MsElui

I beg your forgiveness for trying to help - but your 'very irritated' tone means I am clearly not up to making any useful suggestion and wont bother to try and help any more.

Chrissywissy100

Hi Tonka Toy.

I completely understand that you are getting very frustrated with lack of answers/ direction regarding your questions. I was in the same position when people started talking to me about insurance too. Still am to some extent!

HR can be crap when it comes to giving personalised advice on these sorts of subjects (i should know, I'm a HR person!) more often than not because they are not armed with enough information that can be applied to your personal situation, and also because they are not permitted to advise in detail since it is not their area of expertise.

Similarly, the very nice people on this forum, are not able to tell you what you want to hear, or answer your questions to the extent you want answers as you are also unable / unwilling to give them all the facts regarding the policy you are being offered, and your personal medical needs. That is completely your perogative and your right to keep this information confidential.

The only way we found out details about our medical and dental policy before we signed up, was by talking to collegues. They also are not going to be able to give you specifics about how much youare going to end up spending on meds every month, or even how much is going to be taken from your salary each month. But they will be able to share stories on their expereinces of using the provider, give you an idea of how much they pay each time they vist the family doctor or specialist in or out of the network, have blood tests etc. You may even find one of your collegues has similar conditions to yourself and your family, which may help in your decision making.

Also, since you attend and receive your med currently from a charity doctor / health provider, you could ask them to explain and advise you also. How about also popping into walgreens or some other drug store and enquiring about the non-insured costs of the meds you are currently prescribed? That would give you an idea of how much its really going to cost you if the free diabetes meds suddenly dried up and you didnt take the company policy! I think that'll shock you into making a decision quite quickly! The drug store may also be able to give you costs for your meds if you told them the insurance provider.. making clear than it would just be to get an idea of course!

By the way, no insurance company that I know of will ever tell you excatly what services, medical conditions or meds they will cover unless you apply for them first. By this I mean, if your dr wants you to try a new med, the dr will often write to the insurance company saying why you need it, during which time you have gone to the pharmacy to order it. the insurance company will approve or reject coverage and your pharmacy / dr will tell you this result. The pharmacy will give you the option to purchase without insurance paying for it, or not take it at all if the insurance rejected it. Or you can pay the small co-pay if it is covered by insurance. If it was not covered by insurance and you have a good relationship with your dr, they will try and establish with the insurance something else (a generic) which they will cover.

From personal experience with a diabetic in the family with BP issues also, we have spent in the region of $1000 in the last year on meds (2x insulin types, metformin and 2x BP pills), visits to specialist every other month, blood tests every other month, and 1 visit to family doctor, all within PPO network. The insurance covered over $3000 on meds alone. The inurance covers the Dr visits which cost in the region of $400-600 per visit and on average blood tests are $300 a go also, where we pay only the co-pay of 10 or 20 a go. The premium from salary is 2400 for two of us = insurance has saved us approx 3800. As I am sure you understand this coud be vastly different for your situation / needs and insurance, but you get the idea that insurance for someone with your condition will save you a bundle of money, and stress if something disasterous should happen or you have complications also!

Like many people have said here, Med and dental in the US is one of those things is better to have but not fully understand, than not have at all. Since this thread has been going for nearly 4 / 5 pages and you dont seem to be getting what you wanted from it, I suggest that speaking to reallife people in your organisation (ie your collegues) who use the insurance and have actual expereince of it.

At the end of the day, if you sign up for the insurance, and dont like it, you can withdraw after X period (normally in October I think), but this option doesnt ofetn work the other way around.

Anyway, best of luck with whatever decision you make.

TonkaToy

Thanks for your post but;

I already know what my meds cost to be provided to me and I have expressed this in a previous posting.

I have also said that I have not been given much time to read through a large bundle of documents (that I cannot understand anyway) on my own and make my decisions. There is no-one from the company able to sit down with me to look with me at these documents, which is what I need, to go through all the aspects of what is in front of me. I don't just have a few questions/queries.

There isn't time to speak with colleagues, those few that I know that is - they all have to work as I do and taking up several of their lunch hours is not fair or even practical.

I have to make all my choices by 27 Feb and also, I cannot withdraw from the choices as you suggest until after a year in the scheme.

Ergo, I feel trapped and cannot go forward with this sodding thing.

Ray

Ain't all this a kick in the groin...

Sorry we can't help ... Next please

Elvira

Ungrateful tw*t.

(Karma on its way to Chrissy from me... I'm sure many others will find her detailed post interesting and useful...)

Juswus

It's a nightmare isn't it when you've never had to deal with it before!!
I couldn't believe that I couldn;t get it straight in my head all the different terms. And you are so right, noone knows how to explain the terms because they have grown up here and think everyone understands. I hope everyone here has been able to help you with this


Also...remember....the first 4 times you get a bill saying your insurance company has rejected the claim or not responded, keep sending it back and asking them to resubmit it. I found out recently that they are utter wankers and wont pay up until you've spent hours chasing them up and stressing over unpaid bills :curse::curse::curse::curse::curse:

TonkaToy

I cannot agree with your unfounded, unqualified and unprofessional opinion of me but also, you should know (since you are uneducated about Karma, perhaps because you are using it after you heard something about it from someone else or from way it is perceived by the masses), that Karma doesn't work in the way you have stated (you can't send Karma), but also, it doesn't work at all when negative energy & anger accompanies positive feelings and intentions.

TonkaToy

Thank you for your thoughts and useful info.
You clearly get it and clearly understand me.

Ray

Damn! you really are dopey, look to your lower left of this page ..
its where you can send Karma to show appreciation of a post.


Time to spread your search.

Duncan Roberts

You can get a 90 day supply of metformin for $10 at all the places that do the $4 prescription plans. Even if you are taking 2000mg of the XR version the cost would rise but still be half what you pay now. Every little helps.

And to TonkaToy, the reason medical insurance is so complicated is because it's way more complicated than you think. The system as a whole is light years ahead of the IRS but one big difference is that with taxes the onus is on you to save money and the IRS doesn't care if you figure it out wrong in their favor. If you fill in one form and end up paying more tax than you should, no one will care. With medical insurance the insurance companies are tryong to save themselves money and you can bet your ass they will do way more than you will to do that. Add that in to the thousands of companies, the highly regional nature of the policies and the employer restrictions placed on them it's no surprise it gets complicated. You just have to suck it up and really research your plans, read them 5 or 6 times, ask specific questions and have a list of things you expect to happen in the upcoming year and a couple of things that could be unexpected. You also have to remember that any plan is doing you a favor because if you need medical care and don't have insurance then you really would have something to complain about, possibly to the tune of a million dollars of debt that you will be paying off for the rest of your life.

Rete

I prefer to use Medco for my meds and don't have a Walmart or a Target in our county. But thanks ever so much for trying to steer me to a more cost saving plan.

Rete

TonkaToy

You have to bite the bullet. Among my acquaintances and myself included, the only one who ever read the manuals were my two daughters and that is only because one is self-insured and the other's company discontinued all healthcare plans and went with some new type of plan that no one had ever heard of before.

All any of us wanted to know is if our doctors are part of the plan, what our co-pays are, what the med plan coverages and if our dentist is also a part of the plan.

For the last 18 years I have dealt with breast cancer, diabetes and all its associated health issues and have never ever received a bill for additional fees from any doctor and/or hospital I have had to use and this includes the 6 week blood tests required and the twice yearly mammograms and the biopsies that have been required twice over this period. And throughout those years I have had three different healthcare plans, Oxford, Blue Cross/Blue Shield and now POMCO.

Don't over stress about your choice. Check to see what your co-pay is, is there a wide variety of doctors in the fields you need, if a referral is required for seeing a specialist, and will doctors you are using and/or referred to accept your plan as payment in full. Those are the only questions you need to have answered to make a decision.

Duncan Roberts

I wouldn't be so sure. I have done a lot of research for people specifically finding charities and associations that provide free or reduced cost diabetic supplies and medications, none will cover somebody who has medical insurance. Most even have legal jargon in the things you sign saying that you will notify them if you become insured and you will pay them back should you have coverage but still use their service. Honestly what you want to do leaves a very bad taste in my mouth. There are many, many people who cannot get essential medications because they aren't able to get insurance and cannot work but you seem to think it's OK to get insurance and take money away from the people who really need it. Even worse, pass on the opportunity for coverage just so you don't have to pay. It really is a prick thing to do. Take the insurance and pay for your medications because you can, leave the charities for people who really need them.

tamms_1965

Kroger also does the $4/30 day or $10/90 day for the common generics.

tamms_1965

Exactly what I said a few pages back.

(well almost, I didn't know the part about being made to pay it back, but it makes sense. Charities are for people that have exhausted all other avenues, not for twats that have an opportunity to sign up for company sponsored insurance.)