Monday, January 2, 2012

Another Year...A Lot of Dollars

I'll start this blog by wishing/hoping/praying that everyone have a very happy new year!

2012 Here We Come...

I do love the start of a new year. It feels to me, just like what it feels after you've "spring cleaned" your house, all clean and refreshed and ready for any announced visitor to stop by. But...

Yep, there's always a BIG BUT...

When CF is part of ones life it puts a damper to the new year —financially. The new year is when health insurance benefits restart. It's time to meet the annual family deductible which in our case is $4,500!

We have our insurance through my husband's job. It really is pretty good insurance (for us). A few years ago the company decided to only offer insurance with a HSA plan (Health Spending Account). You invest money into this account and it can actually grow funds for you IF you rarely go to the doctor. For us that means $0 gets invested into a growing fund plan. Oh I suppose we could put more money into our HSA but money is tight enough as it is with what we set aside for insurance.

For those who rarely go to the doctor and can actually roll over money, it's not a bad deal. But for families with young kids that get sick only once or twice, this type of account can bite. You see, you must first meet your annual deductible before health insurance benefits kick in. Yep, all $4,500 must be met before any benefits kick in. In our case that means we meet the deductible by March at the latest, then anything health related afterwards is paid 100%. It also means we have to set aside $250 a month to make sure we have enough to cover the deductible to begin with. It's only $250 because the company gives families $1,300 to help cover some of the costs. Now this doesn't include the additional $200 we pay monthly just to have insurance. So that's $450 a month for health insurance.

Oh the things we could do with $450 a month. I know people that set aside this kind of money to travel places, or to buy a new car, or remodel a kitchen, or, or, or...I think you get the picture.

As thankful as I am to have decent health insurance, I'm also frustrated by it. I must go to in-network doctors (can't go to just anyone you know/like/and trust without paying through the nose) and if the doctors prescribe something that is costly (ya, hello CF meds) then it must get a pre-authorization from the health insurance company.


Do you know how this works? I have to deal with this every, single year starting towards the end of the year when a lot of Andrea's CF meds need new prescription orders from the doctors. This is how it works:

1. Doc prescribes med (pulmozyme or TOBI usually is the problem)

2. I take prescription to Pharmacy.

3. Insurance rejects prescription stating it needs a pre-authorization

4. In-house health insurance pharmacy doctor reviews prescription and agrees that a pre-authorization is needed. They want to make sure our doctor didn't think of a different medication we could use. Ya, a different CHEAPER one is what they're looking for.

5.  I call CF clinic and tell them the problem

6. CF clinic calls or faxes necessary paper work needed by insurance.

7. Insurance faxes their paper work to CF clinic for doctor/nurse to sign stating the drug originally prescribed is the only medication that's beneficial for CF needs.

8. Insurance pharmacy doctor looks it over and signs off. Lucky for us it's not denied.

9. Pharmacy is notified and medication is filled.

10. I pick up medication

I try not to get my 'panties all in a bunch' over this, but there have been times I'd rather have a hot poker up my bum, than to deal with health insurance problems.

So, there you have one of many BIG BUTS.


1 comment: