Hands Off My PPO
Wednesday, October 26, 2011 at 7:56AM Living with type 1 diabetes can be expensive. With all of the prescriptions, supplies, and doctors appointments even having health insurance still means a lot out of pocket.
I am thankful that I have health insurance though my employer. They pay for my coverage but not my family’s. My wife and I decided to use her insurance from her work for the family and I would use mine for myself only. At her job they pay for the whole family’s premiums as long as you use the HMO. That seems to work for my wife and kids but I really do not like the hassle HMO’s tend to cause.
Now you should know that all of my life I have used an HMO. It has only been through 2011 that I switched to a PPO. I cannot go back. The ease of being able to see specialists and doctors that I want to see has made all the difference in the world for me. Granted, my company pays for a basic PPO plan and I pay about $500 a month to up that plan to the PPO I have now. Believe it or not, when I had my family on my insurance, before my wife’s job came along, I paid over $800 out of pocket! And that was the HMO plan!
It made sense for us to take the family off of mine, slide them over to hers, and bump my coverage. And like I said, it works.
Now get this.
Yesterday I hear that come December 1st our insurance is going to change because it is too expensive. My company is making a lot of changes lately and this is one of them. Great.
For someone who has finally found a doctor that he loves and a plan that works those are disturbing words to hear. I could feel my heart rate go up and have not been able to stop thinking about it since.
So much of my care and health depends on that coverage. Having a doctor I connect with makes me want to make the changes he suggests. It makes not want to miss an appointment and take better care of myself. The ease of seeing specialists allows me the freedom to get the checked out the moment they become a concern. To go back to jumping around from doctor to doctor and trying to find one that gets it, treats me well, and who will fight for me is a search I am not willing to take on.
If it changes to the point where I cannot afford the out of pocket stuff than I am not sure what I am going to do. Or what I can do. I am sort of at their mercy.
This past year has opened my eyes to how different things can be. I was always so worried about the out of pocket expenses with a PPO but this plan works since I put so much out up front that I am able to pay less for appointments and services. It may not be for everyone but it is the right plan for me. It just works.
Last night I tossed and turned having nightmares of denied prescriptions and delayed referrals. I refuse to go through that crap again.
I just need to figure out what I am going to do if something drastic changes.
It’s sucks that this is such a big deal but if I want to live healthy, it has to be.
Reader Comments (8)
I have had both HMOs and PPOs; I am fine with HMOs provided I am able to find a doctor in the plan I actually like. However, after leaving California, I have had PPOs exclusively and my company has switched carriers a few times over the past 6 years because of costs. When they switched the last time, I got kind of fed up with what seemed like annual changes in plans, formularies and participating doctors, so selected a PPO with out-of-network coverage which worked reasonably well. However, I got notice about 2 weeks ago that the insurance company decided to discontinue the plan, meaning that my employer will need to remarket their business and solicit bids from a number of other insurance companies. Damn, I'm getting sick of the for-profit insurance companies -- anyone who says this is a good model has obviously never lived with a chronic disease. I will find out in November what my options are, but will have a short time to choose from these plans! At least I don't have a family to factor into my decision, but still, this healthcare "system" (if that term can really be applied) sucks. I'm tempted to look for work in Montreal!!
oh george, i know that sick-to-your-stomach feeling caused by insurance worries! i will pray that you can keep your ppo, and i hope all the stress turns out to be for not.
i am so thankful to josh's employer, because the insurace is fantastic. but i've done time in that limbo you find yourself in. praying!
That must be so frustrating, I can't imagine.
Going through my own insurance decisions/woes and contemplating the move away from awesome health care professionals in the next couple of years has definitely kept me up at night.
I hate that day every year where we find out how much worse/expensive it will be for me to continue with my PPO. There with you brother!
Oh no...sorry to hear about your insurance worries! I've had my fair share of coverage panic recently and know it's no fun. I'll be thinking of you and hoping you get to keep you PPO and your awesome new doc.
Ask if your employer is considering a high deductible plan - sometimes then you can keep the PPO choices for doctors, but are paying more out of pocket up front, but in the end, it has worked out better for us than the HMO costs would be. We have a PPO with a $4000 deductible (for our family, I think the individual is $1500). I know I have to budget for the first $4k of expenses each year. It is a lot, but after we meet that we have 100% coverage on most things - including prescriptions. As you know a T1D racks up the costs fast, so we have met our deductible at some point over the summer the last 3 years. Additionally, you can set aside the $4k pre-tax into the HSA account - we are also fortunate because my husband's employer kicks in $2k of it - since the premium is so much lower.
Keeping you and all T1D's in my prayers to just have good health care coverage!
Sorry to hear about the insurance changes, George. I know those are frustrating and the uncertainty is mind-boggling. I've had both, and it seems that we've had insurance changes every year. Before I switched to Suzi's PPO plan a few years ago, they had eliminated the PPO option here at work but I was grandfathered in and able to remain. But now that's not an option here, and the same discussion is happening at her small business - they really want us to do high-deductible but it's not worth it. I'm hoping we can stay with what we have once the changes materialize, but we'll see. It's a stressful time, and it's a shame more companies and even insurers dont' give us more flexibility in transitioning. One of the many downfalls of our current "job-based" insurance system, at least for those of us who aren't rich enough to pay for whatever we might really need.
I hate that we are always at the mercy of our employers for this kind of stuff, and it doesn't seem like there is any incentive for them to stick with stuff that helps those of us living with chronic things like diabetes.