New Health Plan coming to work !!update 1/06/07

[J.R.E.]

Well,

I knew this day would finally come.  We have had our employee group Cigna plan in place now ( where I work) for over 5 years.

When I first started working, we had Florida Blue cross-Blue shield. At that time I was paying about 9.00 a pay period. That was changed to Humana, from Humana to our current health plan of Cigna. I have a Cigna HMO, with open access. This over a stretch of ten years.

This time of the year, always gives me a little bit of tension, as rumors start, about plans possibly changing. This year they are actually changing health plans.

Open enrollment, will begin the first week after Thanksgiving, with the plan going into effect January 1, 07 . I have no knowledge yet of who the new provider will be. I try not to rush into thought on this, but obviously it still bothers me a little bit. One employee came into work this morning, and asked me if I had stocked up on the KY- gel, because, this wonderful co-pay, will most likely, not be the same in the new plan. 


I made an appointment with the dermatologist this morning, to get in there one more time before the year end. Need a couple more things done. So, I have that set up for December 7th. I am also calling my HIV doctor tommorrow. My next scheduled appointment with him, was January 11,th 07. I am going to see if I can't get a December appointment set up with him also, for blood tests.

Don't know what this new plan will bring, I am not going to get all freaked out about it, isn't worth the stress. I will still have insurance, it will be the new cost,and what is covered/how much is covered,, that is yet to be seen.


Currently at work, we pay $38.00 per period ( every two weeks) Co-pay's for meds are 7.00, 25.00, and 50.00. PCP visit is $25.00. Specialist 45.00, Hospital ER $100.00, Urgent care $ 50.00. I pay $25.00 each for the three meds I on on. I have been real happy with Cigna, others at work have been complaining, how expensive certain things are. One person went in for an MRI, had to pay $1000.00 out of pocket. When I went in for my MRI in 2004, it was a 250.00 out of pocket co-pay. So, things have certainly changed, with this plan, over the years. So , wish me luck, Lets see in two weeks what the new deal will be! I will let you all know, as I find out more.



Ray

[Blixer]

Ray,
Changing health insurance carriers can be a bit on the intimidating and frightening side.  It always seems like you end up losing something in the process.  But at least being in a group gives you some protection.  Hopefully the new plan will be better than you are anticipating.  Best of luck with the change.

[SoSadTooBad]

Ray - just went through the same thing.  My PCP no longer takes the Aetna plan that I am in.  But the plans he stayed with only cover lab work at 80 percent.  And you know how much lab work we end up having. 

My HIV doc does not take insurance, so that is a heavy hit under any plan... 

I pay about $50.00 a pay period, so $100 a month for the coverage.   The PCP visits are $10.00, Specialists are $25.00, prescriptions are $15, $25, and $40. 

Mail order prescriptions are $50 for a 3 month supply - so I end up doing pretty well.  My HIV doc visits are $200 each, and insurance will cover about $30.00 of it if I susmit the claim after the fact. 

I work for a very large company, and I am very thankful for that.   

Right now, about $400 a year out of pocket for the drugs to keep me around to become a dirty old man. 

[Eldon]

Hey Ray,

Certainly with this external change occurring it tends to get you a little jittery due to the unknown factor. In fact, most of us get that way when we are faced with an "unknown". However, whichever the change may be, prepare yourself as you already have done so in the BEST way that you can.

With this change, it is one of the things that you cannot control and you are doing right not to let it raise your stress level. Think "positive". This could be a change for the better. Please do keep us posted.

Make the BEST of each Day!

[J.R.E.]

I found out tonight, that we will be going through Aetna group insurance. Just what plan the company set-up with Aetna is unknown at this point. Will find out more in a couple weeks. I never had to pay any out of pocket for bloodwork with Cigna. I must have bankrupt them over the past three years on meds !! A day at a time....



Thanks Everyone------Ray

[bocker3]

Hi Ray,

Hang in there -- the worst part of dealing with the unknown, is not knowing   .

I know every company negotiates different terms with them, but I have an Aetna Open Access plan and am pretty happy with them.  $15 PCP visits and $30 Specialist visits -- NO REFERRALS.  Mail order drugs are either $10, $40, or $80 for 90 days.  I do have an annual $100 deductible, which usually go to my lab work.  So, my out of pocket ain't so bad.  When reviewing my 2006 claims today -- I've cost them just under $38,000.  I guess I'm quickly making up for all those years of under-utilizing my insurance.

Bottomline -- stay hopeful -- maybe the change will be a GOOD thing.   

Hugs,
Mike

[randym431]

Hi Ray
You're not alone here. As the new year comes near, I have not heard yet if my company will be changing or not. Back a few years ago they were with a provider that paid everything, nearly. It was great!!! Then the last few years they went with a provider that hit you with all these co pays for labs and everything. VL load = $15 co pay, cd4 count = $15 co pay, and now I get the cholesterol thing done and that’s another $15. But they covered meds really well. I paid a $20 co pay each a month for the two I am on. And more important my partners leukemia meds costs him just $20 co pay for a drug that costs $3500 a month with no insurance.
But I too am nervous if my company will stick with the current or jump to another.
I do expect something to change. Even if they keep the current plan I still see higher yearly deductibles and for sure a higher monthly pay check deduction for the current plan cost. Its too bad companies go thru this every year, that is the shopping for plans game.
Its about now that we will find out. I haven’t heard anything yet where I work. Don’t know if thats good news or bad?
pS. My partner did just say (we work for the same company and have the same plan) he did just say the insurance co approved him for another year of his $3500 leukemia med (they approve on a year by year basis), so maybe thats good and means our company is staying with the same provider? (just a hope/guess)
If they wont cover the meds we need, guess it will be robbing banks and stealing little old ladies hand bags for us.   

[aztecan]

Hey Ray,
I feel for you. I hate changing plans. My former employer switched plans five times in five years.
I was forced to switch docs, pharmacies, then forced to use mail-order.

Now, my current employer has been pretty stable as far as insurance goes - so far. I have stopped using the mail order plan available to me. It is Pharmacare. It sucks.

I pay a $68 a month insurance premium and co-pays of $110 for my meds. Two meds I take are no longer covered because there is an over-the-counter version, which actually costs more than my copay would.

All told, I pay a total of $233 a month for my health care if I don't see the doc. If I do, add another $25 to that.

I can't complain. Many people do without. So, I guess I am in pretty good shape. But it does take a bite out of my budget.

HUGS,

Mark

[megasept]

This "changing of plans"  by employers is all about saving money and controlling costly premiums, not improving healthcare for employees and families. Looking at their costs, can we blame them? The biggest threat to the American economy will most likely not come from the balance of trade with China, but with the declining cost/benefit of our healthcare "system." Isn't it time we really question why we can't and shouldn't have universal coverage and a system to control unjustifiable cost increases? Universal coverage could be on a single-payer single-standard (not one for the wealthier or working, one for the poor or indigent) model. We keep our providers, eliminate the insurers all together (28 cents of the healthcare "dollar"), make the government the payer, and thereby extend the same quality coverage to uninsured Americans. And let's not forget the "under-insured" folks, many working at lower wage jobs, with nearly useless coverage, who would benefit greatly from a high single-standard of care.

There is this conflict between the "here and now", which is doing the best practical thing for ourselves right now to get and keep access to medical and dental care. We do a good job on this site comparing notes, sharing problems, while we struggle with HIV (or more). Our advice here is practical, and above all, we show empathy. While we continue that tradition, we need not be blinded to the glaring structural stupidity of the American "model" through which we obtain our healthcare. I think we should be thinking about, talking about, and working towards a new system. As "sick people" we have every right to lead and be active in this debate, which is already stacked against us because we are viewed as "customers" or "consumers", not patients. We will see national and state-based "bipartisan" reform proposals over the next two years, just flitting about the edges of a massive set of problems. We band to together to fight to stay healthy, so why not be part of the solution to this tired old "crises"? Why accept the unacceptable?

My (new) COBRA for medical and dental costs $601 a month---just for me.   16 years ago I paid $115 a month for roughly the equivalent under COBRA. Inflation alone can hardly justify a 422% increase, can it? Not surprisingly I am looking for a new employer to pick up the tab. Ability to pay for my healthcare, or at least maintain some road of access to healthcare, is my primary worry about old age and sickness (well, past the sickness itself). Anyone?  -megasept PS South Africa's Treatment Action Campaign (TAC) offers a powerful model of HIV patient advocacy under circumstances much different than our own.

[poet]

Enough of Pharmacare bashing, Mark.   That poor, CVS owned, New England company.  I ended up with C.V.S./Pharmacare when they bought Stadlander's which was downstairs in my Chelsea building.  Convenient, but for some reason, problems from time to time getting my package from their warehouse to their store.  I stayed with them, however, in MA, the store being in Boston and am very pleased.  I never have to call in or watch out for refills: they do it.  The shipments are automatic so I don't have to remember to remember.  Admittedly not perfect.  This month, due to computer errors, they didn't ship out my Nov. supply but I sit with two months waiting, so it wasn't a big deal.  My point for posting this at all is to balance the picture just in case someone reading our posts is considering or being directed toward using Pharmacare.  Best, Win (And hugs to Mark.)

[J.R.E.]

Hello Mike,

Thanks for the info on Aetna. I appreciate it !! We will see, what kind of plan our company puts together with Aetna.


I called My HIV doctor today, And spoke to the woman there, that handles all the insurance issues. She said"no Problem"  They take Aetna HMO and PPO. I asked if she felt it necessary to see the doctor in December ( before Cigna Expires ) She replied there was no need. The January appointment date stands, that it will be a smooth transition.

She also gave me the associated numbers ( provider number and HMO number) that I can write down on the open enrollment form in two weeks. So things are looking up right now !!



Thanks again everyone-----Ray

[Eldon]

Hey Ray,

It is good to hear that things are looking up!



Make the BEST of each Day!

[northernguy]

It's interesting to heard about the experiences down in the USA.  Up here there is no co-pay for lab tests or doctor visits, as its covered by the gov't. Prescription drug coverage is more similar as its covered by your company's health plan, or by the gov't (with deductibles) depending on income. Not necessarily a better system (I've a 5 month wait to see a GI dr.) just different.

[randym431]

What timing. Just got my companies new 2007 med info booklet in the mail, after reading Ray's post.
For me, things are staying the same for 2007. But they added a little statement notice in the material. It said people that qualify for medicare might want to go on medicare and drop the company plan. Just thought that was strange.

[J.R.E.]

What timing. Just got my companies new 2007 med info booklet in the mail, after reading Ray's post.
For me, things are staying the same for 2007.

Hi Randy,

 I Am glad to hear that things are remaining the same, at your job  !!  It certainly takes the pressure off for another year doesn't it ? I will give more details in a couple weeks. I have a 7:30 Am enrollment time scheduled, along with a one on one,, on November 29th. If the one on one goes to 8:00, I will be able to swallow my Am dose in front of the insurance rep !!!



Take Care----Ray




Take care--

[Life]

Ray....

You think about the bazilion dollars you have paid into health care all your life until something pops up.  Then we worry about cashing in???  Thats so twisted...

Glad you have gotten most of your answers on this one..

Love

[aztecan]

Wow, Win, I didn't know Pharmacare bought out Stadtlander's. I used Stadtlander's many years ago, in the mid-90s. They were pretty good.

Mail order in an of itself is OK. I guess things are different for you because you have a store to rely upon. I used to, but that is quickly disappearing thanks to goofs from a certain mail order pharmacy that shan't be named. 

HUGS,

Mark

[J.R.E.]

Hello all,

Just an update. Its been an interesting last few days. Woke up Tuesday night, and my right eye was sore and very red.( the eyeball itself) So, to play it on the safe side, I decided to go back on the Dapsone for a bit. So I took a dose on Wednesday, and will take another one today. The dose I took on Wednesday must be doing something because it is not as red or sore as it was on wednesday. I will watch it, and if neccessary go to an eye doctor if things don't improve, but so far, looking much better. I don't believe it is related to sinuses. I have had this problem before, always in the right eye.
I have also had some weakness in the legs, and my hands are really bothering me, stiff and sore.



On the insurance issue at work:

We had our presentation given to us Wednesday morning. The new Aetna plan, looks very simular to my current Cigna plan, which will expire December 31st. I will miss Cigna. They have treated me pretty well over the past three years. This morning at 7:00 am, We had the one-on one signup at work for the late night shift workers. They had four lap top terminal taking care of everyone, Took less then 15 minutes to get everthing finalized and electronically signed.

There is a very slight increase in Aetna. The plan will cost $41.00, every pay period. I also opted for addional coverage, through Jefferson pilot financial.

My dental benifit costs, actually went down from $8.00 a pay period, to $2.00 a pay period. ( four dollars a month)., with a $50.00 calendar year deductable. I had a $ 100.00 dedutable on the old plan. And it will save me money, as compared to my old plan through United concordia. I am pleased with that. I am pleased with the coverage.

On the medical,... co-pays have gone up for primary care and specialist care. But still very much affordable. A slight increase on prescription drugs $10.00,$25.00 and $50.00


I also purchased in addition to medical and dental,

Accident insurance @8.00 per pay period.

Cancer insurance @10.00 a pay period (I read the fine print on this)

And Hospital confinement indemnity insurance @ $16.85 a pay period.


Also got additional life insurance. $20,000 is paid for where, I work at, I supplemented that with an additional $20,000 that cost $7.82 a pay period.   Never know....

So, all together this packace will cost me $85.67 a pay period or, $171.34 a month. Hopefully, My health will maintain,nothing castostrophic will happen and I will make it through 2007.... It is sometimes a struggle for me to work, but I am not about to give in yet. I am still able to perform my job efficiently and effectively. Knock on wood !! But it does get tougher by the day.

As I mentioned earlier, My HIV doctor is on this plan so there is no change. My dermatologist, and dentist is also on the plan, so no need to change doctors/dentist !!!


The down side.... Next year the company will be switching to in-house insurance, and I have no idea what that is about. But I am not going to worry about it right now.



Ray

[J.R.E.]

Just an update...

Started using the new healthcare plan from Aetna, which is provided through our group plan at work.

Renewed and filled My viramune, Epzicom and Viread yesterday at Walgreens. $30.00 per month/per med, for the Viread and Viramune, and $50.00/ a month for the Epzicom.


I was paying 75.00 per month for the HIV meds. It has now gone up to $110.00/ per month.

Doctors visit 30.00 ..., specialist 50.00( was 25.00 and 40.00) I am of course very thankful that I am still capable of working full time, and that I have this health care insurance. As I understand it, we are going to self insure next year, and the plan calls for paying for a percentage of the med cost. This is when it will certainly go up. But thats a while from now....


Ray

[bocker3]

Hi Ray,

Glad the switch hasn't been too bad.  I know any increase is a bummer, but you were concerned that it might be a lot worse.
Hopefully, next year when they self-insure, they'll have a mail order pharmacy option.  Right now if I get my meds on a monthly basis, I pay a percentage (with a per script cap), but it's still a flat rate on the mail.  If I remember correctly, you aren't a fan of mail order pharmacy -- but the difference for me is $160 every 3 months by mail, vs.  $525 every 3 months at a retail pharmacy.

At any rate -- thanks for the update -- I had been wondering how things were going.

Mike

[Boo Radley]

Ray,

Aetna was one of the health plans my former employer dropped because it was more expensive than the new provider.  However, the basic parts of each plan were always the same (we went through 3 HMO/PPOs while I was there).  There was a $10 copay for PCP visits and $5, $10, and $25 copay for prescriptions.  Labs and diagnostic tests were always free.  Emergency room visits were $50 unless you were admitted (then there was no copay).

As of 1/1/2006 my Medicare part D provider plan isn't much different from my employer's plan. This year I can afford my HIV meds (Trizivir) because the copay is only $25 and there is no annual cap on what the company pays (before the cap was $3000 so that came into play in March every year). 

By now you should have received a formulary and description of benefits, I woulda thought.  When employed and since disability mine have always come in December. 

Good luck!

Boo

[randym431]

Hi again
Well I was a little wrong. "Most" things stayed the same for 2007, but one of my meds epzicom went from $20 copay to $45. I wasnt too happy to see that, but at least its still a covered drug (so far). I will probably go to the mail order option now. Getting a three month supply at a time for less of a copay (over all). That will bring the yearly cost back in line.
But as I always thought, even before I had this illness that needs monthly maint, job based med coverage is for the birds. Thats the way it is in the US, and it really needs to change. Going year by year, and not knowing whats in store for the future is fine if your young and healthy. But pretty scary if you need to depend on med insurance. And hope your employer is able to cope as well. When Clinton held up that national insurance card way back when, and tried to start national health insurance, Americans were really duped not to jump on the band wagon.
In truth, the companies that make these drugs spend a lot more on advertising than R&D. And they repackage drugs and push off as new. Even Epzicon is not a "new" drug, just a new combination of older drugs.
I think the  drug makers are more concerned in letting guys like Larry King get a woody than anything else.
(Dont get me started) 

[Eldon]

Hey Ray,

Thanks for the update. Insurance is definitely one of the major issues that needs to be addressed in order to get better rates and lower costs for our medications. It is good that you do have coverage to get your meds. I am a bit surprised that your company took an increase on their policy though.

"What can I notice right now that makes me smile?"