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Main Forums => Living With HIV => Topic started by: J.R.E. on November 03, 2009, 11:13:21 am
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As some of you know, this is a time time of the year, for those of us that are still in the workforce, where we begin to worry about group insurance coverage. This is about the time, when companies, start to negotiate, with the insurance giants.
I received this brief note last night in my mailbox, as I got into work at 11:00 pm.
Dear Ray,
"Our employee health insurance plan is changing as of January 1st, 2010.
Attached is a summary of the new plan. If you have any questions, please let me know. Also make sure you attend, one of the open enrollment meetings that HR has scheduled."
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I attended the enrollment meeting at 7:00 this morning
It apparently seems that after we have reached the $1,500.00 deductible, we are responsible for 20 % of all costs. The insurance covers 80%. We never had a deductible before. ( I knew it was coming)
Preventive care pays 100% ( with no deductible) which includes the following:
Routine immunizations
routine lab test/ X-ray
For women, routine mammmogram
routine pap smears
preventive endoscopy ( includes colonoscopy, proctosigmoidoscopy, and sigmoidoscopy
Physician services: ( 80%)
Office visits :
Diagnostic tests, lab and X-rays
allergy testing
Impatient services
outpatient services
Office surgery
Emergency room physician.
FACILITY SERVICES : (80% AFTER DEDUCTIBLE)
impatient care
outpatient surgery
Outpatient nonsurgical care
Hospital emergency services
Prescription drugs: 80% after the deductible.
And they are offering ( at additional costs) Accident insurance,Life insurance, cancer insurance, and hospital confinement indemnity insurance, Dental insurance.
Anything I spend, out of pocket,( for healthcare) after January 1st,2010, goes toward the $1,500.00 deductible. After that I am primarily responsible for 20%
They have something else too, where you can have an amount of money taken out of the paycheck before taxes. I think they call it an HSA. it kind of an interests bearing account,(through a bank), that is used for medical only.
Just to sum up, it's going to be a very expensive year, if i go this route,that's even if I am even able to work next year! It's physically been a very tough year for me! I have until a week from this Friday to either accept this or decline coverage.
I have to really sit down and calculate all this. I have to let this all soak in. They rattle all this info off so fast , at these enrollments.
I also called Bay Pines VA Hospital this morning. I will be heading to St Pete, to see if I qualify for VA care. I've spent the last hour getting all the necessary documents together, for this trip. Friday, is going to be a very long day at the VA.
So much to do, and not enough time... I will busting ass !
Got to go,...It's been a long night and a stressful morning. Time to go to sleep.
Ray
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Ray, this is a fairly typical plan, especially in this day and age. Do yourself a favor and really look into the FSA/HSA option as it allows the money you set aside to be taken out pre-tax. There are no stupid questions to ask your HR department. I should know - I work in HR. ;)
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Do yourself a favor and really look into the FSA/HSA option as it allows the money you set aside to be taken out pre-tax.
Yes, they were really pushing this today. Thanks
Ray
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I was actually going to say, that looks pretty standard to me. It looks a lot like my health insurance, but obviously mine is a bit more tailored to my needs. Sounds like your respective company is simply streamlining their insurance plans to match those of the current market, for whatever that's worth.
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Ray
Often in this type of plan the 20% payment you make is capped at some level. The term used might be "Out of pocket maximum" or "Family Cap" or "Cost sharing maximum". It is probably worthwhle to ask the HR rep if the new plan will have any cap of this nature?
But definitely check out the VA.
A
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Ray
Often in this type of plan the 20% payment you make is capped at some level. The term used might be "Out of pocket maximum" or "Family Cap" or "Cost sharing maximum". It is probably worthwhile to ask the HR rep if the new plan will have any cap of this nature?
But definitely check out the VA.
A
I was just looking at the plan. The maximum individual out of pocket expense is $5,000.00 Total lifetime benefit is $5,000,000.00 I'll study this plan a little closer at work tonight.
I can tell you, very few if any of my coworkers are going to like this. As the week goes on, there's going to be more complaints, especially from the nursing dept.
It wouldn't be bad, if there was a worthwhile living wage down here, but most people I work with, including myself, are struggling, to keep afloat. Pay raises are frozen and have been for me , since March of 08. The are now talking about caps on some of the positions at work, including mine.
I think it's time I probably get a case worker also, ( I'll check that out on Thursday) besides going to the VA on Friday. I am off Thursday ,Friday and Monday, so I have a lot of running around to do.
The bimonthly charge for Humana, will remain the same at $45.00. For a yearly total of $1,080. Add the $1,500.00 deductable, could cost some of us $2,580 per calender year, not including the 20% if we go beyond, which I am sure I will !
No more $7.00 , $30.00 0r $50.00 co-pays for drugs in this plan.
Ray
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Ray, I'm really sorry this is happening to you. I think a couple of the people responding in this thread don't realize you probably have a lot more medical expense than they do. And, with your partner being on disability, and the cost of living there, live on a lot less than they do.
I really hope you get some good news at the VA. I'm sending you huge vibes of good luck. :-*
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And, with your partner being on disability, and the cost of living there, live on a lot less than they do.
I really hope you get some good news at the VA. I'm sending you huge vibes of good luck. :-*
Thanks Betty. But, I think you misunderstood or misread something, somewhere !! My partner is not on disability. He's healthy, with no medical issues, and retired now for about two years . :)
Thanks for the vibes !! :)
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Thanks Betty. But, I think you misunderstood or misread something, somewhere !! My partner is not on disability. He's healthy, with no medical issues, and retired now for about two years . :)
Thanks for the vibes !! :)
Are you sure Ray? I'm with Betty, I thought.... hell it must have been someone else. Sorry to hear about the insurance. They just raised our yearly deductible from $1200 to $1600... gonna be a rougher year than last year fer sure!
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Are you sure Ray? I'm with Betty, I thought.... hell it must have been someone else. Sorry to hear about the insurance. They just raised our yearly deductible from $1200 to $1600... gonna be a rougher year than last year fer sure!
LOL !! No,...Ed is healthy as a horse. Maybe the confusion is Ed's Mother. We had to get her into a nursing home because , she has dementia. He's dealing with that issue, but that's being taken care of through Social security and Medicaid. Ed's mom is well taken care of.
Sorry to hear about your deductible going up also. I guess I was pretty fortunate all these years that we had good coverage where I worked. Like I mentioned earlier, I knew it was just a matter of time.
Ray
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Ray , definitely push for the VA access, even if you have the minimum insurance they will still let you get meds and many services from them, they will attempt to collect from insurance company. Here the VA gone to almost a completely "clinic type service, with many "hospital beds setting empty", so they serve more people on an out patient basis. they may allow you to be a cat5, which means almost everybody has priority over you but the meds are still worth the trouble... good luck
Nick
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Nick,
Thanks for the info. I will be back here tomorrow evening, and let everyone know how things went at the VA. I will be there tomorrow morning at 8:00
Ray
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Sorry, Ray. I guess you must have mentioned him being on social security or fixed income or something, and I just gathered he was on disability. Sorry for the confusion, and good luck at the VA!
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:o
Well,... It's official . I am now currently enrolled in the VA healthcare system.
Ed and I, left the house around 8:00 this morning and made to Bay Pines Veterans Hospital around 9:00.
Bay pines is quite a huge place, all I knew , when I spoke earlier in the week on the phone, was to find Building 100. After a drive around the campus, we finally found it. Building 100 is the first step into getting enrolled. It's the sign in and eligibility building.
I signed in at the front desk, and had about a 20 minute wait, until my name was called.
Ed and I then walk through a door, where we sat opposite a woman on a computer.
I introduced myself and Ed. And explained that Ed is here, because I sometimes get a little foggy minded. She said no problem.
The first thing she asked for was my DD-214 ( discharge) so I handed her that, and she began to put that info into the computer.
She then asked if I am working, and what my annual salary was. ( I came in with my last three years of W-2 wage statements. Also asked about property owned. ( no problem there)
She asked if I knew what my out of pocket healthcare expenses were. I had all that information with me. So, I gave here that info. ( it's good to save receipts !
I told here it was next to impossible ( with the current wages) to afford the group insurance that was being offered at work, along with the deductible, and the drug costs, and that I would be force to drop it, at the end of the year.
After a few more questions she asked If November 19th would be a good time, to meet with the doctor and have some fasting blood tests done. I said, that would be fine. I will also bring in with me, my last three Quest blood tests results from 4/14/09, 7/14/09, and 10/19/09. ( That will give the doctor more than enough info about my current health status )
So, I have an appt. at 8:00 on Thursday, Nov 19. I will have to get someone to come into work that morning, and relieve me an hour early, so I can get there on time.
I also have a two hour orientation program at that time, to find out exactly what all my benefits are and what things will cost. Ed will be with me, for this also, listening carefully to what being said., because I know, I am not going to get it all. After working all night, I am going to be mentally tired.
I have just a couple more forms to fill out, before I go back on the 19th. It's mostly forms, of what the current prescription medications I am on, over the counter medications, and vitamins/ herbal supplements.
That was my morning. Everything went well, and by 10:00 we were back on the road.
If anyone has experiences with the VA, I would really appreciate hearing from you, either in this thread, or by private message. I would like to find out more about co-pays and other costs, and basically what to expect. We do have a small VA clinic, just a couple miles from where we live. Not sure if I will be going there, or not. Still trying to absorb all this. It will be quite a change for me.
Thanks ----Ray
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Wow, it sounds like it may be good. And I truly hope it works out, Ray.
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Ray,
Sounds like you had a good experience over there at the VA thus far. Sorry I don't have a lick of advice concerning your dealings with the VA, just wanted to tell you I am happy for you. I really like the fact that Ed is there to back you up and to help retain some of the stuff you will have to sit through after pulling a shift the night before. I definitely know what that feels like.
Keep us posted on how things go. I'm wishing you the best!
Thomas
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Hope it all goes well Ray.
You all know healthcare, or lack of, is a pet peeve with me.
From what I understand, that 5,000,000 lifetime cap (1,000,000 for most plans) will become moot
if Obama health plan passes. But if it does, what year it takes affect is unknown to me.
Is there any way you could get on VA disability too?
My bro-in-law is on va disab and ssdi. He makes as much a month as he did when working.
Having VA was his huge bonus.
Here at my company, they have yet to tell us anything about 2010 insurance. If it will change or stay the same. That silence is pretty scary. The company is probably shopping around looking for a deal, and not finding one. If all stays the same for 2010, I will be in total shock!!!
As to the life insurance you mentioned to be offered... GET IT !!!
I would guess if this is newly offered to all employees, it will be an open enrollment thing. Meaning no pre qualifying. If you currently have no life ins, Id say go for it. Open enrollment accepts everyone with no health questions asked. At least that is how it worked here.
I wish Id been in the service so I could benefit from the VA stuff. Silly me, it never occurred to me back then. Plus, that was Vietnam era and not the best time to join the military. My draft number was like 9999999999. ;D
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Is there any way you could get on VA disability too?
Hi Randy, I don't think I can do that. I've known friends throughout the years, that were on disability, but it was service related. I am not quite sure how that all works.
Here at my company, they have yet to tell us anything about 2010 insurance.
Hopefully there won't be any change for you. I am surprised there taking this long. Maybe it's a good thing, and there are no changes for you !! Good luck, hope it works out.
I wish Id been in the service so I could benefit from the VA stuff. Silly me, it never occurred to me back then. Plus, that was Vietnam era and not the best time to join the military. My draft number was like 9999999999. ;D
My draft number was 16, ( if I remember correctly) When they pulled that number I knew it was just a matter of time, before the "greetings " letter came.
I am certainly thankful now !! I just wish, I would have signed up a little earlier, for the benefits.
Forgot to mention, I also had my picture taken yesterday. She said the ID card should arrive in 7 to 10 days !!
Ray
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I am just glad I have Ed with Me, to help me sort through all this. My brain feels like mush at times !!
Ray
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I went to the one-on-one at work this morning, and canceled my insurance. The only thing I continued to purchase was dental ( $3.00 bi-monthly, and I continued with the additional life insurance at $7.82 bi monthly.
Stopping Humana ( effective Jan1, and the hospital indemnity) will give me an additional $124.00 per month on my check.
I stopped in my doctors office this morning, let them know that I got it all arranged with the VA. She ask me to make sure they contact the doctor to get any and all health info, when I go to the VA on the 19th for blood tests.
I also have one more ( final) blood test scheduled on December 2nd. At that time I will find out how things are since quitting the Viread on 10/19/09. Everything seems ok. I notice a lot less bloating, and gas issues. Hopefully the viral load will remain <48.
It's going to be hard giving up my doctor, after all, he pulled me from the brink of death, But I am sure I will be in good hands ! Time will tell. My doctor is very excited for me, that I got into the VA.
Also had an opportunity to call Tim ( Moffie) Thanks again Tim !!
Ray
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I went to the one-on-one at work this morning, and canceled my insurance. The only thing I continued to purchase was dental ( $3.00 bi-monthly, and I continued with the additional life insurance at $7.82 bi monthly.
Stopping Humana ( effective Jan1, and the hospital indemnity) will give me an additional $124.00 per month on my check.
I stopped in my doctors office this morning, let them know that I got it all arranged with the VA. She ask me to make sure they contact the doctor to get any and all health info, when I go to the VA on the 19th for blood tests.
I also have one more ( final) blood test scheduled on December 2nd. At that time I will find out how things are since quitting the Viread on 10/19/09. Everything seems ok. I notice a lot less bloating, and gas issues. Hopefully the viral load will remain <48.
It's going to be hard giving up my doctor, after all, he pulled me from the brink of death, But I am sure I will be in good hands ! Time will tell. My doctor is very excited for me, that I got into the VA.
Also had an opportunity to call Tim ( Moffie) Thanks again Tim !!
Ray
That is awesome news Ray!!!
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Sounds good, Ray. I know that little extra money will help.
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Well Ray, looks like things are going in the positive direction. I think you will be pleased with the VA "SOCIALIZED MEDICINE" that you seem to have qualified for. This morning my partner and I, and one other vet are going to Tucson to get our H1N1 shots. The other day we also got the regular flu shot. No my partner is not a vet, but nurse gives partners shots to protect "her guys". Who says that the VA isn't comprehensive?
I think you are going to be very happy with your healthcare from now on. Also, make sure you stay on top of your own records and tests, because the only part of the system that still lacks is the intercommunications between departments, but that isn't only a problem of the VA system.
Good luck man, and call anytime you have questions.
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Good luck Ray, it would appear you made a good decision. We are all of us very concerned over where things could go down the road so it is important to keep on top of health care issues and to continue to advocate for ourselves as individuals and in society. Good luck with the VA.
Jody
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Hey Ray,
My insurance plan also changed to a tiered prescription copay plan. We don't have deductibles yet, or I don't, because I chose to pay higher premiums.
But when you say you have to pay a percentage, it can really add up. I pay $177 a month for Isentress, which isn't too bad, but it isn't just a $50 copay either.
I know people on Atripla who pay more than $450 a month as a copay. That just is plain crazy.
Glad the VA thing worked out for you. I have a feeling I may be jealous of you in a few years.
HUGS,
Mark
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Brief Update...
This past Thursday at 7:30 AM Ed and I were at Bay Pines VA hospital in St. Petersburg. I had an 8:00 appointment, but the doors opened at 7:30.
There were about 14 of us in the orientation room. 13 males, 1 female. There are at least 3 of these orientations a day, with at least 14 people, per orientation. Bay pines VA hospital has approx. 98,000 in the system, and 3,500 employees. It is the 4th busiest VA center in the United States. There is also a regional office located at this campus.
The first thing that happened was check-in. My name was placed into the computer, and the woman proceeded to ask a few questions. She asked me for my current insurance card, and she scanned it. I made sure to tell her that as of January 1st, I will not have any additional insurance. She said no problem, just make sure I keep things updated.
I then went to the next woman in line. She handed me a urine cup, and asked If I was ready to give a urine sample. I said no problem. I Went to the john, and peed in the cup. I came back and handed her that sample.
She then had me sit down, where she proceeded to take 7 vials of blood from me. They were going to do another PSA test on me also.
After that, I sat down and filled out a health questioner, Asking about health conditions, and all current medications that I am on.
I was then handed a seracult card, along with several others, And was told within the next two to three days, to have the stool samples mailed back to them. The nurse said we will get continuous calls from the dept, that handles the stool cultures, if we don't get those back to them. The card had my name in preprinted lables. I didn't have to fill out anything. I already mailed mine back.
For the next two and a half hours, we watched a slide show, explaining everything about the VA hospital, the grounds, and the different buildings. An RN gave this segment of the orientation.
The next part of the orientation was delivered by one of the pharmacist. She explained how the pharmacy operates, and how to get the medication along with future refills. She explained that all medications will be mailed out, 3 months at a time. However she stated my Epzicom and Viramune, can only be mailed out 30 days at a time. I will find out more at my appointment.
The last part of orientation was given by the State of Florida veterans association. This was telling me about additional benefits, that may be available to me.
Finally at the end of orientation we were all handed our primary care information. It had my doctors name on it, along with an appointment date, set for December 9th at 10:00 am. I am to bring my prescription bottles with me ( or the prescription hard copy ) from Walgreens, at that point, as I understand it, he will write the new prescriptions, so I can get them.
I was very impressed by how smoothly everything went !! The orientation went well. Even Ed, commented on how well organised everything was.
As I said to Tim ( moffie) when I spoke to him on phone last Thursday, I don't know why I didn't do this sooner.
I still haven't recieved my photo ID card in the mail. It was only supposed to take 7 to ten days from November 6th, to reach me. I called again yesterday, and they told me the card was on hold in Atlanta. He said the problem was computer glitch. Something about the means test, and not getting my photo info at the same time. So, he resent the photo to Atlanta, and reassured me that I would get the ID card in 7 to ten days. He also said there would be no problem, keeping my appointment December 9th, even if I don't have the card. But If I wanted to be a little more at ease, I can go back to Bay pines, and he will print me a temporary ID , until the other one arrives.
Yesterday I received, ( in the mail) a letter from the Department of Veterans affairs. This letter confirmed my enrollment in the VA Healthcare System. I am enrolled into Priority Group #5. The packet also contained other information, as to what I am entitled to. It's all very self explainatory, easy to understand.
I was 19 years old , when I was drafted into the Army in 1971. I lived so close to Canada then, I could have easily gone across the border, as some of my friends did, back then. I am thankful now that I never did, and I never looked back with regrets, of the time I served.
It will be the VA that hopefully, keeps me alive for some time.
Ray
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Ray,
So far, it doesn't sound too bad. Especially for a government-run medical facility! Imagine that! ;)
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Ray,
I'm a veteran as well but I haven't used the VA system yet. Great to here how this is working for you!
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Damn Ray that place sounds like a well oiled machine... Glad to hear everything is going so well and I agree the decision you made at 19 has obviously finally reaped some benifits for you! My wife's mother lives off Gulf to Bay behind an Albertsons (sure there's hundreds of them), we should all do lunch some time when the wife and I get over there to visit the mominlaw (yes one word).
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My wife's mother lives off Gulf to Bay behind an Albertsons (sure there's hundreds of them), we should all do lunch some time when the wife and I get over there to visit the mominlaw (yes one word).
I often shop at that Albertsons. That's about the only one left that wasn't bought by Publix.
If you know you are going to be in the area PM me. Sounds good ! We can all go out to Clearwater beach for lunch. A Saturday would be great. It's about the only day of the week I have any real energy.
Ray
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congrats to y0u Ray the VA will be a godsend.. I see you did get a cat 5 rating, but as long as you don't have any "elective" surgery" or request an abortion that shouldn't be a problem I have several friends who use the VA system. most of the "complaints" revolve around getting referrals to specialists not available in that facility, they then send you to some "contract Dr" which has been a real hassle for one guy I wish you much good health and service from the VA
Nick
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congrats to y0u Ray the VA will be a godsend.. I see you did get a cat 5 rating, but as long as you don't have any "elective" surgery" or request an abortion that shouldn't be a problem I have several friends who use the VA system. most of the "complaints" revolve around getting referrals to specialists not available in that facility, they then send you to some "contract Dr" which has been a real hassle for one guy I wish you much good health and service from the VA
Nick
Thanks Nick !
We"ll see how things go on December 9th. I think my current doctor , is one if those contract doctors through the VA. I still have an appointment set up with him on December 2nd. Everything's been pretty smooth, so I am sure I will have to hit a pothole ! ;)
I also managed to call my dermatologist, and got an appointment for next week. Got a couple more pre-cancers on my hand that need to be removed. Might as well do that , while my current insurance is still in effect.
Thanks again everyone--------Ray
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:-\ UPDATE
I just got back from my ID doctors appointment.( under my current Humana insurance plan).
Since I stopped taking Viread on 10/19/09,( it's been about 44 days) we decided to check Viral load and cd4 count. Just to clarify, I decided on my last visit with my doctor on 10/19/09, to stop Viread, and see if the Epzicom and Viramune would be enough to keep me undetectable. So I will be a little nervous waiting for those results to come in.
The doctor will mail me those results, and I should get them in 10 days or so. Hopefully, I will still be undetectable. I haven't really noticed any difference in the way I feel.
My appointment with the Doctor at the VA clinic , is still set for December 9th. There's so much to try to figure out. One day at a time ! The main thing I need to do on the 9th, is to get the HIV prescriptions set up and ordered. Not sure exactly how that all works, but I will find out soon enough.
Today was my last visit, with the doctor that I've had for the past 6 years.
They all wished me well, I told them that after I get settled into the VA system, I will make periodic appointments with him again.
I also received the H1N1 vaccine today.
Ray