Switching insurance companies

Ok, I have been pecking away at the list of insurance companies and the policies we have choices from with my wife's new position. It is a total of 7 different medical plans including 3 HMO's, 3 PPO's and 1 HDHSA (A high deductible major medical policy with an accompanying medical savings account). The pro's and con's of each plan were so far across the spectrum that listing them all would be a LONG entry.

The HMO's ranged from co-pays for doctors visits ($20) and specialists ($30) with a 90/10 co-insurance and $1000 per person max out of pocket or $2000 per family to an HMO with $30 doctor visits and 35/65 co-insurance and HUGE out of pocket max's (like $5K) and all of them with the same prescription plan. Of course the difference in the plans meant a difference in premiums. However for the major differences in the co-pays and out of pocket maxs there was only a $100 a month difference in premiums, it just did not seem worth it skimping on the $100 a month to have to pay that much more per year if you should happen to have something go wrong.

The PPO's were outrageously expensive (we have one right now) and while I like the not having to get referrals to see specialists the premiums almost double. There are some other issues such as co-insurance, none were better then 80/10, and the out of pocket maxs could bankrupt you should you have a major problem.

Now having experienced a major surgery, costing well into the 6 low six figures and facing down another in the near future I am looking to switch to a plan that is not going to have me footing several thousand dollars before they will treat me, so the PPO's are instantly out of the question as are the high co-insurance HMO's. The HMO with the 90/10 seems like the best choice based on everything and with the $1000 maximum per patient the most I would pay in a calendar year for a co-insurance is that $1000.

Going on that I called the company to find out more about their plan and to see if my current physician and pain management doctor accept their coverage. There are some subtle nuances to the co-insurance and out of pocket maxs, issue like hospital stays also have a $200 a day co-pay regardless of co-insurance but it is still a better plan then the others. Top it off both my PCP and pain management doctor are on their insurance with the only draw back being that even though I have been seeing this pain doc for almost a year I will have to go back to my PCP and get a new referral. That should not be a problem though.

My concern still though is prescriptions as they do not have a standard co-pay like most companies tend to have. They have a percentage of the manufactures price that you pay ranging from 20% to 100% depending on the meds and how they are prescribed. Now you would think that med X would cost the same no matter where you are buying it but that just is not so. That means I will need to call all the local pharmacies and price out all my meds to see who will be able to save me the most. The problem there is that Pharmacy A may have med X cheaper but Pharmacy B may have med y cheaper. That means depending on the OVERALL cost for my meds from each place will determine where I go. Yet one more hurdle to jump over yet I am held up. The company that handles the prescription coverage will not speak with me as we are not yet members. WHAT? I just want to know what tier they consider my meds in so that I can apply the right percentages when I call the pharmacies. It does me no good to know that they charge $D if I don't know where between 20% & 100% I will be paying. Sigh....

I am in a good mood nonetheless as we figured out which insurance plan we will be going with and I feel good that we have picked the best plan to suit our needs now and down the line. I also found out that they have excellent vision coverage as well as "ok" dental.

The vision plan is only $30 a month for all 4 of us BUT it will cover 100% of my contacts for the year! Sure I have to pay $50 for the eye exam but if I buy my contacts through the plan they are 100% covered. If I go with glasses it is a $25 co-pay for frames and then lens but 100% after that. While I do wear glasses (very light prescriptions) I cannot stand them being on my face. For some reason they always feel crooked so I prefer contacts. Until now though I have stayed away from them as our old plan only covered $100.

The new bed is working like a charm. Since we got it I have slept through the night everynight which is the best I have been able to do since my surgery. I feel SO RESTED that I was able to take the youngest out of the house for a bit today. He has sprouted since we last bought him some long pants and with the temp dropping shorts just are not cutting it. This morning it was 45F which is obviously pants weather but when I went to his closet the poor kiddo only had 1 pair of sweats that fit him.

It felt good to just go out for a few hours with him and do some browsing. We hit Sears as they carry Carters and Lands End as well they are the only store in my EXTREMELY small town that carries children's clothes that are not "gently used". I would have gone down to Old Navy or the Carter Store but we only had 2 hours before we had to pick up my oldest from school.

We did find him some pants, a few pairs of sweat pants for playing and running around the house and this weekend I will take him to Old Navy to find him some slacks and jeans. Since we still had some time to kill we hit Wal-Mart for his bubble bath and his training pants (someday we may make it to actual undies!) and then we hit the grocery store as someone drank all my chocolate soy milk and whole wheat chips ahoy!.

All in all it was a productive day.

Ok, so enough of the rambling on and on and on. It is time to sit down and try to actually hear my show.