Friday, October 17, 2014

It never gets better

Every job change I have had has had worse health insurance. And within each job, every time there has been a change in the insurance plan, it has been for the worse. The new plans came out for next year- we now have our choice of two options- but neither includes out of network coverage. They took that away. Neither my psychiatrist or therapist take insurance.

50% of psychiatrists do not take insurance, it is the highest percentage of all disciplines. And in my state the number of doctors-of all kinds-who do not accept insurance is very high. There are hardly any psychiatrists around who take insurance, and the waiting list for those who do is many months. But at $150 every 2-3 months, I think I will stick with my doctor. My therapist is another matter. And I am sure that there are good therapists who take insurance, but I can never seem to find them. I found one- but then she left for maternity leave. Most have been, at best useless, at worst really bad. So I think that as of December 31st, I will be done with therapy for a while. I guess they got what they wanted- they cut costs.

The high deductible option will still be there- with $500 added to the deductible and no more out of network coverage. The other option is an HMO which is no bargain either. There is still a high deductible- but is doesn't apply to doctor visits or prescriptions- there are co pays for these, and these copays are high. $60 to see a specialist (like a physical or occupational therapist, for example- imagine 2 times a week). And for the HMO I would need a referral for all care- which would annoy me, but I don't think would be too hard to get. I have a good doctor.

I think the HMO would save me money- and I wouldn't have access to any more doctors with the high deductible plan. The downside is that there is no health savings account attached to it. So when I try to figure out what is in my financial best interest, my head starts to spin. Shouldn't they teach this in schools? And I really don't like the idea of an HMO. And I feel very sorry for all of the PCP's who have to write referrals. They must have something better to do with their time.

1 comment:

Unknown said...

I paid $50/session, 3x/week for 10 weeks for CRAPPY PT after my initial ankle injury. I was so afraid of being overly critical because of being a therapist in therapy that I instead was undercritical and didn't question why a)they treated everyone in the "ankle room" the same b)I wasn't getting at all better c)they were doing modalities I knew were ineffective so far out from injury d)the PT wasn't really involved. I saw him every month for assessment and an athletic trainer for modalities and a tech who was treating 4-5 people at once for the minimal exercises they did e)they were padding billing by doing things for ridiculously long periods of time, like getting a whole block fo ther ex by doing 15 minutes on an elliptical which was fine for a little stretching but 15 min was way too long for what I was there for. It was a disaster. I had really crummy insurance then although they got themselves mixed up about paying for counseling and wound up paying for a whole lot of uncovered sessions and then followed that by paying for 80% when they shouldn't have paid more than 40% and they didn't fix it no matter how many times we told them so we finally just went with it. For mental health I was considered out of network, yet my network was in New Hampshire (it was when I traveled). Ohio didn't have a reciprocal agreement with them so they didn't have to pay and then the insurance psychiatrist decided when I was 6 weeks out from a hospitalization that I was incapable of making gains in treatment and therefore ineligible for therapy more than twice per month. Dr Mind fought that and won on the basis of a suicidal patient needing more monitoring but it was a horrible mess.

I hated making those decisions and I'm sorry you have to. I was just thinking today when I got the mail how glad I am to know exactly what Medicare is going to provide me. I do need to stock up on some meds now before the end of the year (I'm in the nice part of Med D where everything is only a few dollars since all my really expensive meds are covered by patient assistance; I'm building up supplies of the ones that cost a lot like migraine meds and anything else I take PRN). I could maybe do an advantage plan but last year the only ones offered to disabled people were terrible for this county and I don't expect that to change. Plus I'm possibly still going to be doing some PT after the new year (I want to do some after I'm out of my brace to maximize strength and proprioception) and I want to have the right to choose where I am going and for how long. My surgery might ultimately cost me more than if I were on an advantage plan (although probably not too much since Medicaid kicks in at my spenddown amount) but it was all my choices and that's what was right for this.

HMOs have scared me since the day a case manager screamed at me for using technical language in my eval and goals and then yelled again because I didn't write dressing and bathing goals for a woman who had just had a massive stroke and was just learning to wash her face hand over hand. I thought dressing might be a little frustrating for the patient at that point.....