darkoshi | Entries tagged with health insurance

This is the end of 2 nice relaxing (sort of) weeks of vacation. At least I was able to sleep as long as I wanted nearly every morning, in spite of going to bed very late. I got various things done. Some things finished, some things further along.

I didn't manage to make an orthodontic appointment yet; still need to get together a list of potential ones to call. It's too bad that this tooth problem manifested a few weeks after our yearly benefits enrollment period at work. Not knowing that I'd need it, I chose a dental plan without adult orthodontic coverage. But it's not a big deal. Even the plans that cover it, only cover a certain amount anyway. But now, not having one of those plans makes choosing an orthodontist more complicated. Should I sign up for a discount program, and see who in my area is in such a program? Or should I use one of the orthodontists in my dental insurance's network (though I don't see what the point of that is, as I'm not covered)? Or try to find overlap between the two? And so on.

I had been feeling optimistic about getting braces, but reading several pages which indicated that dentists now recommend that retainers be worn ***for the rest of your life*** to prevent teeth from shifting back got me feeling down about it. Which is why I let the matter drop for now. I went through all that trouble last year or the year before, getting myself a doctor, and it didn't even really do any good with the problem I have with my hands. Well... It did relieve my worries about having degenerative arthritis. So it did do some good, even though I still have no explanation for what is wrong. But my hands got significantly better on their own.

At the moment, I don't think it's possible that my teeth will get better on their own, but who knows? I discovered something today, about eating when one's upper and lower molars don't touch. Eating individual pieces of raw spinach (or other raw greens) is not a good idea, as it's nearly impossible to chew them up, and without chewing them, they tend to stick in one's throat. But when they are in a sandwich, I can chew them up ok, because there's an extra layer of bread and stuff filling up the space between the lower and upper teeth.

Anyway, I got home too late tonight (considering I need to be up early for work), after spending most of my vacation at Qiao's place. I went to turn on the heat, and discovered that the thermostat's batteries needed to be changed, and of course the old settings were lost, so I had to reset them. One setting always gives me trouble (getting it into "Hold" mode instead of "Vacation" mode). I had thought I might be able to make it to bed by 1am. But now, I hadn't even unpacked my car, I just wanted to turn on the heat, and this garbedly gook dangnabit thing won't work!!! I lost my temper and yelled obscenities.

Not a good way to end a nice relaxing (sort of) vacation. But it's ok; I'm calm again now. I checked the notes on my computer from last time, which thankfully say how to put it into Hold mode, and got it working. I still have my pretty Christmas tree here, and I haven't turned off the pretty lights on the porch yet either. Though I'll probably take them (not the tree) down later this week.

Ok. There's a good chance I can make it to bed by 2:15am now, if I apply myself to it.

HHS Issues Regulations Banning Trans Health Care Discrimination

Federal Register page with link to PDF (scheduled to be published on 05/18)

It even mentions protections for non-binary identified people.

... OCR recognizes that sex stereotypes can include the expectation that individuals consistently identify with only one of two genders (male or female), and that they act in conformity with the gender-related expressions stereotypically associated with that gender. Sex stereotypes can also include a belief that gender can only be binary and thus that individuals cannot have a gender identity other than male or female. OCR recognizes that an individual’s gender identity involves the interrelationship between an individual’s biology, gender, internal sense of self and gender expression related to that perception; thus, the gender identity spectrum includes an array of possible gender identities beyond male and female.

Crossposts: http://darkoshi.livejournal.com/652494.html

Obamacare: what it is, what it's not

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This year, my company outsourced the benefits enrollment process to a third-party vendor. Through this other vendor, the health plan options are divided into bronze, silver, gold, and platinum levels (similar to what is shown on panel 9 at the above link - I didn't realize this was similar to the exchanges).

Each metallic level has a few options to choose from - 3 or 4 insurers, each with different premiums. From what I could tell, though, the deductibles and coverage amounts within each level are basically the same, regardless which insurer you choose. The premiums vary a lot though.

An interesting thing I found out is that my company (now as well as in past years) self-insures its medical benefits. This means that it pays all claims itself, even though administration of the claims is handled via insurance companies.

So... my company pays the actual medical claims/costs. The insurance companies are being paid only to administer the plans. This seems to indicate to me, that the different premiums charged for each insurer's plan must reflect a difference in administrative costs (and/or profit margins).

Crossposts: http://darkoshi.livejournal.com/583549.html

This is somewhat related to the last post.

I thought I had previously posted about the new high-deductible (HD) health care plan I switched to last year, but I had actually only written a comment on someone else's post. So I'm posting it to my journal now.

The HD plan includes a Health Savings Account (HSA) as mentioned in the prior post. The low-deductible (LD) plan instead includes a Healthcare Flexible Spending Account (FSA). HSAs should not be confused with FSAs, as they are different in several regards. HSA's are much better - unused funds roll over each year, earn tax-free interest, and can be used tax-free for qualified medical expenses in retirement. FSAs do not allow unused funds to roll over each year.

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I was surprised last year when I calculated the costs of going with the new HD plan versus the LD plan of my employer's health insurance.

Both plans have a deductible and a yearly out-of-pocket maximum amount, as well as biweekly premiums you have to pay. The amounts differ per plan. The benefits are pretty much the same.

I thought that the HD plan would make more sense for someone who had fewer medical bills, and that the LD plan would make sense for someone who had higher bills. However, that wasn't exactly true.

Supposing I didn't have any health care costs during the whole year, the HD plan would cost me less, as its premiums are much smaller. The HD plan would cost me only $260 while the LD plan would cost $2184.

Supposing I had just enough costs to meet the high deductible ($2500)... then I'd end up paying about $200 more for that year compared to the low deductible ($400) plan. The LD plan's biweekly premiums are so much higher ($84 versus $10), that by the end of the year, you pay nearly as much in premiums as the higher deductible amount would have been.

Supposing I had high enough bills to reach the yearly out of pocket maximum, the total amount I'd have to pay on the HD plan would actually be $500 less than the total amount that I'd pay to reach it on the LD plan.

Based on all that, it seemed that whether or not I were to have a lot of medical bills, the HD plan was likely to cost me less.

The LD plan seems like it would only possibly be the better option for people who don't have enough savings at the beginning of the year to cover the higher deductible.

Not all HD and LD plans are the same. The deductibles, premiums, and benefits can be very different than my own situation. Anyone who is considering them needs to do their own comparisons. One shouldn't assume however, that one is better than the other without researching them first.

Another good thing with last year's changes to my company's health care plans was that the contributions were made variable based on salary bands. Employees with higher salaries pay higher premiums now than employees with lower salaries.

Crossposts: http://darkoshi.livejournal.com/536555.html

American healthcare was already socialized by Reagan, we’re just fighting about how to pay for it - somewhat misleading title, but interesting. Till now, I wasn't sure what the laws were regarding whether hospitals can refuse to provide treatment or not.

The Law That Changed Everything—and It Isn't the One You Think - more info on EMTALA

Wikipedia entry on EMTALA

Crossposts: http://darkoshi.livejournal.com/534129.html

I've been sick since last Wednesday with what appears to be the flu. On and off fever/headache, chills, sore throat, aches, runny/stuffy nose, occasional sneezing and coughing. Last night my left eye started getting inflamed, and today it's been quite red. So tomorrow I'm going to go to an urgent care center to see if they'll prescribe me something for the eye.

I suppose the main question now is, do I drive way across town to the urgent care center which my health insurance covers, or do I go to a closer one which would presumably get the lesser "out-of-plan" benefits. Or do I spend time trying to search the health insurance website to see if they've added coverage for any other centers since I last checked.

Oh jeez... This page says:
"Conjunctivitis caused by adenoviruses or enteroviruses is self-limiting and requires no therapy other than careful hand washing to minimize spread to others.
... Bacterial conjunctivitis is typically treated with one of a variety of prescription ocular antibiotics. The AAO guidelines state that this infection, too, may be self-limiting and not require antibiotics, though they caution that this practice is only approved for adults."

Maybe I should wait to see if it goes away on its own. I'd hate to go to some center just to have them tell me to let it heal on its own, or to get medication that I don't really need.

Now the question is, do I even go.

I tend to be concerned with my eyes, because during high school, I had some kind of chronic eye infection. I didn't realize that's why my eyes always watered and felt sensitive to wind; I took it as a normal state of being. When someone finally pointed out that it wasn't normal, and I got treated, they felt much better.

"awakening with one or both eyes glued shut was the single strongest predictor of a bacterial infection, with an odds ratio of 2.96 (one eye) to 14.99 (both eyes). "

So far it's only one eye. It wasn't glued shut, but there was crud on it. And it's felt sticky all day on the inside corner.

"Classic "pink eye," or, more appropriately, acute follicular conjunctivitis caused by adenovirus, is distinguished by bilateral watery discharge and erythema, often in the presence of a viral upper respiratory infection;"

I haven't had much watery discharge. It feels dry and sticky.

I suppose I should go, to get a doctor's opinion if nothing else.

Update: Oh yay, the Doctor's Express on Forest Drive is now covered too!
There are also covered "walk-in clinics" in the CVS pharmacies... I wonder if it is better to go to one of those versus the Doctor's Express.

Crossposts: http://darkoshi.livejournal.com/458243.html

I'm going to ask my psych to write me a prescription for budeprion (the generic form of Wellbutrin). I'm interested in how that one will affect me, compared to the Pristiq and Lexapro. Also, based on my pharmacy plan, budeprion is a "step therapy" prerequisite for Pristiq. So even if I go back to Pristiq after trying the budeprion, I'll then have a lower copay for it than if I didn't try the prerequisite.

As for the Pristiq, I'm not sure what my opinion of it is. I've noticed 2 side-effects that concern me. One is that I feel my vision is a bit worse. I especially notice that at work. Glaucoma is one of the things to watch out for when taking Pristiq, and my family has a history of glaucoma. So having my vision be worse worries me.

The other side-effect is that it seems to interact badly with antihistamines; it makes me much more drowsy than when I take the antihistamine on its own. This happens even with loratadine syrup, which is supposed to be a non-drowsy antihistamine. When I took a dose of loratadine syrup last week, against one of the unexplained itchy swellings, I ended up feeling drowsy for 2 whole days.

I've had a few other side-effects, but they were temporary and not of much concern.

I definitely feel better on the Pristiq than I did on the Lexapro. But I'm not sure if I feel better than I did before taking either of them. I feel sort of hyper... like wanting to get a lot of things done. I'm finding it hard to just relax and not do anything. But that may have been the case before getting on the anti-depressants too. I'm not sure. My mood seems somewhat better. But maybe it is a coincidence; I'm not sure. I feel like I've been too busy to brood or be sad; not that I wouldn't still be sad if I took the time to just think about things. Maybe I want the Pristiq to be helping me. Maybe the thinking that I may be feeling better is the placebo effect.

Oh, and I did have one "good" dream recently, while on the Pristiq. One of those very rare ones, even though after waking up and thinking about the dream, it didn't seem as special as it did while dreaming it. But still, even having a dream like that is noteworthy.

I had to pay $50 for a 30-day supply of 10mg Lexapro tablets. The price without insurance would have been $105. The insurance-agreed (Aetna) pricing is $87.02.

Apparently Lexapro is a "Non-preferred brand copay" type medication (where I pay 20% of the cost of the drug with a $50 minimum).
If it were "Preferred brand copay", it would be 20% of the cost of the drug with a $30 minimum.
If it were "Preferred generic copay", it would be 20% of the cost of the drug with a $10 minimum.

Apparently Lexapro is non-preferred, because it is considered "step therapy", and I would have to try "one or more 'pre-requisite'** medications before the step-therapy medication will be covered".

So if the doctor had prescribed one of the others first, and then Lexapro, it would have been cheaper. If the doctor had prescribed one of the others first, it probably would have been a generic one which would have been even cheaper. And it might have even been one of the ones you could get at Walmart for $4.

I wonder if the drug companies and the doctors have some kind of deal, where the doctor gets a kick-back for prescribing drugs which don't have generic equivalents.

** The pre-requisites are listed as:
Any one of: budeprion sr QL , budeprion xl QL , bupropion hcl QL , bupropion hcl sr QL , citalopram hydrobromide QL , fluoxetine hcl QL , fluvoxamine maleate QL , mirtazapine QL , mirtazapine odt QL , paroxetine hcl QL , sertraline hcl QL , venlafaxine hcl QL

Great. I called Aetna, and the customer representative confirmed that there's only 3 psychiatrists in my city (not even technically *my* city, but the locale across the river) who are covered by my insurance, and all 3 are at the same address.

Whereas in Augusta, I found 23. In Charlotte, about 30. In Charleston, 6.

I feel a ridiculous urge to kill myself just to spite them.

Eh. I guess at least it makes choosing a psych simpler than if there were any choices. The thing is, I still don't believe it's true that only those 3 people are covered by Aetna.

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And I can't understand why they don't sell any better disposable menstrual pads than they do. I've bought 3 different kinds, and 2 of them are those frickin plastic-covered things that stick to the skin on my butt and smell nauseating. Stupidly designed "wings" which are so narrow that they don't stay stuck to the underwear, and are more likely to come loose and attach to my skin. I may end up having to take my cloth pads on my trip after all, even though washing them will be a pain.

I did a search in Aetna's DocFind tool again, this time searching by distance from zip-code, and I found 3 psychiatrists, all at the same address. That's better than before (when I got *no* results), but it still is hard to believe that there would only be 3 psychiatrists in my urban area covered by Aetna. So I emailed Aetna about it.

I was thinking about meditation today. Maybe meditation feels good to people who are not depressed, but doesn't feel good to people are depressed or dysthymic. Maybe the default brain state for mentally healthy people when they let go of all thoughts, is a good feeling. But for people like me, the default brain state is neither good nor bad. It's just empty. So letting go of all thoughts just results in me feeling nothing. It can be relaxing, but it doesn't make me feel good.

Then again, there are many webpages that say meditation can be good against depression. Maybe if I envisioned feeling good while meditating, it would work better. Maybe it's just pessimism which makes it seem like a non-productive activity.

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Who's my god?
Am I special enough for a god?
Everyone has potential.
What does a god get out of those who belong to it?
Pieces to play in a game?
What game is this?
What is fun about *this* game?
What is fun about *that* game, for that matter?

Gods are created
in order to have something to believe in.
There isn't anything I feel drawn to believing in anymore.
What was different, before?
What was it about light-sabers and Darth Vader?
What was it about ESP and magic?
What was different?
I was younger, less jaded, less experienced.
Is that all it was?

tickety tock
tickety tock
the mouse ran up the clock

With my insurance plan, the copay for office visits is $30. The chiropractor's office I've gone to the last few years always charges me $30, because that is my co-pay. (I pay right away, before leaving). The amount they charge for the services is over $30. However, the allowable/negotiated amounts for the services I've received has always been closer to $20, as shown on my insurance's Explanation of Benefits forms.

Last year, I brought the EOB form with me and pointed out that I had overpaid the previous times, and that I therefore should have credit on my account. Due to this, they didn't charge me for that visit. But for the 2 visits earlier this year, they again charged me $30 each time. I'm sure if I pointed it out again, they'd give me a refund, but they don't do so automatically. I wonder if they are doing this knowingly with all their patients, and whether it could be considered fraud.

Is it normal for a doctor's office to charge you your co-pay amount, and to not automatically send you a refund if the allowed charge ends up being less than the co-pay?

eh. words not forming well. thoughts not. not for replies. but for my own incogniz... inconceiv... inconstrue... contemplative non-sensical... yeah whatever, post, yeah. makeup is a pain. putting nail polish on is a pain. waiting for it to dry... lipstick gets ingested, doesn't it? you eat something, and it ends up swallowed. got some blue stick for tomorrow i guess. seems an odd idea to wear it. wanted black really. but you put it on, and it will end up some where else. in the food. or smudged off. and the polish will scrape off. a pain, not being able to use one's nails like normal. blech. and all this stuff for no good reason. novelty novelty difference whatever. poor little doggy. poor little me. this is what i do when i should get ready for bed. scope creep! scope creep! yee-haw, not mission creep, no.

i don't have a face yet. and i need two. for the jackolantern and the waterlantern. tiny jack. oh dearie. hmmm. shoo-bop, dippity do-bop. hmmmmtired. this is what i do. because. the fumes. my eyes. i can't cope. scope creep! my eyes can't cope. my poor little eyes and me and the world. the cost of health coverage has risen 15% each year for the last 4 years. ain't that a thought. 60 percent in 4 years. blech. friggin doctors. and insurance companies. i write programs for ins. co.'s. yep. i make lotsa money. yep. but my eyes can't take it. i'll end up with glasses. or whatever. maybe. whatever.

this is what i do. when it is easier not to get up. it's not warm.the lights are pretty. i have a hollow watermelon and a hollow little pumpkin. waiting for their faces. any i don't have any. yet. maybe i'll find some from last year's over...ideas.

i had a dream... i'm sure. yo yo. i had a yo-yo. i still do. green butterfly. and my glow-in-the-dark frisbee.
MOONLIGHTER 110 G. MODEL FRISBEE BRAND FLYING DISK.
1975 Wham-O Mfg. Co. San Gabriel, Calif. U.S.Pat.No.3359678.
yeah. who else got one of them? "For night time play"!

mhmmm. thank you for your attention. good night.