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Very angry over health coverage change

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Posted 8/17/2010 12:10 AM (GMT 0)
Last year, my state started an insurance program for low income adults without children. I was fortunate enough to sign up right away and get on it. Since then, they have not added any new members, they never expected so many people to need it. Anyway - it is essentially like a medicaid type coverage.

Here is the bad news - I just got a letter in the mail saying I'm going to be forced to choose from an HMO plan. My doctor's offices do NOT accept the HMO form of this insurance. They only accept the plain kind that I have had until now.

I am going to lose the two brand new doctors that I loved so dearly. I envisioned them helping me solve all my medical mysteries and getting better. Now, I'm screwed.

I honestly do not know of any doctor's office in my vicinity that will accept the new HMO plans.

I'm so upset I could just start bawling right now. Add to this - one of my eyes has an itchy lump on the edge of the eyelashes and I was hoping tomorrow my doc could help me figure out what's wrong. Well, I can see her tomorrow - but for how long in the future? She was going to be running liver panels for another 3 or 4 weeks to check that I am okay after this last illness. They were going to be looking at my gall bladder to make sure it is okay. I was going to meet with a rheumatologist - but I got so sick I couldn't go . NOW - now this is all down the tubes. I'm screwed.

I am so terribly sad right now I can't even tell you.

None of the offices for this insurance issue are open tonight. I'll have to call them tomorrow - but it won't do any good - I mean, it isn't like I have a choice!
Posted 8/17/2010 12:28 AM (GMT 0)
Oh, (((((Princess)))))! I am sooo sorry this is happening to you. Just what you didn't need.

Not fair!! This is why we need the public option! Everyone should have the security of knowing that the basics are covered, and the health of your body (which you can't exactly do without!) is a basic.

Debbie
Posted 8/17/2010 1:12 AM (GMT 0)
I would make sure to call them, there might be a plan that you can get under if nobody takes hmos. I truly hope that this works out for you. It is such an overwhelming thing when they change our insurance. And I don't think it is fair. Keep on them about it. Often you can get places.

Hugs, Karen
Posted 8/17/2010 1:27 AM (GMT 0)
Thank you Debbie and Karen.

Yes, Debbie, that public option that assures the patient they can see the doctor of their own choice is so important.

You can bet I'll be on the phone all day tomorrow. *sigh*

Wanna know what's really pathetic? I looked up one of these HMOs - and they list the doctors you can see. They allow me to see "some" doctors at my retired doc's office. Two problems: 1. When I was not insured, I couldn't pay for the total of my health care there - and they won't allow me to come into their offices without $100 in my hand before each appointment now. 2. The doctor's they show on their list are ones I'm somewhat familiar with - several of which I would probably die if they are my only choice for help. Two bungled my diagnosis so badly that I was damaged by their advice. Either way - I'm just screwed.
Posted 8/17/2010 1:52 AM (GMT 0)
I'm so sorry that you are caught up in such a crazy insurance limbo. When you see
your doc tomorrow, let him know what you are up against and how this stress is
affecting you. Maybe he has some insight to how you can get the help you need.
Chick, I will be praying that everything works out for you. Life can sure throw us
some curve balls. Wishing you the best of luck my friend!

Hugs, Robin
Posted 8/17/2010 2:15 AM (GMT 0)
Thank you, Robin. I'll be sure to talk with her about this. Just today I was so thrilled because when I went to have more blood pulled, I ran into my main doc in the corridor. She called me by name, after only knowing me a short while and we had a little talk. I felt so very fortunate to have found both of these wonderful women doctors. They're right in my small town - 3 miles from my driveway. This comes on the heels of my former doc retiring in March '10 - and spending years only able to afford to see him once a year. :-( It is just so disturbing to have my hopes dashed just now. I can't remember feeling this upset even during the whole time I was sick these last three weeks. My spirit feels crushed.
Posted 8/17/2010 4:09 AM (GMT 0)
((((((((((((((Princess)))))))))))))))) I am so sorry that this happened. You have been such a support to me and now that you are having problems I am feeling helpless as to what to say. I will be praying really hard that your doctor figures someway that you can still see her. Once again I am so sorry that this has happened to you.
Gentle Hugs
Shirley
Posted 8/17/2010 4:26 AM (GMT 0)
(((( Shirley )))))

Prayers are greatly appreciated. Thank you very much. There isn't much to say - but I know you're there and you're wishing good things - and that is really the biggest thing I could want. So you're doing exactly everything a friend could do - exactly the right thing.

*hugs*
Posted 8/17/2010 9:42 AM (GMT 0)
Hi sweetie,

I am on medicaid and got that with my disabilty. My doctors office wasnt taking any medicaid when I called them begging them to have the chance when all other means of treating me and I too felt so screwed. But I hadnt been seen at this old office in over 6 yrs when I moved and found a new doctor which of cource left me high and dri with only 2 days left on my medicine. But when I talked to the office gal who said no deal no how I told her to talk to the doctor and let him decide about it. So guess what? He did call and he said he would work it out and he was glad to have me as a patient again. So it doesnt hurt to ask. If he is nice as you say he is then he might be able to do something. Take care and I hope you get some positive answers.

Gentle Hugs,
Karen
Posted 8/17/2010 2:46 PM (GMT 0)
((( Karen )))

Thank you. You're on to something. I'm going to exhaust every idea!

Also - I have a glimmer of hope. I called the ombudsman for this service and found out that if I have an established SPECIALIST doctor, I can fill out a form about continuity of care and get exempted from this HMO program. They won't do it for a primary care doc - but they will for a specialist. Once I'm exempted for the specialist, I'm free of the HMO and can keep seeing my primary doctor, too!

Now - this is a reach - because I had to cancel with that Rheumy a few weeks ago when I was really sick and possibly contagious. I just called and booked him for 9:am a week from today, Tues 24th. I'm going to speak to one of my docs and tell her what I'm doing - and maybe between my two primary doc ladies they can convince the Rheumy to fill out the form and keep me on my regular medical coverage.

Oh Pleasseeeee let this work. You all know how critical a good doc is. I've barely had a good one that I was allowed to see for long. I can't lose these two ladies now - and this Rheumy, too.

Crossed fingers are appreciated!
Posted 8/17/2010 3:07 PM (GMT 0)
CP:

Keeping you in my prayers my dear.

Yes, we all should be able to choose what doctors we want to see, insurance companies should not be able to tell us who to go to.

This is OUR lives and we want the best care that we can get.
I'm sorry that this has happened .
Big hugs coming your way.
Posted 8/17/2010 3:17 PM (GMT 0)
I agree with QT Karen.  Talk to your doctors.  Tell them your concerns.  It is really up to them as to what they will accept because it's all about money.  You might be surprised and find that you really have compassionate doctors that will accept whatever your insurance will pay out.  I'll keep you in my prayers.

 

Sherrine

 

Posted 8/17/2010 5:53 PM (GMT 0)
Well, not as excited as I was earlier.

Bad news: the continuity of care form is only effective for 6 months. Then you have to merge into an HMO. So there is no way to get out of this.

Good news: Sounds like I can keep seeing my doc through October - I think.

I had my follow up with one of my doc's just now. The doc definitely does not, and can not, accept the HMO plan. She said in all the years she's been there she knows for sure they'd never accept that HMO plan. She did say she and my other doc would go over the list of over docs in the HMO and help me find a new one though. There is something about these HMO plans that they want absolutely no part of. They'll do medicaid and medicare - and straight health insurance, but not these state authorized low-income HMO plans. I bet they pay them even less than medicaid.

I'm coming around to the idea that I can handle changing docs yet again. I just have to get over it. That's all there is to it.
Posted 8/17/2010 9:34 PM (GMT 0)
Confusion continues. Some of the doctors in these HMOs aren't affiliated with my local hospital of choice. :-P One of the hospitals is REALLY far - and not at all convenient. A second hospital is not THAT far, but it is locally known as the place you only go if you want to die, if you know what I mean. Crap.

I did bite the bullet and call my old doctor's office. They have three offices which are close to me - and all three are being sold to a bigger hospital group. The sale isn't complete until Sept 7th and they don't know yet whether the new ownership will change which insurances they'll accept. If they accept my insurance, they would allow me to pay $100 per month toward my old bill in order to see a doctor there. Considering I'm still trying to scrounge up $700 to have my first dental crown done - I can't imagine how I'm going to find an extra $100 every month for the doctor, too. Crap. Double crap.

Confused? I am.
Posted 8/17/2010 11:51 PM (GMT 0)
Yes! Confused. And very sorry.

Wish there was something I could actually DO to help you. Guess it will have to be good intentions through the ozone.....

Debbie
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