Monday, January 09, 2006

Nothing Comes Easy!

Often I post my gratitude lists because I really do try to maintain a positive outlook on life. But another coping skill is to learn to "vent" when something frustrating comes along. So, occasionally you will find a post containing one of my "rants." I'm sure you will relate in some way to what I'm discussing.

Today's rant is a combo one: Medical "Businesses" and Health Insurance Companies

Picking healthcare coverage is about as technical as reading the instructions for setting up your VCR in Russian. I selected a comprehensive health plan with prescription drug coverage through Humana. I chose my physicians based on THEIR recommended in-network list. Just when I had 3 visits under my belt with the physician, and we were getting "settled," I found out my doctor was no longer in-network. Just from last month to this month that has all changed. And no one notified me. The doctor's office did not notify me to say they had decided not to continue in a contract with this insurance plan. The insurance company didn't tell me they removed my physician from their in-network list.

All of a sudden, when some tests and treatments came up, I was put in a holding pattern, but no one told me why. I decided to call and get to the bottom of it, and that is when I discovered the change. I called the doctor's office, and they said it was between me and my insurance company. But it was THEIR Alliance Primary Care (business side of the doctor's office) that chose not to renew their contract with Humana.

So, now, I will be selecting my third primary care physician in just six months, all because of insurance hassles. OR, I can pay out-of-network prices. But-that rebounds and becomes a bigger problem than just paying higher office copays. It means, every time that doctor orders a test, if it is at an out-of-network facility, the ins. co. doesn't have to approve the test. Or if they prescribe a medication, they can have the pharmacy put a red flag on it, and then delay getting back with them on approving it.

It has been a hassle all the way around.

And don't get my friends and family started who are having to select a Medicare prescription plan. Talk about confusing!

Where is all of this heading?


Blue Cross of California said...

Great blog I hope we can work to build a better health care system as we are in a major crisis and health insurance is a major aspect to many.

Anonymous said...

My prescription assistance status is still unclear. Another letter of denial today, after being told in person last week that it would be automatically given to me. What a waste of postage, manpower, and paper.