Monday, July 13, 2009

Who's Watching Over Me?

We have a new fairy godmother. It's called Anthem HMO. I'm pretty sure it stands for Horrible Monetary Option.

Or maybe it's Hyperventilating More Often.

Several months ago the company I work for sent around an email saying they were shopping for new health insurance. We were asked to fill out a survey about what we would want in a new insurance option. I was very specific - I would be happy with any option that was the same price or cheaper that had exactly the same coverage - or better.

Obviously, my opinion was not given much weight.

A while later we were told that Anthem was the leading contender and asked to please log into their website - following a specific set of instructions - and check if our current doctors were on the plan.

I was greatly relieved to find that all of our doctors were on the plan.

Then came the sales pitch - the insurance rep came in to give us an overview of our benefits. It sounded great! Everything we had before but no referrals. No more trips to our insane primary care doctor who sends us to the ER every time we need further testing.

Yep, everything sounded great. But...oh wait...some things would now cost $150 instead of $0. Oh well. All those $20 copays we'd be saving by going straight to a specialist without stopping at the PCP for a referral would even things out.

Oh, and by the way, the insurance company wants you to take the generic version of a drug if it's available.

That sounded reasonable - most doctors check that box on the prescription to allow generic if available.

Oh, and make sure if you go to Urgent Care you check if the doctor on duty is in-network or you will have to pay through the nose. Huh? Who the hell knows which doctor at an Urgent Care facility takes which insurance? Usually the Urgent Care facility is either in-network or not. (This is a huge problem for us since we avoid our doctor at all costs and try very hard to get sick after hours and on weekends.)

Better yet, just call the insurance company before doing anything to make sure it's covered.

Also, there was an HMO and PPO option. The first 95% of the presentation was about the PPO. There was one PowerPoint slide at the end that the rep rushed through, basically saying Oh, everything is exactly the same as the PPO but there is no out-of-network price. Either the doctor is in-network or you pay the whole thing.

Hmm. I was planning to choose the HMO option. It was the same price as what I was already paying and the PPO was 2x more expensive. I better check on this in-network situation.

No worries. The only difference was the out-of-network price, but all the doctors in the network were the same - supposedly 93% of all doctors in our area.

So I felt okay about the new insurance. Could be worse. I didn't stress about it.

For a few weeks we got reminders to fill out the application and I kept putting it off.

Finally, the day it was due I started filling it out. There was a space to fill in our Primary Care doctor and their PCP#. I went to the website, followed the new instructions specifically for the HMO option and discovered much to my horror, that only one doctor that anyone in the family goes to is in-network for the HMO!

I figured I must be doing something wrong and asked the HR director what it was. She emailed back that my doctors probably just weren't in the HMO - hers weren't; that's why she picked the PPO!

Oy. Apparently, when we were asked to check a few months ago, we were checking if our doctors were in the PPO plan. That's why they came up.

Crap. The expensive PPO plan was not an option for us. We could not afford that much more taken out of each paycheck.

KosherCook and I have been completely stressed out ever since, because this change has proven to be just as aggravating and problematic as it sounded. In just the two short weeks since it started, the new insurance has "caused confusion and delay" (to quote Sir Topham Hatt) getting doctor's appointments and tests scheduled.

But, the icing on the cake was on Friday afternoon when I went to pick up my asthma medications I take daily and they weren't covered. Anthem thinks I should be taking something they like better - a cheaper medication that I've already tried and doesn't work.

Maybe HMO stands for "Help - More Oxygen!"


  1. Be still my heart... your's is still beating!

    It's SO good to "see" you again!

    Every month or so I pop over to see if your blog is still up and running and if you've posted another whimsical life story! I was delighted to see you today.

    Hope to "see" you more often! Welcome back - you've been missed!

  2. Thanks for checking back! I have about 6 months of content I still really want to post - so I'm hoping to be here more often.

  3. I totally hear you about the HMO stuff- the state recently got rid of the excellent coverage from Kaiser ( highly rated in every measure that's been taken) and instead offered several options which were, well, just not as good. Oh, and we still haven't gotten our new cards, except for DH, so I hope that neither Mr. Adorable nor I get sick any time soon.

  4. Keep write on!! Y'all hear??



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