I Freakin Hate My Insurance Company

[redheadheather]

DS was diagnosed this past August w/gluten intolerance... DH's grandmother had celiac and DH has had "food issues" [both allergies and intolerances] his entire life. I asked them if he could get a blood test and they stated if he "wasn't having any symptoms he doesn't need to get tested [this is still part of the quote!! EVEN IF HE HAS IT HE IF THERE'S NO SYMPTOMS IT'S NOT NECESSARY TO BE CONCERNED ABOUT IT"!!!

ARGH

At this point I just don't know if we should get outside testing done or what.

They astonish me.

[hez]

Don't ask, tell them to do a blood test. I thought it was recomended for children to be tested every 2 to 4 years if one of their parents has celiac disease. I get reall angry when I have to fight for my health care!

[bluelotus]

You are not alone in your feelings about dr's and insurance....believe me. See some of the input on the "family members should be tested" thread.

[VydorScope]

  redheadheather said:

DS was diagnosed this past August w/gluten intolerance... DH's grandmother had celiac and DH has had "food issues" [both allergies and intolerances] his entire life.  I asked them if he could get a blood test and they stated if he "wasn't having any symptoms he doesn't need to get tested  [this is still part of the quote!!  EVEN IF HE HAS IT HE IF THERE'S NO SYMPTOMS IT'S NOT NECESSARY TO BE CONCERNED ABOUT IT"!!! 

ARGH

At this point I just don't know if we should get outside testing done or what.

They astonish me.

<{POST_SNAPBACK}>

Hmmm has your son ever had a stomache ache, ever? Diarhrea ever? I am sure you can FIND symptons if you go looking. Might just take some umm clever thinking...rember theres sposdly over 200 possible symptons... surely you can find a few...

[Felidae]

Wow am I happy to live in Canada. My doctor sends me for every blood test she can every year. She also sends me to specialists when needed. I can't imagine having to go through insurance for a blood test. I feel for you.

[KaitiUSA]

I have had enough problems with the crazy doctors over the past few years and if they don't give you a blood test you tell them to give you one or tell them you will find another doctor.

They have the mentality that if it doesn't show signs of being broken then don't fix it...but you know it's better of catching a problem before it gets out of hand and 10 times worse.

[lovegrov]

Two things. First, you can collect info showing how folks should be tested as proof the experts recommend this. You can probably also find info about "silent" damage. Silent damage put me in the hospital for 11 days and cost my insurance company tons of money.

I'd also agree with Vincent. Diarrhea, fatigue, achiness, mental fogginess, gas, etc. These are all possible symptoms.

richard

[jenvan]

I would definitely get tested! Insurance can be such a %#$(# ! My employer is switching to an HSA, which means for my husband and I to get ANY coverage, we have to spend a $5,200 deductible each year...then we get our coverage. !

[VydorScope]

  jenvan said:

I would definitely get tested!  Insurance can be such a %#$(# !  My employer is switching to an HSA, which means for my husband and I to get ANY coverage, we have to spend a $5,200 deductible each year...then we get our coverage.  !

<{POST_SNAPBACK}>

I wish my empolyer would go to a HSA, they are much better in the long trm. The short term is rough, ie the first year, but its definitly the way to go if you can get past the first year or so. 20 years from now, I think that the HSA's will drasticly improve health care as they open the field up to more patient / doctor control and less insurance contorl.

Just a rough transistion ....

[skbird]

  jenvan said:

I would definitely get tested!  Insurance can be such a %#$(# !  My employer is switching to an HSA, which means for my husband and I to get ANY coverage, we have to spend a $5,200 deductible each year...then we get our coverage.  !

<{POST_SNAPBACK}>

I feel your pain, Jen. My unsurance (intentional) is like this - first $500 is covered, then the next $5,000 is not. Great plan for most fairly healthy folks, and will save you from bankruptcy if you get in a car wreck, but for people like me, who keep getting sent from GP, to Rheumy, to Gyne, to GI - it sucks. Nevermind the Chiropractor... or the psychologist I started seeing this past summer to deal with all this crazy health stuff. I am trying to get my work to allow me to buy up to a better plan (I figure paying $50 a paycheck before taxes is waaaaaay cheaper than I will be paying for stuff this year... so far I am out of pocket $1,000 and still have my first gastro appointment on Thurs, so likely some scopes happening, and a possible laparoscopy on the horizon for endometriosis... say goodbye to any hopes of going on vacation this year, either!!!)

Anyway, that totally bites.

Stephanie

[jenvan]

I understand why some support an HSA, I for one have done a lot of reading and have yet to be convinced for myself. Basically--I will spend a considerable amount of out of pocket $, but unless something catastrophic happens, I will not reach my full deductible... So in my situation, I may get up to a couple hundred in the HSA, but I will pretty much be paying out of pocket for everything. I understand why those who go to the doctor little or those who are fairly wealthy like it. And I do like having control of my own money, but in my current situation its not so great. At the least I think HSAs would be wise to cover preventive care intially. This plan will keep some from going to the doctor for preventive care appts, and in the end may cost everyone more. However, I will be moving on from my current position in the near future...so I'm not too worried. At least I have family to fall back on if need be. I feel for those who are truly 'on their own...'

[VydorScope]

  jenvan said:

I understand why some support an HSA, I for one have done a lot of reading and have yet to be convinced for myself.  Basically--I will spend a considerable amount of out of pocket $, but unless something catastrophic happens, I will not reach my full deductible...  So in my situation, I may get up to a couple hundred in the HSA, but I will pretty much be paying out of pocket for everything.  I understand why those who go to the doctor little or those who are fairly wealthy like it.  And I do like having control of my own money, but in my current situation its not so great.  At the least I think HSAs would be wise to cover preventive care intially.  This plan will keep some from going to the doctor for preventive care appts, and in the end may cost everyone more.  However, I will be moving on from my current position in the near future...so I'm not too worried.  At least I have family to fall back on if need be.  I feel for those who are truly 'on their own...' 

<{POST_SNAPBACK}>

Im am not wealthy, or healthy. The way you save (or in many cases your employer) saves big time with the HSA is the monthly payment. My empolyer pays over $1000 PER MONTH PER EMPLOYEE for heatlth coverage. It will bankrupt him if he has to keep paying it as the price sky rockets. HSA is the only reasonable way out. In fact for our company setup he will put 2500 in the HSA, and the dedcutible on the plan is 2500, so for the employees get about the same health coverage, with alot more freedom, and he cuts his monthly health bill by around 66%. I am realy pushing to get him to do it.

It might not work for everyone, but I see it as a great move, esply for ppl like me who struggle paycheck to paycheck. The very wealthy will not benifit from it as most of them are smart enough to already have money set aside for medical needs. I dunno why ppl think it will help them more then anyone else.. helps them less realy.

Like I siad in the long run the Health Care industry in general will be much better off as you put the PAYING PATEINT in control, and reduce the control of the often cold and uncaring insurance companies. Bringing the decsion making back in to the docts office, and away from teh lawyers and ins companies benifits everyone, IMO.

[mom of a celiac]

  VydorScope said:

Hmmm has your son ever had a stomache ache, ever? Diarhrea ever? I am sure you can FIND symptons if you go looking. Might just take some umm clever thinking...rember theres sposdly over 200 possible symptons... surely you can find a few...

<{POST_SNAPBACK}>

There are over 200 symptoms??? I need info I believe and Dr thinks it is possible that my 13 yr old son has Celiac Disease.....However b/c of insurance and such cant get biopsy and blood test till 10/24....in mean time my son has lost 12 1bs in 2 weeks and that brings him to only weighing 69 lbs at present. He has always been small I took him to Dr after Dr through the years concerned over his size. I will post more details on message board later. They want me to keep giving him gluten until after the test...they say if he gets sicker and loses anymore weight they will hospitalize and then the test will be done. He can barely get out of bed some days. I do not know what to do.

Please help!

[debmidge]

An insurance company reviews the doctor's reasoning for initiating a test and if the doctor presents the symptoms in the proper way, there's no way the insurer will deny the claim. This is like saying you had cancer, but no symptoms other than vague pain, just because your blood test shows normal white blood cells the insurance company won't allow a CT Scan or MRI. It's how the doctor presents it. It could be that your doctor just isn't interested enough to write out a report, etc. to justify the special blood test. Or he/she's really that inept not to investigate your claim any further. Either day, can you go to another doctor?

If all else fails, the one line from a customer that an insurer hates is: I'm going to report you to the State Dept. of Insurance.

[VydorScope]

Unfortinitly if you want the test to be valid he will have to be on gluten until you can get the test. How much is the blood test? Would it be with in your means ot pay for it your self? I dunno your situtation, or the cost, so I hope thats not anunreasonalbe question!

[skbird]

  VydorScope said:

My empolyer pays over $1000 PER MONTH PER EMPLOYEE for heatlth coverage. It will bankrupt him if he has to keep paying it as the price sky rockets. 

<{POST_SNAPBACK}>

I have to ask, where do you work? We had an insurance meeting yesterday at work, my company pays $130 a month for a 30-39 year old employee's insurance (such as mine). Since I decided to buy up to the marginally better plan offered, I will be paying the difference, which is $19 a month, so my better plan is officially $149 a month. Over $1,000??? Cadillac insurance or something???

Just curious.

Oh, btw, I'm in California, if that makes any difference.

Stephanie

[jenvan]

since my firm is so small, we have higher premiums... mine is about $700 a month

[VydorScope]

  skbird said:

I have to ask, where do you work? We had an insurance meeting yesterday at work, my company pays $130 a month for a 30-39 year old employee's insurance (such as mine). Since I decided to buy up to the marginally better plan offered, I will be paying the difference, which is $19 a month, so my better plan is officially $149 a month. Over $1,000??? Cadillac insurance or something???

Just curious.

Oh, btw, I'm in California, if that makes any difference.

Stephanie

<{POST_SNAPBACK}>

Only 4 employees... and its very low end for what it covers, no dental, no vision, nutin. And its the best rate we could find. It was around 900 LAST year, and this year it went up the max allowable.

[debmidge]

That's true (I do insurance for a living) smaller groups pay higher premiums. There's savings in large numbers. Larger groups also have more clout to control level of coverages, premiums, deductibles, etc.

But, every state has a Dept. of Insurance that oversees the plan's rules. But first talk to your HR person to see if they can rectify your insurance coverage issues.

You may have to switch doctors because in my opinion, this is a problem stemming from the doctor, not the insurance company.

The insurer wouldn't want to keep you from getting diagnosed properly, but must be informed as to the reasons why a test like this needs to be performed.

A prior post mentioned over 200 celiac disease symptoms and you are bound to have a good number of them.

Perhaps even a fib like "someone in family (mother father sister brother) has celiac disease and I was told to get tested because I have similar symptoms such as blah, blah, etc."

Write up on your own a list of your symptoms as justification. and if you feel like fighting with the insurance company after the test, then you write a letter an "appeal" their denial of claim. But before you go this route you should either change doctors or contact your HR and advise them that your insurance company, if it's really true and it's not the doctor, is giving you a hard time with regard to this test.

D.

[CeliacMe]

  jenvan said:

I would definitely get tested!  Insurance can be such a %#$(# !  My employer is switching to an HSA, which means for my husband and I to get ANY coverage, we have to spend a $5,200 deductible each year...then we get our coverage.  !

<{POST_SNAPBACK}>

I am not in any way trying to defend insurance companies, as I also think that many of their rules are stupid and counterproductive- BUT they are pretty broke from the rising cost of healthcare, namely perscription drugs. Some of these drugs are outrageously expensive and many companies haven't started cracking down on what is on the formulary until the past 2-3 years. I work in a pharmacy and am finishing my BS in business, so I think that I know especially from what I have observed in the pharmacy.

Look on your label next time you get a Rx from your local pharmacy, it should say what the cash price is as opposed to how much your insurance charges you for it. It's not the pharmacy marking it up either, pharmacies make more money off the markups on generics, that's part of the reason why most pharmacies have a policy to reccomend a generic if one is available, even if the patient requests brand name. Some examples are: Fosamax ($80 for 4 pills), Zithromax Z-pack ($70 for 5 pills) and omnicef ($125.99 for a 60 ml bottle). Also, drugs like viagra which cost $14 a pill, which most insurances pay for 4 to 6 per month. Plavix is $130 for a bottle of 30. Imagine needing two or more of these perscriptions per month, which many people do. That bill adds up for the insurance company exponentially. Also, don't believe that the money goes to "research." At pfizer's annual meeting this past march, they decided to cut R & D money in order to keep their vast marketing department and sales staff. The starting salary for a drug rep at pfizer is $52,000 per year. Plus they get a $2,000 raise each time they complete a phase of training (about 5 phases in the first year) and a bonus. So, their first year starting annual salrary ends up being around $80,000. PLUS they get a company car and expense account, which they use to wine and dine doctors, adding up to thousands per month- for one rep. There are about 60 salespeople in a popluated area like Broward county Florida. So if you start adding up all the bills, you can figure out for yourself that they don't charge THAT much for R & D.

Not to get all political, but - There are various groups lobbying for restrictions on what drug companies can charge for medicine. I feel that if t his were done than the cost of healthcare could be cut down significantly. Also, the shortage of healthcare professionals doesn't help. I am not at all trying to minimize your conflict with your insurance, just trying to help you understand why they are the way that they are. You could write a letter to your local congressman or senator complaining that we don't restrict drug companies prices like other countries- like canada do. Until then, you are going to have to fight with them for your blood test. You should be able to get "routine" bloodwork everyyear and given your familie's medical history, I don't see why that wouldn't be considered routine.

[tarnalberry]

  CeliacMe said:

Some of these drugs are outrageously expensive and many companies haven't started cracking down on what is on the formulary until the past 2-3 years. 

<{POST_SNAPBACK}>

It's unfortunate that, in updating formularies and the costs associated with different medications, insurance companies assume that generics are equivalent to brand name. They're not. They can often be used as substitutions, but there are sometimes differences in inert ingredients that can cause a person to react badly to the medication. Generic albuterol (inhaler) made me much shakier than a brand name formulation. Generic naproxyn sodium gave me bad stomach issues that brand name stuff didn't. For other drugs, generics work just fine for me. But insurance companies don't - to my knowledge - address the differences between generics and brand name in all patients.