Health care is a basic human right, not a privilege. For some reason, we’ve allowed ourselves as Americans to be fooled into accepting that one must be blessed with “means” to actuate appropriate health care. As a nation we have failed to realize that our health care system is a barometer of our society’s value for human life.


Friday, December 14, 2007

2008 – New Arrivals

This is the time of year that not only are most of us in the midst of some sort of Christmas (Holiday?) consumer frenzy, but we are also anticipating a change that the new year often brings. What is this change? Annual Health Benefit changes, that’s what.

This in and of itself is enough to bring most individuals with chronic conditions (or family members with chronic conditions) to their knees consumed with stress. Changes that employers make to group plans are typically not favorable. Here are some examples of “positive” cost-saving changes an employer may make:

1. Increase deductibles (You know, from something like $500 to $850)
2. Switch all health plans to high-deductible consumer-driven plans (Suddenly your deductible becomes $1500 - $2000 from the $500 it was the year before)
3. Increase specialist co-pays (From something like $20 a visit to something like $40 a visit)
4. Increase the percentages YOU pay (last year you were on a 90/10, this year it is an 80/20)
5. Force you to buy all maintenance meds from a mail-order pharmacy AND increase your prescription co-pays AND decrease your formulary (which seriously, it isn’t like that generic co-pay applies to ANYTHING I would need for my diabetes)
6. Decrease the amount of annual coverage allowed for DME (Durable Medical Equipment)
7. Increase the maximum out-of-pocket allowed OR decrease what is an “approved” out-of-pocket expense.
8. And last but least satisfying for most employers (it seems employers want to be a bit sneakier in how they bankrupt you with health expenses, premiums are much too obvious!) raise premiums!

These are just a few of the “positive” life-altering changes our employers make every year in regards to our health care which has individuals scrambling trying to figure out how exactly they are going to make it another year, with the rules changing once again. Fun stuff.

So what did my employer do?

Haha. Funny that you ask. My employer was “bought” and “integrated” and as a result, we have “adopted” our “new company’s” health plan which just so happens to be a choice of the following:
High Deductible Health Plan, 80/20
Consumer Driven Health Plan ($1375 Employer paid followed by $1125 Member Responsibility (a huge delayed deductible) followed by 80/20)
Some Really Shitty PPO 80/20 with like 80 dollar RX co-pays and 40 dollar co-pays for everything else that don’t count for out of pocket expenses

Ever wake up one day and wonder what the F*** happened? Ya, sometimes I feel like that.

So I chose the consumer driven health plan, out of desperation really. The PPO was seriously so shitty I computed about $8000 in out of pocket expenses. I figured there was no freakin way I could afford the “shitty” coverage it offered on some sort of “Gold Standard” pretense. What-the-F***-ever. How this consumer driven health plan works is that your first $1375 in medical expenses is completely covered 100%, followed by a $1125 member responsibility (one month’s worth of test strips for Gracie & myself), followed by 80/20 coverage for everything (including RX’s) and no co-pays. There is a maximum $4500 out of pocket on this plan. Fiscally, this plan was the most responsible. I’m bracing for a tough year, but I’m crossing my fingers things will all work out (It just has to).

So on the flip side, I do a little research, and this CDHC thing does have its perks. For one, continuous glucose monitoring is an approved DME expense and does not even require prior authorization. So you know what? Jan 2, 2008 I am going to buy myself a REALTIME monitoring system and I am on my way with continuous glucose monitoring. Even better, Medtronic will bill my insurance and I will pay 0% of cost because it will fall (and practically deplete) my first $1375.

So, I guess next year really is a new year. It doesn’t mean I’m all that happy about the health insurance situation, but I have managed to find the silver lining.

1 comment:

ConsumerAdvocate said...

Sarah - I also have a high deductible CDHP. This type of health plan has definitely made me a more cost-conscious consumer for health care services. I even created a website to help other consumers lookup/compare prices for routine health care services to help them make the most out of their health care dollars. Check out and let me know what you thik. I welcome all your comments on this grassroots initiative to expose health care prices.

Happy Holidays.
Mona Lori