the same illness as the fancy pants drug anyway.
Sorry Rite-Aid......I just can't stomach paying through the nose for these drugs if I don't have to!
I need to go take something for a headache now and stop thinking about this crap before my blood pressure shoots up again.
Dealing with the insurance and medical systems long enough is likely to kill a person!
Or at least drive you crazy.....but wait!, you'll need a preauthorization for that!!
Sluggy
