Thursday, March 6, 2008

Insurance issues

I had a big long post about this, but then I realized not everyone cares or knows the lingo, so I'll try again to be straight and simple. (Yes, this is the short version.)

We found out this week that our health insurance will be changing by the end of this month. Not because we want it to, and not for the better. M's employer has recently merged (supposedly, although it's more like an acquisition) and unpleasant changes abound. We've been SO blessed by the coverage provided through this job over the past few years, and I'm thankful for that. It's just really unfortunate that the positives of the job are starting to be outweighed by the frustrations.

In our area, there are two options for health care and insurance pretty much. If you have Insurance #1, you go to hospital/health system A. If you have Insurance #2, you go to hospital/health system B. I've never seen anything like it, in all my years working in medicine. I've worked in both systems here, and I prefer Insurance #2 with system B. That's what we've had for the past several years. Now we'll have no choice any longer, we will have to go with Insurance #1 and system A. It's not that system A is's very well known and highly regarded by many. It's just big and bureaucratic and views patients as numbers, literally...they ask for your "clinic number" constantly. I have connections and in-roads to system B, and that affords us great care on a personal level with lots of perks. It'll be very hard to see that go.

The big problem, beside having to change doctors for me and M, is that Insurance #1 will not cover us going to Children's where all Braska's specialists are and where we have purposefully centralized her care. It does have some out-of-network benefits, but it will be significantly more expensive to continue with our doctors there. Whereas now we go, pay no copay for specialists, and have the visits covered at 100%, we'll be required to pay either 35% or 50% of every visit and service. We'll still do it...I'm not changing her doctors now, when we've established and finally have a good rapport and groove worked with all of them. We will just have to plan very carefully in order to pay more out of pocket for healthcare.

It's just such a bummer, that although the amount we pay per pay period for the coverage goes down just barely, our coverage changes significantly toward the negative. The amount we are required to pay, even before the issue of Braska's specialists, will be greatly higher overall. I'm appreciative of having the availability of coverage, don't misunderstand. It's just hard to see a good thing go away.

To end on, I'll give some stats that I think are plain amazing...
Since Braska's birth, including the birth/delivery charges, her medical claims total just under $400,000. We have paid just under $10,000 for our part of those services, and the large majority of that has been covered by Braska's benefit fund. So once again, let me just say THANK YOU SO MUCH to all you wonderful people, family, friends, and many who we've never met, who have given so generously. We know that God has provided for us through your willingness to share.

We'll figure it all out. We're meeting with Jim, our beloved financial advisor, next week to get everything in order to prepare for the change. It'll all be ok. It's just frustrating to have to make this kind of adjustment.

Have I mentioned that I'd love to just cut and run to the city?! Dream on, RK, dream on.


  1. I hate hate hate insurance companies. I love how they put on all these caring commercials. Ha! Of course, I worked for the MO Dept of Insurance for 5 years in the complaint department so I didn't have a lot of good experiences with them.

    Good luck. I know it can be so frustrating

  2. Ruby has Katie Beckett coverage through the state (WI) which picks up her extra, out of pocket costs ... can you get a similar program?

  3. Hoping for the best possible outcome in this for you all!

  4. I've been there and changed insurance companies back and forth between system "1/A" and "2/B" a couple of differnet times. It is a PAIN I know. If you need any good referals of any docs for either you, M, or Braska, we are currently in system "1/A", and I know a few:o) Good luck!

    Misty Houston

  5. It's pretty amazing that for $400,000, your portion was $10k. That's what?...math...carry the 6...2.5%. But I guess in Europe it would have been...carry the zero...nothing. They probably would have even paid for your gas back and forth from St. Louis. Our health care system is so messed up. It is really great that Braska gets the great care she does (of course props to you for coordinating it:).

  6. what a headache - and after over a year of building relationships with drs and medical will all work out though, and don't ever forget to ask for a little help from your friends if things get way too tight!

  7. Debbie--I can only imagine what you heard at the Dept of fun, I'm sure.

    Michelle--We don't qualify for any programs here due to income, and that's ok with me. I don't feel like we need it at this point. We're able to make it work financially, so I'm good with it.

    Shannon--Thanks. That's all I can ask for.

    Misty--Thanks for the referral offer. It's been several years since I was in the 1/A system. We'll see if my old docs are still around.

    Mary--It is pretty amazing, the math. But I will say this, I wouldn't trade our care here for any amount of money. Our friends that we've come to know who are dealing with the same issues we are health-wise and developmentally in various countries in Europe, and Canada too, don't get near the service we do and seem to have to wait and wait and wait for every appointment or therapy IF it's available to start with. I'll gladly pay my part to have quality care available right when I need it. Socialized healthcare seems to work, arguably, until there's an issue or a "special need" which is where we live. Of course the system could be better, but I'll take it any day over the alternative of universal/socialized.

    Jessie--Our friends have been life saving, and we'll forever be grateful! And we know if we have a true need, it will be met. We are still greatly blessed and provided for.

  8. Pray on, RK, Pray on. We will, too.
    Love you!

  9. Insurance can be so frustrating!! I hope things are able to get worked out.

  10. I feel the pain. I have been back and forth since we moved here. Drove near and far to see specialists during both pregnancies and then we change. So glad that we are not having more babies here, I would hate to have to find all new docs for that! Along with Misty we are in 1/A right now and if you want any referrals, you know where to find me. We have been very happy with the new docs we have in 1/A.

  11. Thanks for the update. We want to stay posted on stuff. Well written, of course, and very pertinent!

    Love to all!

  12. wow that is so frustratingly unfair.


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