My insurance premiums have gone sky high

[Horse with no Name]

Our out of pocket expenses are higher. The only thing that has gone down is our generic drug copay ($10) but it is the same formulary list as Walmart's $4 prescriptions.
This is on the heels of my carrier denying a surgical procedure that they initially authorized but now say it wasn't medically necessary--even though the pre-op AND post-op biopsies support the initial diagnosis. I have filed complaints and grievances and feel certain I will win but I shouldn't have to jump through the hoops to do so.
I've also found that a couple of colleagues were planning on having elective surgery and our insurance carrier denied THEM as not necessary. They have to start the fight against them.
I got a packet in the mail today. They have replaced the "Call a Nurse" with a new program. They now "recommend" that we call some anonymous "health coach" before seeking any type of medical care--even an office visit. Basically, if you have a fever, you are to take Tylenol and then call them back with the results before you are allowed to make an appointment. Luckily for us--it is a 24-hour phone line.
Recently our company has also started a "wellness program" that gives you money at the end of the year if you follow the program (Several hundred dollars). However, I filled out the first part of the questionnaire and submitted it and when the second part came up, I realized it was a database that will most likely be used to exclude coverage at some point. One of the conditions was also that they draw a bunch of labwork. I decided that I did NOT want to partake in this program and have been receiving correspondence ever since.
And yeah, I am pissed off about it too!

[thunder rising]

1. "health coach" ... rub some dirt on it. Quit whining. You're OK.

[uppityperson]

2. what bloody insurance company is that?

That looks a lot wrong on a lot of issues.

[Horse with no Name]

3. I have filed a complaint with the State Board of Insurance

I'm just awaiting the results now. And yeah, there is a LOT wrong with it this year.

[uppityperson]

28. Good. Insurance Commissioners need to know this stuff is going on.

[babylonsister]

4. Jeeze. And don't you work in health care? What's going on? nt

[Horse with no Name]

5. Yep. I wish I knew.

We just had a massive layoff. They have relatively taken away our sick time to where we cannot use it without fear of retribution. Our raises are frozen, our hours are cut, and they aren't matching our 401k's this year.
Ultimately--these are huge paycuts that are virtually impossible to factor how much you are REALLY losing.

[Tandalayo_Scheisskopf]

6. What is going on...

Is that they see that changes are on the way, they want to make as much money as possible before the changes and they are instituting programs that they can point to and say "See! We are engaged in preventative medicine! Just like you want! Aren't we good boys and girls??!!", even though the main thrust of such programs is to deny needed care and thus, paying out on the coverage.

Note: They are killing the doctors with malpractice insurance premiums as well.

And you want to know what the biggest driver is in the astronomical rise in concert ticket prices? Show Insurance premiums. Just as an aside.

[Liberal_in_LA]

7. Kaiser Permanente had a call center where the 'nurse' told me to drink coke for an upset stomach.

:eyes:

[TahitiNut]

11. She was obviously a fan of 'Doc Hollywood.'

:shrug:

[Liberal_in_LA]

13. and has stock in Coca cola. lol.

[enlightenment]

21. While one could hope for more from a

'nurse' - coke (especially flat cola or better, coke syrup) is great for an upset stomach . . .

They used to sell coke syrup in drug stores (on the pharmacy side, not the soda fountain side).

[notadmblnd]

22. they still do

[enlightenment]

29. Really? Neat - I'll have to go find it.

The syrup really does work as effectively as any of those vile-tasting anti-vomit OTC meds (can't recall the name of that 'cherry' flavoured crap . . . but anything that tastes so bad that it makes you want to vomit seems counter-productive if you're taking it to prevent vomiting . . .)

Thanks for heads-up!

[proud2BlibKansan]

8. My employer also wants my body fluids as part of a 'wellness program'

I say fuck that. So now I pay an extra $10 a month but it is worth keeping my body fluids out of my employment file.

[Horse with no Name]

9. Can you imagine what they are screening for??

They are BLANKET waivers you sign allowing this.
I was like...uh...thanks but no thanks. I'll pay more money to keep my privacy a little longer.

[TahitiNut]

12. They're screening for Purity Of Essence

:dunce:

[Horse with no Name]

15. I lost that in a backseat in 1978.

They're going to be mightily disappointed.:D

[proud2BlibKansan]

17. I beat you by 10 years

:)

[proud2BlibKansan]

14. I work for a school district

They schedule 'wellness fairs' and set up tables in a high school gym. They expect us to go stand in line, get blood drawn and then pee in a cup for them. Oh and we can take off work to go do this.

The custodian at my school called to set his screening up and they told him to come at 11:47 the following day. He asked them if this was a wellness screening or a military induction. LOL

[OhioChick]

10. How ridiculous.

Insurance companies have to be the biggest bunch of crooks....well almost.

Having a chronically ill kid, I deal with them often and they're always trying to screw you.

On edit: spelling

[proud2BlibKansan]

16. I used to be on the committee that negotiated with our insurance carriers at work

You are so right. They so suck. We rarely got to negotiate at all. They came in with a price in mind and we maybe could reduce it by 10%. Maybe.

[OhioChick]

19. The insurance company that I have now is awful.....

I can make call after call, have treating physicians write letters on my kid's behalf (that treatment is medically necessary) and appeal until I'm half dead.......and they still get denied. Pisses me off. Makes me wonder what the hell I'm paying for.

[Horse with no Name]

20. Start filing complaints with the State Board of Insurance

That's what they are there for.
I was able to do it online and then fax the supporting documentation.
If you can possibly get your provider to do it--it will carry more weight:
http://www.ohioinsurance.gov/Company/insprmpt5.htm

[OhioChick]

24. Thanks for the advice and link!

I really appreciate it. :)

[PDJane]

18. What I would like to know

Is why the cry of not being able to choose your doctor, wrong though it may be, is such a slam against 'socialized medicine' when you can't actually choose your own doctor under most insurance plans anyway?

The only viable method to cover everyone is single-payer healthcare. Take the profit motive out of both coverage and procedures. Hell, the US spends more per person on health care than anywhere else in the world, and you still don't cover everyone.

While you're at it, institute drug price controls. You're the only nation on earth without them.

By the way, I wouldn't allow my employer to study my bloodwork either; I am quite sure that the process is not for the sake of benevolence.

[SoCalDem]

26. No employer should EVER have the power of life & death over an employee

and when THEY control your health care or access to it, that's exactly what they are doing..
An employer should hire people to do a task, and then pay them for doing that task.. They should not have any right to know how much you exercise at home, or if someone smokes in your house or if you drink beer at home.

They CAN set rules that mean no drinking or smoking at work, but what you do when you are not doing their assigned tasks for a paycheck, should be none of their businesses.

By "giving" you health care, they become your "nanny" since some amorphous "3rd party" is setting rates THEY pay "on your behalf", based on your private behaviors..which are inherently NONE OF THEIR BUSINESS..

Insurance and employers HAVE to be taken out of any medical plan ....(which is why we will never have nationalized medicine...one of many reasons)

[B Calm]

23. My employer kicked my wife off the group health insurance plan. They

came out in December announcing that if your spouse worked at a place that provided health insurance, he or she could no longer be on your family plan. Thus forcing my wife to go through her employer for her health insurance and paying a lot more than what my plan cost.

[Horse with no Name]

25. That's BS

:(

[deaniac21]

27. You'd probably be better off calling a cab than a nurse. Their

medical knowledge is woeful.