Saturday, June 11, 2011

Insurance Annoyances

I have had my share of insurance annoyances over the years, but ever since joining government service, I've tried to minimize the headaches by carefully researching plans and making realistic choices for my health needs.  So I'm unimpressed by the insurance headaches I've encountered since being home.

My previous insurance, a modified consumer-driven health plan, worked very well for me.  Preventative care was paid for without deducting from my fund, dental care up to a certain amount was covered each year, and I had ancillary vision benefits.  I also have elected to get additional vision benefits each year so I could get glasses/contacts fairly often.

However, when I moved overseas, I decided that the tailored FS plan (most of you know which one I mean) would be the better choice.  People said it worked well even in the US, and my PCP was in-network.  The price was comparable, the estimated out-of-pocket expenses would be comparable, and if anything catastrophic were to happen overseas, it seemed the easiest to deal with.  (Having had my fair share of overseas medical concerns, I wanted something easy to work with.)

This has not panned out in reality, sadly. 

The new plan only covers a few dollars for dental, so the x-rays I needed this week and the small cavity I had to have filled are all out of pocket.  They would have been covered except for a few dollars overage under my old plan.

The worst, though, is that all of a sudden my PCP is no longer in-network.  I know I checked before switching plans, but when I went in for my annual exam the other day, they didn't seem familiar with the company.  A bit of digging revealed that they are not, in fact, an in-network provider.  And I'm not willing to pay out-of-network costs.  Plus, I am not home long enough to research providers and establish myself as a new patient with someone else.  And I like my PCP.  So, I am going to see if I can do my annual in KSA just to make sure I have continuity of care. 

I am considering switching back next open season to my old plan; the $750 deductible after primary benefit funds are exhausted and before 90% coverage kicks in seems a small price to pay.  Especially because in 16 months of care I never came close to exhausting the primary coverage fund.  The only downside is that I lost the initial fund I'd built up and will have to start from scratch again.  With this current plan I have a $300 deductible that starts immediately and no primary coverage fund.  Plus prescriptions are out of pocket instead of coming from the fund. 

The kicker, though, is that my vision plan is fairly limited for in-network providers at home in NH.  It was great in DC, but there's less choice here, unless I want to go to a big box store super retailer.  Which I don't.  I thought today I'd found a great small practice in southern NH, where I am going this week for shopping anyway.  They said they took my insurance on the website.  But when I called, they said they stopped taking this plan.  The receptionist was slightly unsure because the plans she quoted weren't mine exactly, so the office manager will check Monday.  But I can't find another good place right now.  I don't really need an exam - I mostly want new glasses and prescription sunglasses.  My foray into the world of contact lenses lasted about two days last summer before it became painfully clear that I am inept at inserting said lenses.  Even when I was sitting in the optometrist's office and demonstrating the technique they couldn't figure out why they wouldn't go in.  They wouldn't go in for them, either, so I felt a bit justified.  But it's still frustrating.  I really only need glasses for distance and driving and watching movies, few of which I do in KSA, but the prescription is light enough that I can wear the glasses all day without eye strain, which I often do when I'm going in and out of meetings where I need to read presentations.  And in KSA, having prescription sunglasses would be ideal. 

Still, these headaches are minor compared to the ones I used to have with some of the more annoying companies I used to have to deal with.  I'd spend hours on the phone convincing the insurance company that, yes, I did need an MRI on my knee or that, no, the knee surgery necessitated by the tear shown by said MRI was not, in fact, elective.  I am still paying off that surgery, as it cost far more than the insurance company allowed.  Or electing not to go to the ER when I first injured my knee since I, at that time, didn't have an extra $250 to spend just to walk in the door before insurance kicked in.  My personal favorite, though, was convincing the same insurance company to pay for 6 months of malaria meds instead of 3 months, back before I lived in a place where I could get meds shipped by mail.  I itemized the cost of medevacing me when I developed cerebral malaria versus paying an extra three months of prescription costs up front.  I finally got my meds. 

Thoughts?  Have any of you had concerns Stateside with the FS plan?  Run into difficulties with serious illness with a consumer-driven health plan(CDHP)? 

No comments: