Insurance

I have been dealing with some yucky insurance issues lately and I have had no desire or intention to write about it---like Scarlett O'Hara "I can't think about that now, I'll think about that tomorrow"!  However;  earlier this evening I was reading the blog of another Mom who has a son with ND CNS LCH.  She had been cataloging the roller coaster ride that Insurance bureaucracy takes us on and I had to laugh, plus I felt so much better just knowing other people weren't better at getting through the red tape.  Is that bad that it made me feel better?  I certainly don't want anyone to deal with these NASA level phone calls, but sometimes when I get off the phone I feel so stupid and slow, like if I had 10 more points to my IQ I could figure it all out.  But her blog reminded me I am not unintelligent, not missing the genetic coding necessary to understand co-insurance, deductibles, and out of pocket premiums.
Four years ago we signed on to a private health insurance policy for our family that cost us $666.00 per month.  It covered Jackson's DDAVP pills and HGH shots.  Fast forward to 2010 by now our premiums were $1100.00 per month and Jackson's HGH had a $25,000.00 cap on it, that is after we pay $7500.00 out of pocket major medical (HGH in 2010 was considered major medical and not a prescription medication like it had been previously).  Jackson's HGH is just over $5500.00 per month which works out to over $66000.00 a year a difference of  $41000.00 plus our $7500.00 so $48500.00 uncovered HGH for 2010.  We applied for patience assistance with the pharmaceutical company who made his medicine but because we had health insurance we weren't eligible!  Go figure.  Then we applied for patience assistance at our Children's Hospital and we were accepted, but we had to go around and around for a month because our insurance had to be capped out and we had $800.00 in benefits left for Jax at the time.  Can you order $800.00 dollars worth of HGH---shockingly no!  That cost us another $1200.00 to "max" out his benefits, but the next glitch was since our Insurance company had switched his HGH to major medical our Rx benefits for Jackson were NOT maxed out although we weren't allowed to get HGH on our Rx benefits.  No refunding the $1200.00 either!  Luckily Children's Hospital is capable of common sense and with a few phone calls and several hours of perseverance we got his medicine for the remainder of 2010. I felt bad because he missed several weeks of it. 
Then Jan. 1st, 2011 came (cue threatening music) our particular insurance plan was "discontinued" and we were "moved" to a "comparable" plan.  The first thing I notice was that HGH was back in the prescription benefits column---so far so good.  And there was no longer a $7500.00 out of pocket for the family, it was now $16500.00!  Yikes, but at least the new prescription out of pocket deductible was only $2500.00, at this point I was fist pumping and dancing---$2500.00 not $7500.00 and no cap---yippee.  I was happy for about 8 days---I should have known better, but since we were paying $1900.00 + a month in  2011 ( I'm too tired to do the math but what % of increase is it to go from $666.00 to $1900.00 + in 48 months?) I figured we were due some better coverage, still can't believe I didn't smell the rat.  I mean, really Becky, since Jackson was 4 years old I have learned the Insurance companies have the worlds' smartest financial wizards---not wall street, not major corporations, but the Insurance companies.  Of course I had read it wrong.  Not $2500.00 deductible for Rx's but a cap of $2500.00 for Rx's per person per year, or in insurance lingo pcy (per calendar year).  So 8 days into 2011 Jax had exhausted his prescription benefits!  Brilliant, perfect, if you'll all excuse me I am going to crawl into bed and sleep until 2012.  I had such a defeated feeling about me.  Fast forward to March 18th, and we are applying for "group" insurance, mind you this is one of MANY different options we have researched, called on, and applied for.  Hours (many hours---!) have been spent on the phone and on the Internet.  We have met with our insurance lady and I have her number memorized now---can't remember my sisters number by heart, but Clarissa and I are TIGHT!  The tax documents are copied, the forms filled out, signed, witnessed and now we WAIT.  Wait to see if their is a loophole unforeseen by us and the insurance agent.  If not we will officially be on a "group insurance" plan as of April 1st.  Of course we are cautioned by all involved to pay both premiums in April just to assure us a smooth transition--why not it's only money!  Of course since we are switching from an individual family plan to a group one the out of pocket expenses we have paid thus far in 2011 won't be attributed to our new policy, however; Mrs. Noftle if you would like to stay with an individual plan........or split Jackson off to his own insurance, or......  We should know before April 1st if we have been accepted into the group plan.  I actually DREAMED last night that I was going through my cute lime green folder (I find it helps to put "headachy" papers in cute folders, makes it easier somehow) and I found a plan that covered my whole family for $115.00 a month with no co-pays or co-insurance or max oop.  I was so excited I called Clarissa up right away, no waiting to look her number up!  She couldn't believe she had forgotten this plan--it was a nice dream!  I hope someday in the future, I'll be glad I wrote this all down.  I also don't want pity, I'm KNOW I'm not the only human that is frustrated by these things, so no poor Becky comments!  Maybe I want this written down for posterity sake, like when my Great Grandpa and Great Grandma Pugsley wrote warning my Grandma Bishop not to spend $15,000.00 dollars for a 4 bedroom house on 3 acres---they felt the price was WAY TOO HIGH!   I want my Grandchildren to say--"Big deal, Grandma, we pay $1900.00 for a pack of gum!" actually I don't want that either---see there is no knowing what I want!  Just ask Michael!