Dinosaurs and Good Health Care Insurance…

What do dinosaurs and good health care insurance have in common?

Both are extinct.

DinosaurAt least in my world. I am longing for the days of my youth, when my parents’ health coverage was super-duper. It was like living on Big Rock Candy Mountain, except it was insulin that flowed freely and test strips that grew on trees. I had numerous in-patient  visits to Joslin Clinic and not once did we worry about insurance issues. (Except when a study was supposed to cover labs that were in addition to my normal labs and kept billing insurance for them. That’s a funny story for another time. Promise I’ll get back to that.)

Good-bye Candy Mountain. When I began work after university, I learned about “pre-existing conditions” exclusionary policies and dealt with purchasing insulin and supplies out of my own pocket (and sometimes getting an extra vial from my doctor). Please forgive me for waxing nostalgic, but I remember when I could buy a vial for $30. I wasn’t testing quite as frequently, but I was getting by, waiting for the one year “no diabetes coverage because it was pre-existing” to be up.

I got up close and personal with the ugly side of exclusionary policies when, at 23, I developed pancreatitis and was hospitalized for six days. The ER doctor had written in the intake notes that my blood sugar was elevated and I had ketones in my urine upon arrival, and the insurance company denied coverage due to “DKA”.  It took me making phone calls from the hospital bed and getting records changed to show that I was admitted to the ER and hospital for pancreatitis and nothing to do with my diabetes.  I would have ended up with an almost $40,000 bill otherwise.

Over the years, I’ve had some good health care insurance plans and some not so good, but now… I’m staring into the abyss of the high care deductible insurance plans that are all the rage these days. I’ve talked about how expensive it is to take care of diabetes, but as John will be changing jobs soon, I’m grimly steeling my jaw at the upcoming changes.

High-deductible health care plans are great if you are healthy. They suck if you have a chronic illness. They’re actually classified as “catastrophic illness” plans and feel like such. More and more companies in the U.S. are choosing to go to these plans, because… they’re cheap. If you’re going to offer a health care option for your employees (soon to be mandatory in 2014 for U.S. companies), this is what everyone says is the cheapest way to do it. You pay a premium, you pay everything until you meet a ridiculous deductible, and then coverage kicks in.

We did it last year. Choices were made that I never thought I would have to do when it came to my health. Priorities were made. Prescriptions have to be paid up front and I need insulin and strips, so no delaying those purchases. Alas, my CGM sensors were shoved at the bottom and not purchased until the crazy stupid deductible was met with a string of surgeries that couldn’t be put off. The same is happening now. I’m not paying $60 for two vials of insulin. I’m paying $296. Don’t get me started on the rest of my supplies.

(I understand why some supplies are expensive. They have to cover the cost of research. But I have an issue when I am told that with an insurance discount (and I know that my insurance does not pay for any of it, thank you very much, so there is no discount…), a particular supply is around $300, but without insurance, it’s $795 according to the packing slip. Who is going to pay that? Not me. Probably not you.)

John’s new job has a “traditional” health plan option that doesn’t require a deductible for prescriptions. I’m sure that there are caps and limits and denials coming ahead. I also wonder when they’ll drop that and only offer high deductible plans. We don’t have an extra $1096 a month to shell out for 7 months before insurance steps up to the plate to pay part of my prescriptions and medical supplies. I’m so angry I could roar like a T-Rex.

Poor dinosaurs. I am starting to understand how they felt.

How do other diabetics deal with high deductible insurance plans? I’d love to hear from other Type 1s who have these…

 

 

 

0 comments
  1. I remember the good old days too… getting supplies, meds, and services without fear of the out-of-pocket expenses or insurance rejections. My deductible isn’t *that* high, but even after it’s met, I have to pay a percentage, so the medical bills are never ending. Like you, I’ve started prioritizing, which is supposedly what They want people to do to reduce superfluous medical care expenditure, BUT I like to think that my annual eye exams, my visits to the podiatrist, changing my pump site as often as recommended, check-ups with the nephrologist, and getting labs every 3-4 months shouldn’t be considered superfluous healthcare. I can’t afford that shit though, so I delay and avoid.

    I get my insurance through Jason’s employer, and although he works for a healthcare company – for-profit, making tons of money for their 1% – the plans are shit, and the amount that’s deducted from his pay to have me on his plan is mind-blowingly absurd. He’s considering looking for a new job, partly because the benefits suck, and I can only hope that he finds a position at a company that doesn’t have such craptastic coverage. I know those companies exist because I have clients with fabulous insurance.

    The whole insurance issue causes me such anxiety and rage. Insurance is only for healthy people. The rest of us can suck it. Ugh.

  2. I work for one of the largest health insurance companies in our country, so I’ve been on a HDHP w/HSA since they were invented (we are the guinea pigs for the rest of the country…my personal opinion). I am on single coverage right now, which is a $1700 deductible, followed by an 80/20 until I meet my out of pocket, which is $3400. The first year was hell because with a HSA you don’t get all the money at the start of the plan year (like you do if you still have a FSA). My strategy has always been to put the max allowed into the HSA and now that it has been 5 years since I went on it I finally have a few hundred dollars always floating in the pot. The benefit of a HSA is the money rolls from year to year, whereas all the money in the FSA goes away once the plan year ends. A HSA is basically like a checking account; you never lose the money…but you have to build it up from nothing. I actually take a different approach than you. I try and max out my deductible as fast as possible by buying 6 months of sensors, etc. right at the turn of the new plan year. Then I only pay 20% for all my routine stuff. It basically means I have $1700 saved up come 1/1 and then I blow through it all within Jan/Feb. I sure as hell would rather be in Mexico with that $1700…

    1. Katie, it would be great to blow through it, but we can’t this year. We met the deductible in June last year, but have nothing in the account despite putting money constantly into the HSA. (I still owe the hospital for two surgeries, an overnight stay from a complication from one of those surgeries, and the shoulder thing. Thanks, diabetes.) As fast as the money goes in, it goes right out. And of course, it rolled in January so it started over again. Our deductible is significantly higher as a family as is our out of pocket expenses. I’d join you in Mexico with all the extra money!

  3. So far I’ve managed to avoid the high-deductible plans. When my wife’s company (who insures me) dropped the high-premium, low-out-of-pocket-cost plan that we were on, they twice allowed people who were already enrolled to continue with it during the next open-enrollment, but no one new could sign up.

    I think the way to make employer-sponsored high-deductible plans work is in conjunction with an FSA. Make the deductible and annual FSA contribution match. Since you can withdrawal from an FSA before you contribute, those high early-year ‘expenses’ actually come out of your pocket gradually throughout the year. And if you exhaust your FSA funds, then leave your job before fully funding it, you win. (The employer absorbs the cost of your remaining contributions). Yeah, you may be unemployed, but you need to look for the bright side.

    1. As a result of job changes, we are switching to a high deductible plan in a month or so. Lord knows I have spent way too many hours pouring over the benefits documents and creating spreadsheets in an attempt to figure out which plan is our best option. I hope my calculations prove to be correct.

      To encourage us to take the high deductible plan, the employer puts money into the HSA account that is equal to the amount we will be paying in premium. Coincidentally, this amount equals just slightly more than the deductible for one family member ($3,000 for an individual, $6,000 for the family). Luckily, it is an embedded deductible, so we do not need to meet the $6,000 for just me. The max out of pocket is also $3,000/$6,000.

      So we are really only on the hook for about $3,000 for the year, assuming nobody else in the family develops anything chronic or catastrophic.

      That is a drop in the bucket compared to the $6600 we would expect to pay on the traditional 80/20 plan and the $10,000 we are paying with our current 90/10 plan.

      I think the trick with the high deductible plans is that you need to figure out a strategy for having the money available at the beginning of the year, because once you meet the deductible and/or max out of pocket, your coverage kicks in. Katie’s plan to build a buffer in the HSA account sounds like it would accomplish this goal.

      And yes, a big part of our decision to take this job was the huge savings in medical expenses.

  4. The deductible at my old job kept going up year after year. I didn’t realize how much the FSA/HSA money helped buffer that until I didn’t have it available in my new job. So far at the new job, we still have a low deductible plan ($500) and the company pays the full premium cost. I am pretty sure that is because the people making the plan decisions have chronic health issues as well.

  5. It’s a real mess for so many people. I’m self employed, but we have health insurance through my wife’s employer. We thought we’d try the high-deductible plan this year, and it kicked our ass. I’ve never been so far in debt from health related expenses before.

    Thankfully we’re nearing the end of her plan year, and it looks like we’ll be able to choose a traditional plan for the next year, but I worry about when all we have to choose from are the high-deductible plans.

  6. […] do dinosaurs and good health care insurance have in common? Christel at The Perfect Diabetic has the answer… and it’s a great […]

  7. If you get a discount for mail order drugs do that. I try to time my perscriptions so that I am filling a 3 month RX in the last month of the plan year. That means I have approximately 3 months into the new plan year before I need to order supplies. This 3 month gap is usually enough time to stock plie funds in my HSA account to cover the new RX order. For example, our plan year ends in June. I have a Dexcom order for 3 months of supplies being sent out June 7th. I also have reminders to order my insulin and test strips by June 18th. Our plan also has an online tool that lets us see how close we are to meeting our deductible and when it was met. I have no shame is calling the heathplan to get a refund for anything that was paid after our deductible was met. I’ve done that 3 times this year and recovered over $400 in funds that way. I’m sure that they would’ve sent me a check eventually but calling the provider and saying I met my deductible on x day and according to the insurance you owe me $X in a refund” tends to get me that check faster.

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