I thought I had good insurance....

[Jenn15b]

But it seems to be all relative.  My insurance is good for routine things but when it come to a special case like acoustic neuroma....it just stinks.  First off, I wish I had the freedom to go to a doctor out of state, while there are several doctors in state that are equally qualified, I wish I had the option at least.  At my initial doctor's appointment the doctor ordered several tests, one isn't covered by my insurance.  Now my out of pocket expense is $108 but I am on a tight budget and $108 is a lot to me.  What next? then I will have a co-pay each visit and gas to travel to the doctor 30 miles away.  The expenses are quickly adding up.  My employer only offers an HMO option but I plan to request to help out on deciding insurance and will promote offering a PPO plan.

[oksandra]

Hi,

I am also on an HMO and have only limited coverage for surgeons.  I went to one neurosurgeon who is willing to write a letter for my HMO and possibly talk to the HMO's medical director.  He may be doing extra for me because he is a colleague of a friend of a friend, but still I think you can try to appeal for out of network coverage even with an HMO.  My HMO first told me that this wasn't an option but then they told me it was on a "case by case" basis.  Going out of state is still expensive, of course, but it may help.

I must make it clear that we have not started the appeal yet, much less won it, but it is definitely worth trying.  I am new to this, as you are, but I think there is research supporting the case that it is cheaper for insurance companies if an AN is treated at a high volume hospital because the long term complications are much less.

I should also add that you can try to appeal the test they didn't cover.

[sgerrard]

I too would encourage you to pursue an appeal, and to get as much support behind you from medical specialists as you can. Acoustic Neuroma is not a common diagnosis, and often, it seems, the medical people at an HMO or insurance company are not very familiar with it. They will initially treat it as a "routine" neurosurgeon case, but can be open to learning more about it and the special skills needed to treat it. It is the kind of rare case where an appeal is reasonable and may be granted after closer examination.

Best wishes,

Steve

[leapyrtwins]

Insurance isn't really designed to pay for everything 100%.  That's just the nature of the beast.

Jan

[Jim Scott]

Jenn ~

I'm sorry to learn of your insurance hassles but I have to concur with Jan, that medical insurance (or any other kind of insurance) isn't designed to pay for everything at 100%, although it would be nice if it did.  To keep insurance costs reasonable, there have to be some restrictions on the coverage.  Co-pays are typical and can add up, I know. Unfortunately, as you posted, your expenses are adding up, which is not unusual with AN cases.  I had good insurance coverage at the time of my diagnosis but I paid over $2000. 'out-of-pocket' before my Blue Cross medical insurance began paying for everything (tests, doctor fees and hospital) at 100% and I still had to pay office visits co-pays. This is simply the nature of most medical insurance coverage.  

Unfortunately, I doubt things are going to improve any with the new health care bill just voted into law, but that is a separate issue.  However, I expect that annual premiums for most health care insurance plans, be they PPO or HMO, will rise, soon.  I trust that this will not place too large a burden on you or anyone else.  

Jim    

[nteeman]

So what does it mean 'good insurance'?  This discussion comes up often at my place of business as it offers several options. In one plan there is no deductible and for routine medical stuff there is an inexpensive copay, but you must use doctors and facilities that are in the network. In the other you have a yearly deductible based on your income and family size but after the deductible is met you are covered 85% for in network and 75% for out of network. For routine checkups and healthcare the first plan with the cop's comes out cheaper. But I always argued that you get insurance in case of a worse case scenario not best case. So in the example I outlined above lets say you get a brain tumor, you must use a surgeon and facility in the network or it is not covered, period. This also means that you first have to go to your primary doc and get their referral to see a specialist.  In the second, more expensive plan, you can see a specialist right away without a referral, and you can see anyone you chose. Yes the coverage is better with those in-network providers but you can still see anyone and the bulk of the cost is covered.

I can't tell you how many times I have seen people chose the first option and go for years saying how they can't understand why anyone would pay all that money for the second plan --- until they get a serious health problem. I'm not even talking life or death here, I mean they need knee surgery, or their kid breaks a bone or something like that. All of a sudden they can't believe the PLAN won't let them see the doctor they really want to see, or use the hospital of their choice.  Sometimes if they argue with enough people and get enough doctors to write letters on their behalf the insurance plan will make an allowance. But still, who wants to go through that  when you need medical service to be covered?

So when you say 'good insurance' what do you mean? Insurance that is cheap and covers your routine medical costs? Or a plan that may cost a little more on a yearly basis but covers the bulk of your expense when something severe strikes? That is what you have to decide.

Neal

[Jenn15b]

Neal, That is exactly my point, an individuals view on insurance is all relative to their current health.  I also think you have different options depending on the size of the company you work for, when I worked for a national company they offered PPO and HMO at costs comparable to the coverage.  Currently I work for a company with less than 500 employees and they only offer an HMO.  My frustation with my HMO is not just because of my new diagnosis, I fractured my knee on vacation in another state - naturally I went to a local hospital for the basic needs, then did the follow-up with my primary doctor.  Well, all of it was paid out-of network, so the bills are still coming in from that accident.  If the I had the option at work for a PPO plan I would have quickly enrolled in it but since HMO is all they offer....well as they say, the coverage is "nature of the beast".

[sues1953]

Insurance is a crazy thing, if we had a crystal ball I think we would be able to choose the right one.  My husband owns his own small business and joined a very large group of small businesses to be able to have choices at a reasonable cost.  I chose an HMO because we are healthy and everything we needed was covered with a small co pay.  After my diagnosis I found out rather quickly that I could  not go just anywhere for treatment.  To make a long story short I ended up finding a very good Dr. within my network.  I have a yearly max out of pocket amount of 1.000 dollars not counting co-pays, which I have incurred almost 500.00 so far.  I figure I am very fortunate.

Good Luck to all of those fighting their ins co, its not fun.

Sue in Michigan

[Jim Scott]

So when you say 'good insurance' what do you mean? Insurance that is cheap and covers your routine medical costs? Or a plan that may cost a little more on a yearly basis but covers the bulk of your expense when something severe strikes? That is what you have to decide.

Neal ~

To answer your question: for me, the latter.  However, 'good insurance' is obviously a relative term, contingent on the insured individuals situation.  The Blue Cross coverage I referenced in my previous post was, as you can guess, a PPO plan.  However, a PPO may be impractical for someone such as my adult son, with no medical problems and no dependents.  He is quite content with his less-expensive HMO.  So, 'good insurance' remains a very individualistic idiom that infers that one's medical insurance coverage was good for them. I trust this helps clarify the issue.

Jim

[nteeman]

Jim,

That is exactly my point--what is right for me and you is not necessarily right for your son. Everybody has to make there own decisions on that and as time goes by your needs may change your choice of a plan may change as well. I am not trying to say what is best for everyone.  And for those who don't have options but must take the only plan their employer offers - well, you just have to make the best of it and learn all the ways to work it the best you can.

Neal

[Jim Scott]

Jim,

...And for those who don't have options but must take the only plan their employer offers - well, you just have to make the best of it and learn all the ways to work it the best you can.

Neal ~

I agree.  I'm now on Medicare (no choice in the matter) and I'm afraid my medical options are rapidly shrinking, but I still have my Blue Cross coverage as a 'secondary' insurer, which helps...sometimes. 

Jim

[cakulmom]

As self-employed, we had little choice in our insurance or the premium we paid.  We took the only company (after applying to 5 different ones) that would accept us 7 years ago.  We were healthy people too--no cancer, heart issues, smoking, etc. 

What we found was a very expensive premium for catastrophic coverage only--no dental, no Rx, etc.  We now pay $1100/mo. for two (60-year-old) adults--$5000 deductible EACH plus another $2500 EACH oop.  So this year, with my AN, they are going to pay and I will get something in return for my $1100/mo.  Of course, I've already paid $7500; heaven forbid hubby gets sick this year too!

That said, we had the good fortune of taking our 22-year-old son OFF our policy one year before his malignant brain tumor diagnosis and onto his own policy, NOT dependent on full-time student status.  So another insurance company gets to share the pain, and thank God, his policy does have Rx coverage because his oral chemo drugs run $2000/month!

If you have group insurance through work, and don't have a huge monthly outlay, count your blessings and keep your job.  And if you lose your job, take the COBRA.  The new health care plan doesn't go into effect until 2014--till then, you can be denied coverage for your "pre-existing" condition!  Truly, health care expenses are going to bankrupt the country sooner or later.

[Crazycat]

Oh my God....

[gary]

My wife canceled my insurence last dec and this march I started seeing doctors not knowing she had canceled it. So I have no idea what to do now, I do not have insurence, and even if I could , this would now be a pre exsisting condition. I have not told my wife I have it as I see no reason to .

[yardtick]

What        I think you should tell her, like yesterday!!!!