Medical Insurance, What do You have?

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Jenn4dex
Regular Member


Date Joined Mar 2006
Total Posts : 494
   Posted 11/6/2007 4:45 PM (GMT -7)   
OK the company I work for merged with a HUGE international company, so you would think that the new health benefits in January would be cheaper? No they are not. I cannot believe a company that is located in 300 countries doesnt' have cheaper healthplans than what I have now.  So i have to decide between United Healthcare (HMO) which is more expensive or Kaiser, is another option.  A more expensive option than that is Aetna HMO.  EPO's/HMO's only, I can never afford a PPO again. They have a drug plan that is only affordable if you buy 3 months via mail order on ALL drugs. Any opinions on Kaiser? It's further away for me to travel, but I could get significant savings with Kaiser.  Will they prescribe any pain meds if needed? I have to make this decision by next week so any opinions would be appreciated.  I have been told that if you are healthy, Kaiser is fine, but don't get sick.  Please help!


Jennifer
Diagnosed 1/06
CD of Terminal Ileum
Taking Pentasa, Prograf and Remicade, Forteo Injections, Actonel, Calcium and Vitamin D, B12 injections.

Post Edited (Jenn4dex) : 11/6/2007 5:23:09 PM (GMT-7)


JudyK89
Veteran Member


Date Joined Dec 2006
Total Posts : 1986
   Posted 11/6/2007 5:11 PM (GMT -7)   
It really depends on the area you live in. Do they offer any other HMO's besides Kaisar. It wouldn't be my first choice.
Judy
49 years old, Crohn's Disease   
Six resection surgeries, permanent ostomy, adverse reactions to Remicadeback on 6MP for maintenance, hoping for a long remission from this last surgery. 
 
 


mindyk81
Regular Member


Date Joined Oct 2007
Total Posts : 54
   Posted 11/6/2007 5:32 PM (GMT -7)   
I'm on my husband's insurance. He took a new job last year, and I was so thankful. His old company's employee contribution was going to go up from $300 to $750 a month! The benefits weren't all that great either. He got a new job offer right about the time we found out about the increase. It's much cheaper now, and our benefits are awesome.

I hate this time of year because most companies do open enrollment, and you get to see how much it's going to go up. Even his went up a little bit.

Jenn4dex
Regular Member


Date Joined Mar 2006
Total Posts : 494
   Posted 11/6/2007 5:35 PM (GMT -7)   
And I just switched to this job 6 months ago (returned after 7 years working there before in LA), a company that had good benefits. I returned so I could obtain remicade, my last job had a PPO and it was $5,000 per treatment. Now this company was bought out by AIG and I'm so confused. We have more options in Jan, but none are cheaper, except for Kaiser. I'm just tired of this whole insurance thing. All I do is shell out $ and never feel any better. I don't mind going to a new doctor, I need a change and a new opinion, but am just very unsure. All of my extra money seems to be going to copays, drugs and I am still paying off bills from a PPO from 6 months ago. Is this ever going to stop? (I'm in the Sacramento, CA area.)


Jennifer
Diagnosed 1/06
CD of Terminal Ileum
Taking Pentasa, Prograf, adverse reactions to Remicade, Forteo Injections, Actonel, Calcium and Vitamin D, B12 injections.


JudyK89
Veteran Member


Date Joined Dec 2006
Total Posts : 1986
   Posted 11/6/2007 5:45 PM (GMT -7)   
Jenn, do they offer any other HMO's?

I'm in the San Diego area, and while I complain about my insurance (Health Net), and it's not cheap (around $350 a month just for me), I am getting older and I have a nasty disease history. And so far, aside from charging way too much for the Humira, they've been great about covering everything. And the Humira is just because of the way their drug formulary is written up (selft injectable vs. infusion).

They have limits on some things like my ostomy supplies, and my wound vac that I had for 2 months, but overall, it's way cheaper than a PPO and I've had tons of tests and hospital stays.

My sister-in-law has Kaisar and while she says she likes it, she had a neck injury and had to wait months, go through physical therapy (even though they weren't sure what was wrong) before they would approve an MRI. I think Kaisar is great as long as you don't need frequent tests and care. Seeing a specialist isn't always easy, and you won't necessarily see the same one. At least that's how it seems to be down here, it may be different up in LA.

If I were you, I'd get whatever insurance covers Cedars Sinai. Call them and ask what they take and compare it to the list you got from work.
Judy
49 years old, Crohn's Disease   
Six resection surgeries, permanent ostomy, adverse reactions to Remicadeback on 6MP for maintenance, hoping for a long remission from this last surgery. 
 
 


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 11/6/2007 5:46 PM (GMT -7)   
I have anthem blue cross but I think thats a Northeast thing.
26 Year old married female.  Diagnosed w/ CD 3 years ago, IBS for over 10 years before that, which was probably the CD.  Currently on Pentasa 4 pills/4x day, hysociamine prn, nexium, and ortho evra.  Good times!!!
 
 


Jenn4dex
Regular Member


Date Joined Mar 2006
Total Posts : 494
   Posted 11/6/2007 5:55 PM (GMT -7)   
I am in Northern CA now, I moved up from LA and it's been hell ever since! Thanks for your imput.
Jennifer
Diagnosed 1/06
CD of Terminal Ileum
Taking Pentasa, Prograf, adverse reactions to Remicade, Forteo Injections, Actonel, Calcium and Vitamin D, B12 injections.


randynoguts
Veteran Member


Date Joined Jan 2003
Total Posts : 6050
   Posted 11/7/2007 3:32 AM (GMT -7)   
hey jenn4dex. i have 3 insurances. social security, veterans admin. and an HMO. my hmo was purchased/merged with kaiser permanente about 6-8 years ago. i have had no problems with them. i used to get my TPN from them (like 500bucks aday) no questions. i have had most of my 14 surgeries there, again no problems with bills or care. my wife of corse has the same coverage and she has had a few problems. with us it seems the sicker you are the better the care. if that makes sense? now i realise that my HMO like kaiser is a not-for profit. and that seems to make a differance in care. some people hate Hmo's because of denials of care, they are trying to make a profit. the not for profit ones seem to just give you the care you need.
randynoguts 



     http://www.geocities.com/randynogutsweb/


Ltordo
Regular Member


Date Joined Feb 2007
Total Posts : 33
   Posted 11/7/2007 3:49 AM (GMT -7)   
Hi Jenn, I have United Healthcare and am quite happy with them.
They pay for my Remicade infusions at 100%.

58 yr old female
Dx with Crohn's-Colitis January 2007
Meds: Remicade, Aciphex


Sugarmarie
Veteran Member


Date Joined Jul 2003
Total Posts : 1205
   Posted 11/7/2007 5:29 AM (GMT -7)   
Aetna ppo love it they have been very good to me for 10 yrs
Confucius say : He who goes to bed with itchy butt wakes up with stinky finger.

Words of wisdom: Never trust a fart

:) Sugarmarie A.K.A. Poopy Pants :)


skeptical
Regular Member


Date Joined Jun 2005
Total Posts : 369
   Posted 11/7/2007 7:05 AM (GMT -7)   
Wow, I'm so surprised. I had UnitedHealthcare through my husband's job and the ONLY hospital and 80% of the doctors in this county won't take it. It was very difficult during the time I was undiagnosed. I had my surgery 3 counties away. Then my husband and I started our own business (which we love!) and had Cobra for a while (awfully expensive) until we could find a new insurer. Every single one we talked to refused to cover anything having to do with Crohn's disease. They don't cover the B12 shots, GI visits, hospitalization or drugs. I spend about $500 a month just on meds and I haven't seen my GI in over a year because of this. They recently dropped my kids and still it costs over $450 a month for my husband and me. (and not much for me unless I break my arm or something)

We are now looking AGAIN for an insurer. *sigh*

bektold
Regular Member


Date Joined Jul 2007
Total Posts : 456
   Posted 11/7/2007 8:33 AM (GMT -7)   
I have Blue Cross/Sheild of Michigan (my company is based in Ann Arbor, even though I live in Texas), and they've been wonderful to me.  I had a two week hospital stay earlier this year, and they covered the whole thing.  I haven't paid a dime.  In the next week or so I expect to start working on approval for Remicade, so we'll see how that goes.  But all the specialists and tests and meds have been covered, and my most expensive name-brand prescriptions are $30 a pop.  And any time I've had to call customer service they've been very friendly and helpful.  I could not be happier with my insurance.

jdiane
Veteran Member


Date Joined Jan 2003
Total Posts : 1131
   Posted 11/7/2007 8:56 AM (GMT -7)   
Just remember your going to have much more limitations with Kaiser. I have never liked their plan at ALL! I was miserable with them many years ago.
 
 


Jenn4dex
Regular Member


Date Joined Mar 2006
Total Posts : 494
   Posted 11/7/2007 9:33 AM (GMT -7)   
I am still confused but from these responses it sounds like Kaiser has too many limitations. I am at the top of the drug chain pretty much right now, I just finished Remicade, it did not work very well for me, and my doctor through Blue Cross wants to try Humira. I may do the United Healthcare, but hope I can wait for 2 weeks for any brand name drug as it takes 2 weeks through mail order for it to even be near affordable. AIG has a separate prescription drug program, even with the platinum plan, brand name drugs are 4 times the price I pay now with Blue Cross at a local pharmacy. I have never heard of this. Just another sign of the times I guess. Any more imput, bring it on, and thanks for your responses!
Jennifer
Diagnosed 1/06
CD of Terminal Ileum
Taking Pentasa, Prograf, adverse reactions to Remicade, Forteo Injections, Actonel, Calcium and Vitamin D, B12 injections.


rootsmith
Veteran Member


Date Joined Jan 2004
Total Posts : 598
   Posted 11/7/2007 11:26 AM (GMT -7)   
My daughter lives in the Bay area of California and just
switched to Kaiser in Sept. because of a job change.  She has to use their doctors and facilities but that didn't seem to bother her. She's already had 2 crises. The first right away, an emergency visit due to a cat bite and the second, she let one of her prescriptions run out.  She got in right away to see a new specialist.  I have no idea about coverage but I my thinking is so far, so good   
10 years, many tests, 3 gi doctors, Pentasa 1000mg 3x day
diovan, simvastatin and now trying good ol' zoloft


sejinro
Regular Member


Date Joined Aug 2007
Total Posts : 22
   Posted 11/7/2007 12:03 PM (GMT -7)   
I have had Kaiser since I was born into this world. I believe the level of the quality of service at Kaiser really depends on the facility. Historically, it seems the older the facility then worse is the service. I have had emergency and routine care at my local Kaiser without any major issues. Plus, I had a resection as well. I would say, overall, my experience with Kaiser has been positive. Again, it is very location specific. Plus, having some connections doesn't hurt either so that you can choose the appropriate primary care physician, GI specialist, dietician, etc. You, as a Kaiser patient, are allowed to choose the doctor within Kaiser.

Jenn4dex
Regular Member


Date Joined Mar 2006
Total Posts : 494
   Posted 11/7/2007 3:10 PM (GMT -7)   
Kaiser sounds so tempting. Paying $20 for a 100 day med supply vs paying $125 for a 90 day supply through mail (waiting 2 weeks) order sure sounds better. I would have to travel furhter for doctor visits, but still the savings is significant with Kaiser. I go to doctors at UC Davis Medical School and I looked up some of the kaiser doctors and they all went to UC Davis. Ugg. I don't know what to do, I have a few more days to decide. Thank you guys!
Jennifer
Diagnosed 1/06
CD of Terminal Ileum
Taking Pentasa, Prograf, adverse reactions to Remicade, Forteo Injections, Actonel, Calcium and Vitamin D, B12 injections.


Jenn4dex
Regular Member


Date Joined Mar 2006
Total Posts : 494
   Posted 11/7/2007 3:31 PM (GMT -7)   
I have also heard that Kaiser is also kind of behind the times as far as "new drugs" for treatment of chronic diseases? Do any of you have this opinion as well? I only ask becuase I am running out of drugs on the list for crohns anyways? My next one is Humira and have no idea what we would even do after that. I don't think there are any left?
Jennifer
Diagnosed 1/06
CD of Terminal Ileum
Taking Pentasa, Prograf, adverse reactions to Remicade, Forteo Injections, Actonel, Calcium and Vitamin D, B12 injections.


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 11/7/2007 5:27 PM (GMT -7)   
If you are getting on a group plan and they have to accept you either way, why don't you call each plan and ask them your specific questions? Write down who you speak with and if anything is a deal breaker for you get it in writing so you don't get burned later. If you speak w/ an insurance agent the company may be bound by what the agent tells you. If you just talk to a random call center rep this is probably not the case. Most also have a disclaimer when you call that what you are told over the phone is not a "guarantee of benefits."
26 Year old married female.  Diagnosed w/ CD 3 years ago, IBS for over 10 years before that, which was probably the CD.  Currently on Pentasa 4 pills/4x day, hysociamine prn, nexium, and ortho evra.  Good times!!!
 
 


tsitodawg
Veteran Member


Date Joined Sep 2006
Total Posts : 845
   Posted 11/7/2007 5:31 PM (GMT -7)   

I had United Healthcare for first year after being diagnosed.  They were really good about covering my remicade and other medications, but were very difficult about an emergency hospitalization that I had due to a blockage.  It took them 2 years of fighting with a hospital counselor to cover it as medically necessary. 

I have since switched to I.H.C. Select Med and love it.  They actually paid the disputed hospital stay twice even though it was from before I was covered by them.  The hospital counselor kept having to send them a refund because United was the one that was responsible.  I have not had any problems having to qualify for any of my surgeries or procedures either.


malakai
Regular Member


Date Joined Aug 2007
Total Posts : 277
   Posted 11/8/2007 6:55 PM (GMT -7)   
I have Group Health which is a sister company of Kaiser and so far so good. I have to agree with the person that said that it depends on the facility. I go to the facilities on the Eastside Bellevue/Redmond because they seem to have better customer service skills than the one in Seattle. It also depends on the provider in that my PCP believes in integrating western and eastern medicines together and my GI is straight western.

I am not on remicade yet nor humira so I haven't been through the hoops to get that approved, I agree to call customer service and ask them questions on drug formulatries etc. FIND OUT WHAT THE GROUP number is for your work BEFORE you ask them however because the coverages and limitations for each company are wayyyyyy different depending on the individual contracts. Then use that to weigh your decision.

Good luck =0)
Newbie - 35 yrs old Diagnosed: 08/03/07
Meds:
Asacol 3x day
Imuran 50MG 3 x day
Lamictal 125 MG/day for bioloar II


randynoguts
Veteran Member


Date Joined Jan 2003
Total Posts : 6050
   Posted 11/8/2007 9:42 PM (GMT -7)   
jenn and malaki, my group health covered the remicade before it was even approved for crohns. almost 10 years ago or more. i have never been denied a medication that my dr ordered. they also sent me back to Omaha for an evaluation for small bowel transplant.
randynoguts 



     http://www.geocities.com/randynogutsweb/


malakai
Regular Member


Date Joined Aug 2007
Total Posts : 277
   Posted 11/9/2007 2:45 AM (GMT -7)   
Jen good for you for trying to be an informed patient. Hopefully what info you are receiving is helping point you in the right direction at least where to start...

Randynoguts.... thanks for sharing that info regarding group health HMO. I JUST watched Sicko the movie and it scared the crap out of me. I never had to think about a claim never being covered because I never had anything chronic aside from asthma. I will be as dilligent as Jen in my next job. Oh and Jen the reason why I told you to look up the group number was cause a few years back I worked for Premera Blue Cross as a customer service rep and it was amazing to see the differences one group coverage had over another. One would assume they would be all the same but that is how the company saves money when they sign up for insurance.... the exclusion riders.
Newbie - 35 yrs old Diagnosed: 08/03/07
Meds:
Asacol 3x day
Imuran 50MG 3 x day
Lamictal 125 MG/day for bioloar II


teddybearweiser
Veteran Member


Date Joined Oct 2004
Total Posts : 3042
   Posted 11/9/2007 4:09 AM (GMT -7)   
Hi Jenn, I have Blue Cross and Blue Shield PPO for 26yrs.
Hi, I am teddybearweiser, I am a male.
I was diagnosed with crohns disease when i was admitted to the hospital
in 1992, in Jan of 1993 I was back in the hospital for surgery for my crohns. I had part of my right colon resectioned with ilecolonstomy.
 My GI doctor has me on Asacol, Dicyclomine,Imuran,Celebrex and Remicade. B-12 injection once a month.
My Internest doctor has me on Lisnopril-HTCZ and Folic Acid. Diagnosed
with Osteoarthritis July 2007
 


crohnie42
Regular Member


Date Joined Dec 2006
Total Posts : 371
   Posted 11/9/2007 5:54 AM (GMT -7)   
THe Blues of MA. Used to be the The Blues of NH. It is a PPO and expensive
Michele
~~~~~~~~~~~~~~~~~
 
Female Dx'ed with Crohns Disease in 1992
Been on every med for crohns that exists
Several Fistula surgeries
Dx'ed with Colon Rectal Cancer March 2007
Dx'ed with Stage 2 Vulvar VIN
On Chemo and Radiation for 6 weeks
Using Humira with excellent results
IN REMISSION~~~!!!!

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