A community of 30,000 US Transcriptionist serving Medical Transcription Industry

insurance? - stoopidforbelieving

Posted: Nov 07, 2012

I just went over the NEW (using the term loosely) insurance for January.. wow.. there is not much change to mention. Well, except that smokers will have to pay more. We will still have to pay (single) 2500.00 out of pocket before they will even pay the 75% (my heart goes out to those with families!). I dont know about the rest of you, but that just dooms me to no benefits to speak of or else to just owe out the wazooo. I had been told by my physician that I had to go to a pain clinic. The first visit cost me 250 dollars (0ut of my pocket), the medication, that I had to settle for (old meds, could not try the better higher priced ones) cost me over 100 dollars and, here is the best part - my lab work, 1500.00, this makes for a total of in one day 1850.00, (although the insurance only put 689 to my deductible - go figure!) and guess what? I have to do that again next month and the month after that. They are telling me I need injections ( these run from 1500 to as much as 5000, depending on what), I cannot afford them till I cough up the 5000 dollars out of pocket expense. I dont know what others make at nuance, but on what I make, I will not be able to do it. Thing is, I got on a sliding scale at my physician's office, but where is there a pain clinic with a sliding scale? I have to go to pain clinic because of an auto accident. I will have to do this from here on out as surgery is not an option! Heavens!~ I can hardly pay my monthly expenses as it is. I am so disappointed. I had been assured that we would have copays for doctor visits, that the whole medical plan would be better. As far as the medicine. Well, guess what? A lot of the new drugs, which I need, are not usually covered under bluecross and blue shield anyway, just another way for the big insurance companies to keep from having to lose that profit margin.

My grandpa was a smart man - years ago he told my dad that the thing that would bring this great country to its knees would be gas and medicine.. well... we are on our knees. how far till we fall on our face and eat dirt?

I am one woman who is praying for socialized medicine! My brother had it while in another country, even though he was an american citizen, and he loved it! I would much rather pay 10% of my earnings and never have to worry about losing all I have worked for including my home even my vehicle, or God forbid my health/life because I cannot afford to pay for healthcare.

at 5000 out of pocket expense per year ( and believe me, that will be happening for me this year), at the about 8-9 dollars an hour the average nuance person makes, that estimates to be what? 17,680 a year? (calculated at 8.50 x 40 x 52 weeks), so basically that is almost a third of our gross pay? So, 30% versus 10%? hmmmmmm I am not the smartest rock in the box, but this does not add up to me!

Sorry folks, I just had to rant! I know it does no real good, but I am just plain mad that there is nothing that can be done! I have tried to get insurance elsewhere and it way to expensive to even try to get, not to mention still dealing with high deductibles. man oh man.. I thought getting into a company network would help at least as far as health benefits go. guess that is what I get for thinking!

Insurance - Bobo

[ In Reply To ..]
I really feel for you. I'm part time and got the insurance and as you said it didn't cover anything. I basically was just giving away 160.00 a pay period. I decided I couldn't afford it anymore and when I tried to drop it they told me I wouldn't be allowed until January. The only thing that saved me was they finally canceled insurance for part time people. It infuriates me what they're getting away with especially people like you who are in pain. Hang in there.

Can they really made me say if I smoke or not? - sm

[ In Reply To ..]
What about people who don't wear their seat belts, who have unprotected sex, who are heavy drinkers.

It says they will ASSUME that you ARE a smoker unless you certify otherwise. nm - TranscendTransplant

[ In Reply To ..]
nm

I am the OP; I watched the webinar but. . . - sm

[ In Reply To ..]
I missed the part where it said they will assume you smoke unless you certify you are not. Is a "certification" one way or the other legally binding?

Sorry; I meant I am the OP about smoking. - nm

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x

On the screen where it gives the - TranscendTransplant

[ In Reply To ..]
insurance benefit details, there is a category to the left fot "frequently asked questions-FAQ". Click on that. It says that everyone will automatically be entered into the "smoking" category unless you fill out the certification form for nonsmokers. Somewhere (I don't remember where), there was a spot to get the certification form. You had to state that you haven't smoked in the last three months, that you will continue to be a nonsmoker, and that if your status changes, you will notify them immediately. I wonder how many people aren't going to realize that!

How about obesity? Big insurance risk - NM

[ In Reply To ..]
x

Wait, you mean there are expenses that don't even count toward the deductible? - insurance dummy

[ In Reply To ..]
Without divulging anything that's too private, could you explain a little more about why only $689 of your $1850 expenses counted towards the deductible? Is this kind of thing typical?

You expressed my feelings exactly. What new insurance. nm - ihopeidontgetsick

[ In Reply To ..]
nm

sorry - alyMT

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I cannot afford that either, that's about 200 per month you are putting towards health costs on top of your premium at least. They are paying hardly anything with that deductible. But it looks like for you they are paying a substantial amount at those costs. I just hope my husbands insurance is better. I have heard with medical insurance high deductibles are becoming the norm.

Put it this way, the only thing that changed was the office visit amount. We already had the 2500 deductible before that went towards labs, diagnostics, etc. I would see if you can go through your office and pay cash for the appointment at a discount, it might not be too much different than the previous 65 we paid. If the shots are considered part of the appointment amount that is a major loss, ouch.

Don't forget to check - einsurance...

[ In Reply To ..]
or other similar sites. I have heard of people finding decent rates that way. Not for me, unfortunately, but maybe you will have better luck.

thanks - stupidforbelieveing

[ In Reply To ..]
Thanks for the input on that. I had looked for insurance elsewhere, but I weigh over 220, which is the cut off for being accepted for any insurance for a woman. The last insurance that I was able to get, which I did have for 10 years, stopped carrying me, because after 10 years, with me not using it at all except for yearly stuff, they decided I was too much of a risk. Not to mention that for a single policy, I had been paying nearly 600 dollars out of pocket a month for a 10,000 dollar deductible. At those odds, I think they did me a favor by refusing me.

that is my cheapest route - stupidforbelieveing

[ In Reply To ..]
what I listed IS the cheapest route for me. They are charging me the "cash" rate because I have to meet my deductible first.

When the claim is settled...sm - see message

[ In Reply To ..]
there should be a discounted amount per the insurance company's agreement with the provider. Then your expenses will be after that till you meet the deductible.

(Why do you say $5000 out of pocket expense? Earlier you stated your single out of pocket will be $2500.)

The cost of insurance, and the cost of healthcare overall is a mess in this country. It's across the board. We had an ER visit last month. The physician's fee alone was $850. I do think that physicians should be paid well, but $850 for one visit?

5000 is the maximum out of pocket expense you have to pay per year I believe - MTgirl

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x

the 5000 - stupidforbelieving

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To clarify, the 5000 is the amount we are supposed to be paying "total" out of pocket before the insurance pays 100% on the single policy. But, I found out since I posted that although my pain clinic is supposed to be in-network, that the lab they use is not, so now I will have to pay 10,000 out of pocket on that before they kick in and pay. Insurance and doctors are the new mofia - jmho

Hate to say it but - solution is to leave Nuance

[ In Reply To ..]
Have you looked for another job? I know it is hard to get into something else, but if you are only making $8-9 an hour at Nuance and have to deal with this horrible insurance, perhaps you could get another job that had better benefits and the same (or even better) pay. Good places to try might be your local school, hospitals in your area, colleges, etc. You could try taking a civil service test for a job in your local government. I've seen civil service jobs here for a typist/clerk that any MT could definitely do. Nuance is going to continue to treat us badly and give us horrible benefits as long as we allow them to do so. I have found that the only solution is to walk away from this company. My boots are on and I am walkin' on after next week.

yes I have - stupidforbelieving

[ In Reply To ..]
But you know, the problem is, since my car accident, I cannot even work full time. I have to work for an hour and then try to get out of my chair to stretch out my back and legs (now what company will allow that?). With the wreck I sustained herniated disk and sciatica in two different places in my left leg with a messed up knee. who would hire me? I cannot stand for long periods of time due to this, cant sit for long periods of time due ot this, and because I have to work enough to make the mortgage, I can't "not" work either. right now, till I can get these medical problems fixed, I cannot really work outside the house.

I guess I am one of those that likes the accounts I have and I am gradually increasing in my pay to the point of it actually being worth my while as far as the actual work goes. I am just really bummed about the insurance. I know I will be able to eventually get something else. I am in the process of taking online classes through the college system to try to get something that will work around these physical problems I have right now, but that will take time. I am just discouraged for now.

I would encourage you - not to close that door

[ In Reply To ..]
I would encourage you to talk to someone at the Department of Labor in your area. My mom works as an employment counselor and assists people in finding a job who have challenges (some like you described and others). Another type of job might be easier on you if you are able to sit for an hour, get up and walk around, and then sit some more. There are lots of jobs that are not nearly as demanding and will allow you to take short breaks to walk around, etc. I think it is at least worth a try. I know it is hard to get stuck into thinking that you have no other choice. I thought that way for a long time. Just try to keep your options open. All of the added stress from the bad insurance and working for this company isn't good for your health either.

Canada has socialized medicine and it isn't that - me

[ In Reply To ..]
great from what I hear. You might have a 3 month weight to get in to see the pain management physician, 3 months for an appendectomy, etc.

quite sure you would not wait 3 months - for an appendectomy

[ In Reply To ..]
unless it was elective LOL! No one is going to have to wait for an urgent procedure, but waiting 3 months to get in to see a pain doctor is not the end of the world and in fact, the average is much more like one month.

Canadian perspective - Nancy

[ In Reply To ..]
I am a Canadian with back pain. I saw my family doctor and got the name for a physician who specializes in back pain. It took three days to get in to see him. This was not just a consultation, but also first treatment.

Just a word of caution: Don't trust Michael Moore's so-called documentaries. He tries to pretend he is "just one of the guys" but he's a millionaire with an agenda. There are some elective procedures that take a while, but important things happen quickly. My mother-in-law broke her hip and had her hip replacement the same day. My mother has had therapy for four cancers almost immediately. I gladly give up a portion of my income to fund our socialized medicine. Is it perfect? Not by a long shot; but I won't go bankrupt.

thanks! - stupidforbelieving

[ In Reply To ..]
My brother was in Germany and had the same experience, though he was not a citizen! Propaganda is the worst enemy for many. I know people in other countries that have socialized medicine. They give same experiences as you. My mom had to wait over a year here for her hip surgery after she fell. And she has some of the best insurance~ Double insured actually! She still had to wait! It is sickening!

You want to know the sad part? My neurosurgeon told me that if I had been seen initially and immediately after the accident for treament, much of the damage would not be permanent. The nerves have been impinged so long now that even releasing them will not stop damage already done. So now, because of the system we have, I am damaged for life. Sure pain clinic will take edge off the pain, but i will always have to deal with this for the rest of my life. If I had had the accident while visiting in germany, because I was there, I would have been treated immediately citizen or not. Sad huh?

I will tell you another experience I had. Six months after I had been dropped from my insurance I had been paying for, for 10 years, because I was too big of a risk, I had to have gallbladder surgery. Because my income at the time was so low, I "qualified for indigent care help", which I hated to take, but I had no choice. Well guess what? I had all the paper work that said I qualified, I would have to only pay like 10-15% and payments would be worked out on my budget. So, I had surgery. One week later, I started receiving bills. For being in the hosptial from 9 am to 1230 pm (roughly 3-1/2 hours seriously! from the moment I walked in to the time I was wheeled out ot the car), I received a total of 30,000 in bills. They actually decided to renig on the help they had agreed in writing to give me. So I turned them in. Because, unfortunately, it is common practice for hospitals to put a person on programs such as indigent care and get their money from those funds and turn around and try to charge the person anyway, trying to threaten them with bad credit and worse to sneak out more money on top! It is a nightmare! I know that because I have friends that work in the areas of the hosptial that do this quite often! It is sickening!

And like you said, the elective procedures may take longer, but they can, because they are not necessary, they are elective!

Thanks again for your imput!

Just curious: What did Michael Moore say - about the canadian SM

[ In Reply To ..]
system?

Insurance - Bobo

[ In Reply To ..]
Actually, doctors would prefer you pay in cash at an office visit and therefore, they charge a much lower rate. After I lost my insurance, my doctor said she would only charge me $52 for an office visit because she would not have to do any paperwork and end up getting more payment that way than having to deal with the insurance company. It is a win win situation for both of us. You might want to ask your doctor about that.

thanks - stupidforbelieving

[ In Reply To ..]
believe it or not, that rate is the "cash" rate. They were giving me a "break", until my deductible is met. I appreciate them trying to help, but the lab work still went against insurance, sigh.. either way I am sunk on that one. But it is a necessary evil. I need pain relief to even do my ADLs, so pay I must somehow.

Smokers should have to pay more - see message

[ In Reply To ..]
I have a family member in the insurance business. Smokers have a much higher rate of illness/disease and subsequently more claims as compared to nonsmokers.

what about obese people, shouldn't they pay more as well as smokers? - I certainly think so.

[ In Reply To ..]
I may smoke but I am far from obese, fat or anything close. Frankly I am very very very, may I say again, very healthy.

true, but... - stupidforbelieving

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Smokers have to pay about 9-10 dollars more a payperiod for that (single plan, I did not check the other ones), which is what about 10%?

Obese people, I know, because I am one, are not allowed the insurance at all unless we work for company that has insurance (such as Nuance) that cannot disqualify us because of our legal disease/handicap (yes morbid obesity is both). If I could get insurance on my own for 10% more than somebody else and actually get it, I would. 10% is a small price to pay for being allowed what everyone else gets, in my opinion.

I knew a lady that smoked, had high blood pressure, diabetes, high cholesterol and came down with breast cancer. She was independently insured with the same exact insurance that I had, and in the beginning same deductible and, taking age difference in consideration, for same amount of charge. She was allowed to keep her insurance, but I was denied. Though I never used mine, fat healthy woman that I am, and she on the otherhand had about 500,000 dollars worth of charges in less than a year, then she had a heart attack the next year, they did not drop her then! And all this time she STILL SMOKED. It was her right to continue to smoke, just as it is my right to continue to eat, but to deprive me of health insurance,though I did not cause them money out of pocket and to allow her to continue - tell me, where is this fair or just for me and others like me?

Right - anon

[ In Reply To ..]
As MTs we should all know smokers should pay a bit more

Smokers - mt20years

[ In Reply To ..]
Fat people should pay too then. Maybe stupid people as well.

Many of these drug companies have patient - assistance programs SM

[ In Reply To ..]
and you can sometimes get the meds for free. I did this with a very expensive pain medication for years until they lost their patent. I also do this with Cymbalta, it is free for me. You would quality with the wage you stated. I have my own insurance through BC/BS but it is really catastrophic in order to afford the monthly premium. With the expense of having to go to a pain clinic monthly, it seems you would eat up that deductible fairly quickly, right I get that you cannot afford to pay it, but when you have insurance don't they submit to insurance company and then you can make payments?

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