Friday, July 24, 2009

Feeling so sad and so mad!

We have just become aware of a drastic change to Branden's health insurance coverage which will go into effect on September 1st. It will affect all non-contracted Dr.'s, lab's, etc. I'm so SAD because the coverage was (in my opinion) already so low and now it's going to be ridiculously low and I am so MAD because they have opted to make this change mid-plan year. I certainly understand that IF you are lucky enough to be healthy than staying in-network for services is pretty easy or at least doable, BUT if you have a medical condition like our daughter does (or will have as soon as she arrives) than staying within network isn't always an option. We have already met with her first non-network Dr. which she will be seeing on a regular basis and will be performing two VERY EXPENSIVE surgeries. I know that he will be the first of many non-contracted specialist and I am just so very overwhelmed by what this new change is going to mean for our family. I am seriously concerned that the baby's medical expenses could bankrupt our family. If you have ever had a real and imminent financial concern than you know what I am talking about. I am SO stressed out over this and poor Branden just doesn't know what to say or do. I am truly a wreck right now and I know that I need to stay calm to keep my blood pressure down and to help keep this baby in a few weeks longer. I am 35 weeks on Saturday. I am so thankful that she will be arriving before September 1st and can only pray that she will not have any additional surgeries after that date. Shut revision are extremely common and I just pray that she will not need one, not only because it's super scary but also because I have n idea how we will be able to pay for it. I know that I should be grateful that we have insurance albeit some months it barely feels like it but I don't feel grateful right now. I feel sad, mad and really scared! I realize that companies do what they believe will be "best Financially" for the whole organization but when you are so drastically affected by a change it's REALLY hard to feel anything but anger and resentment toward them - regardless of how gently they tried to present the information to us.

Check out this example that was provided to us:

Example is for one individual only.

Current Non-Network Plan
Non-Network doctor charges $40,000
Insurance pays 70% $28,000
Balance Due $12,000

Employee responsible for 30% up to $4,000 maximum out-of-pocket amount $4,000
Insurance now pays additional balance at 100% due to out-of-pocket maximum $8,000

Total Insurance Pays $36,000
Total Employee Pays $4,000


New Non-Network Plan Effective September 1, 2009
Non-Network doctor charges $40,000

Adjusted amount that insurance will accept (In-Network ACR Amount) $30,000
Insurance pays 70% of In-Network ACR amount $21,000
Balance of ACR Amount Due $9,000

Employee responsible for 30% of ACR amount up to $4,000 maximum out-of-pocket amount $4,000
Insurance now pays additional balance of ACR at 100% due to out-of-pocket maximum $5,000

Plus employee is responsible for total amount over ACR ($40,000 - $30,000) $10,000

Total Insurance Pays $26,000
Total Employee Pays (Amount over ACR Plus Out-Of-Pocket) $14,000

So in this scenario presented above - under the current plan, on a $40k bill we would have to pay $4,000 (which would be out out-of-pocket maximum). This is what we had been planning for ever since we found out about the baby's medical condition and the surgeries she will need.

But under the new plan effective 9-1-09 for that same $40k bill we would have to pay $14,000. However, keep in mind that $10k of that does not apply to anything and if she was to have another $40k bill (which is VERY likely if she has another surgery) we would then need to pay ANOTHER $10k and this could go on as many times as billed for that calendar year. Then come January 1, 2010 it would all start up again and if she had another expensive "issue" it would be ANOTHER $14k because we would need to pay that $4,000 out of pocket maximum again.

I have to tell you that the term "Out-Of-Pocket Maximum" seems so stupid now considering IT IS NOT THE MAXIMUM we would pay - it is only the beginning of what we will be expected to pay. I'm sorry, I just think this is complete bullshit and the more I write the more pissed off I get. I think it is horrible that hard working families can be put in a situation like this when we have done nothing wrong. We seriously live such a modest life in an effort to have me stay home and be the primary care giver to our children - we don't have cable, get the newspaper, we RARELY ever go out to eat, we don't buy unnecessary things - we have tried to do it right so that we can provide for our children now and in the future and then something like this happens. No one plans to have an ill child and I think it is seriously unfair that this situation is going to so drastically change our financial future and the even shittier thing is there is really nothing we can do.


Howe Family said...

oh Nicole I don't even know what to say. this is horrible news and you have every right to feel pissed off and sad and mad and all that. Right now I can't tell you that everything is going to be okay because I certainly don't know that. all I can say is that I am truly sorry and completely understand your feelings. I love you guys and will continue to pray that things will work itself out somehow.

Cathy Outten said...

Health insurance is one of the number one stressors in my life, I think about it way too much. And we don't have any major health issues. I'm so sorry for you, and it sucks to have it pulled out from under you like that.

5chamberlins said...

I am just speachless...I know I shouldn't be as we have had conversations about it... but somehow reading it is different. My heart just aches for you guys - this really should not be something you have to worry about. Please know that Jason and I are praying that some wonderful doors will open for your family that will lighten this burden...
love you.

Colleen Gates said...

I love you NIcole! You are so right about this insurance shit. I have felt this exact same way and I'm glad we got to talk a little about it yesterday. I'm going to do some more investigating for you into other funding options. There are non-profits out there that offer financial help. I have a great contact that I just sent an email too and I will let you know what I hear back.

The Patno Family said...

That is horrible. I had similar issues with my PPO insurance after Elisa was born and it really soured me on PPO care. I paid for things that I should've never had to pay for had I had an HMO with the exact same doctors (dr. wasn't listed under the HMO listing so just assumed he was only PPO, later found out he was listed but in a different city. I had no clue until it was way too late!). I wish you best wishes and I want you to know I am always thinking about you guys.

The Patno Family said...
This comment has been removed by the author.
The Beard Family of 5 said...

I wish there was something I could do. You are so thorough in your research and knowledge, I am really hoping that by you talking about it will help point you in a direction that we don't know about to help you with some funding. There has got to be something out there - it's not like people out there that can't afford this stuff don't get to get the care for their children too right? Don't stress now, keep that baby girl in there for 2 more weeks... Let me know if I can help. xoxo

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