Insurance problems - Scared and need to cry and rant!

Hello, Family,
Most of you know I've been having problems financially, health, unemployment, etc, etc, etc.

After much back and forth, and my cousin helping, I finally managed to get a minimal health insurance plan that my cousin could afford to pay the premium on. I wasn't eligible for Medicaid (long story, but it probably would be the same situation I'm about to describe). When I was calling about this policy I specifically asked if they would cover surveyllance endoscopies for my Barrett's esophagus and precancerous condition, and they said yes, at 100%. There's only 4 doctor visits a year covered, and no Rx coverage, but the precancerous stuff was my #1 worry (obviously). This was also a conversion policy from my old BC/BS policy so although it took a lot of wrangling around, there was no pre-existing exclusion on the policy.

Well, I had my visit with my new GI, who I liked and who's from a different hospital. Scheduled the EGD for Dec. 14th. Today I get a message left that I had a $1,000 deductible on this procedure!!!! Was instructed to call my insurance company. So I did (you know what these calls back and forth are like). Was told I had NO deductible, HOWEVER, if the procedure is done in an "ambulatory surgery center" - you know, those places where most of us go these days for same day surgery stuff - that they weren't participating with the insurance so the insurance only pays 70% and I would be billed the other 30%! 30% of these procedures, with anesthesia and biopsies and all is not going to be any small change. So it's not a "deductible'. Big deal. Same difference to me. I called BOTH local hospitals and their outpatient surgery centers are just that - ambulatory surgery centers, and yes, I'd be responsible for 30% of the cost.

So now I have to try my doctor's office back and see if they could do it in the hospital, which is participating, but I know what the answer will be. No. But I'll ask. I understand they need to pay their costs, truly, I do. And that this is the way hospitals are likely going to keep getting around their contracts as "participating providers" in the future, but I don't have that kind of money to pay!

Interestingly, the HALO procedure IS done in the hospital, so I may ask if my insurance would cover that and just have the HALO done now. But you know, I SHOULDN'T have to base moving prematurely into the HALO on cost! And that's exactly why I'd be doing it.

Truthfully, I'm more scared than angry. This is only the beginning of it for me. Even if I got Medicaid, the same thing will be true - even worse, as specialists don't even take that at all.

I'm not asking for fancy, unnecessary stuff. Just to stay alive. Is that too much to ask?

And, BTW, this just a few days before my birthday. Yea, happy birthday to me. NOT.

As a somewhat separate issue, as I've mentioned in a previous post I've been closing down my business, and this post isn't about that, but I was at the office until mid-morning, and have boxes stacked all around me. Had to move it in small boxes, but boy do I hurt today. Can hardly turn my neck. I was shopping at WalMart at 3am, and had been drinking coffee, so of course was awake once I got home until around 6am! And then I slept half the day away only to awaken to have to deal with this insurance business. I just wanted A DAY OFF!!!!!! A day to grieve my business closing. A day to REST MY BODY. And now this.

Sorry this went on so long, but I had to come somewhere I knew people would 'get it'. And I know you do.

Thanks for listening!

PaLady

PaLady try to relax now, maybe your doctor will take your case into consideration and do the procedure in the hospital so you don't have the co-pay. I'll keep my fingers crossed for you. Could the doctor some how do the scope in his office environment?

4 visits per year, that's all. So does your follow-up visits after your procedure count as a visit or if you have to have surgery, which I take it the HALO is, will that be another visit or does it count as 1 visit if you are still taking care of the same issue. Sorry for the questions, you have enough on your mind now.

So sorry for all the frustration you've been going through. Just wish I could jump through this screen, give you a hug & tell you it will be ok. My thoughts are with you.

Char- Thanks so much for the cookie offer, but we'll have to make them virtual cookies! Unfortunately, the Barrett's and GERD mean a low fat diet! But virtual ones - no peanut butter, please! - are fine!

Jag - The HALO is a relatively new version of what we all know as Radiofrequency for nerves, but this time done to zap precancerous cells in the esophagus. It's relatively new and I had hoped to have a second endoscopy and biopsy first, to confirm the intial diagnosis, before going for the HALO (which I don't know if the insurance will cover anyway, since it is so new) but I will call and see to at least find out if my insurance will cover it. That is done in the hospital. It's still outpatient basis, but I suspect the equipment is at the hospital. No, none of these are done in doctor's offices - an endoscopy is like a colonoscopy, just down the throat instead!

Melissa - thanks so much for the well wishes.

All of you - thank you so much!

PaLady

 

   Dear PaLady,

  

     I am very sorry you have such heavy burdons to bear right now. I know how unreasonable BCBS can be.... I dislike having to drive past their "new office building" on my way to the specialists in albuquerque. I become filled with anger each time. 7 to 8 floors and a city block of shiny tinted windows and extensive art work. I paid for the fancy new building. Paid for it with my very life.    I dont even care to go into their latest round of antics. All I can say is I am sorry. I am ever so sorry you have to deal with them during a time in your life when you need proper health care.... A chance to decide your own future, on your own terms. There isnt anything I can do other than listen. I am so very sorry they are doing this to you.

 

*huggs*

  dani 

Boy, do I hear you. Just wanted to let you know that I'm sympathetic. You know what I do and let me tell you it's really bad for people without insurance. I keep working FT b/c I'm really scared to be w/o insurance and it's really hard--I keep thinking that some day I will just pass out at work from the fatigue. I really feel bad for people who want to work and can't but then can't get any assistance. I'm not sure anything, as far as health care, is going to get better any time soon--I can feel the collective anxiety.

PALady
Please tell me what can I do to help you with this situation?

My heart goes out to you!

White Beard

PaLady-
Sorry to hear this. I was so hopeful you had really found a good policy to take care of the Barretts stuff. I'm praying the doctor will do this at the hospital instead.

Take care,
Bill

Bill,
Thanks!!! I'm hoping that's true, too. But as long as I'm going through this dance with the hospital and insurance company I'm going to see if the HALO would be covered. Maybe I'd just get it done and overwith.

Cross you fingers for some good news!

PaLady

I really hope you have a Happy Birthday despite all your worries and problems and stresses and sore muscles. I too wish I could help. I find it so destressing to hear of your plight with insurance. It just doesn't seem right that you have to pay anything, overhere you'd have a health care card and medicare would cover all expenses or 90%.

I can only send my best wishes, my heartfelt hugs and save you from my singing rendition of Happy Birthday.
best regards, golitho

Tina, Golitho and Susie,
Thank you (and everyone) so much for your caring replies. I guess it's the only comfort I've got right now.

Susie what you're saying is really scary because all of us with disability will eventually be on Medicare, and if we live long enough will be. I know hospitals and other places need to pay their bills. They need to be reimbursed at decent (but not indecent) levels, and the cutbacks that have come over the years have pushed many of them into this junk of creating new entities which aren't participating providers, and thus they can bill us for the difference. I have a call in to my GI's office now asking if the EGD can be done in the hospital but I'm already pretty sure the answer will be no. Otherwise once everyone caught on everyone would want them in the hospital.

I don't know what 30% of the procedure is but I'm pretty darn sure I can't pay it! I can't believe your bills, Susie! Although I am in favor of health care reform, I fear all the compromises that may be made may make things worse in the long run instead of better. And I know, we can't get political. This really isn't meant as a political statement, but one of humaneness. I fear that programs like the insurance I've got will be considered "insurance" regardless of what they DON'T pay for. I don't mind going without any medical care I don't truly need. Heck, I don't WANT more than I need, but to not be able to get medications and procedures that literally are life-saving to not just me but all of us is criminal, IMHO.

Ok, off my soap box.

Thank you all again!

PaLady

We had to enroll for health insurance through my husbands company recently for the upcoming year. Previously the insurance company would pay 85% of testing and hospital stuff, $20 co-pay for pcp & $30 for specialist. This year the better insurance will only pay 80%, $30 for pcp & $40 for specialist. There was a cheaper plan available that will only pay 70% with the same co-pays for doctors. We went with tthe cheaper one cause last year I had two MRI's on back, CT scan on kidneys, two lumps removed from right breast and even with the insurance paying 85% I still owe the hospital big money. We did get the radiology and anestheology bills paid off. With the choice of paying 20 or 30 percent it was gonna bury us deeper in debt no matter which one we chose. I just keep paying the hospital $40 per month and they never say a word and leave us alone. They still treat me too. I just had xrays on my knees & right kidney the other day.

PaLady maybe you could set up a small payment plan with the surgery center ahead of time, just enough to keep them off your back. Most hospitals work with you if you at least pay something regularly.

PA Lady,
This is horrible and you are the brunt of it. An honest person that doesn't take advantage of anyone or anything seems to always get side swipped in this crazy system while it seems the sneaky ones seem to pull it off and continue to do so.

I worked in healthcare for 33 years in a County governed facility. May I ask if you have that situation where you live? If you do you might check with them and see if they have any type of programs. Our plan was called "Charity Care" and it had guidelines for income and if you met those requirements the hospital would write off some if not all of the bill. Our hospital was part of the Hill-Burton Act in the late 60's I believe and the act required that we operate that way. This was just something that popped into my brain when I read your post and all of the responses today. It might be something you could check on. I also know is Kansas they have places that will cover the bill to some extent and you pay back the company with a very small interest rate.


Again, PA Lady I am sorry for your struggles and I do care. Wish I could help you more.

Cathy

I will write more later, as it's been a long day. I can't believe how many doctor's offices have called and how many calls I have made, although did make some halfway decent progress. Will know more on Monday and for now I don't care as I am tired of it all and want the weekend to rest!

Skeye - it was so good to hear from you. I know you're busy but when you get some time let us know how you're doing.

I'll write more later. But thank you again everyone!!!!

Hugs for you all,

PaLady