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Health Insurance Saga


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11 replies to this topic

#1 barefut

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Posted 02 August 2007 - 03:43 PM

Found out that Washington Basic Health Plans only covers Cellcept at 50%.

SO, even though my premimums with Basic Health may be only $30/month, my Cellcept would cost me more than my COBRA premium!

I have Roche's Patient Assistance Program application in hand to take to rheumatologist for her to fill out her portion and sign. It was like pulling teeth to get them to even mail me the application. It's like you have to apply for an application!!!

So now I am scared to death to send it for fear of being denied.

I wish there was a person who's job it is to provide fast and free counsel to people in my desperate situation. Someone who I could sit down with who knew all the answers and all I had to do is explain my situation and they would say, "Oh well this is what you need. This is the best thing for you, sign here, you're done."

I wonder what would happen to me if I just could not make the COBRA payments anymore (which I can't - sister did and I won't have that every month!)and lost my coverage and then had to be on the waiting list (yes, there's a waiting list too!) for Basic Health and I could not pay for ANY health care or medications. Is there a safety net for me? Would the hospital charity programs cover someone without any insurance at all? I am ready to just throw in the towel - seriously- and call it quits on this insuraqnce nightmare completely. The stress is killing me!

I have been to my car insurance agent and she was so un helpful with regard to health insurance - yea, she sells it but she can't tell you anything about it.

Wish I had Steve Kobrin working for me on this one.

#2 Sweet

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Posted 02 August 2007 - 04:16 PM

I'm sorry you are even having to go through this. It is very difficult and it's hard to figure out.

In one of my PM's to you I suggested you find a "community Health center" near you. Most of these centers have a person like you are wishing for that can sit down with you and help you figure it out. Did you call any of the places I gave you?

Hang in there girl.
Warm and gentle hugs,

Pamela
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#3 WestCoast1

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Posted 02 August 2007 - 05:07 PM

Oh Barefut,
Insurance is SO frustrating, it seems that even the one "in charge" of the plans says that they are there to help you, but I don't buy it! I have learned the hard way that it is up to you alone (unfortunatly) to get the best plan for your situation. I am paying right now for my poor choice.

If you can sit down with the phone handy, write down how much you will be spending on medication, what you can pay for co pays and what percentage you will have to pay over all for procedures. Then take two plans and compare them. Start calling and ask questions from both plans.

One thing to remember about charity type insurance through the county or what have you, is the wait time. If you have an emergency usually the only way to get immediate attention is to go to the ER. Ther are exceptions to every rule....but these are just a few things that I found to be true in the past.

I can only wish you luck and say that I DO feel for you....things will work out!

Hugs &
*WestCoast*

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#4 barefut

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Posted 02 August 2007 - 05:14 PM

Pretty new avatar Sweet. (So was the previous one :) )

I did read up about the community health center on the Peninsula. The closest clinic to me is Poulsbo.

It seems like what I have now though, in the way of my family practice doctor. My clinic is connected to our local hospital, Jefferson Healthcare (formerly Jefferson General Hosp.) and they have a sliding fee scale program which I just got approved for 100% charity. They refer me to specialists at Virginia Mason and they also have a sliding fee scale. I have to reapply for charity every 3 months.

I guess it makes sense that if I am approved for 100% charity for whatever my insurance does not cover, that I would be approved for the same if I had no insurance at all. But it is a scary thing to think of going without any insurance for this reason:
What happens if/when my financial situation changes and I CAN afford health insurance, and DON'T qualify for chairty anymore and then I can't GET any health insurance because I had a lapse in coverage, or I am an individual, or whatever other reason they can dream up?

Then it pays for me to be poor and there's no incentive to crawl out of my hole. That's what turns otherwise good, law abiding citizens into criminals because they go to work "under the table" and don't report cash income just to make ends meet and I am not comfortable doing that.

No one has ever mentioned to me that there are people to help me with this insurance stuff. I am going to call them tomorrow and see if they have anyone who has all the answers. If the clinics you mentioned do then I would hope that there is someone at our hospital with a little time and a lot of knowledge to spare and share.

All this stuff just makes my head spin! Sorry about the personal-ness of this post everyone. Probably not anything in it helpful to anyone else, but it sure feels good to vent about it all. AGH!

Thanks as always, for your help and support Sweet! Your screen name fits you well. :)

Love,
Barefut

PS
The movie "Sicko" starts playing in my town next week. I want to see it - then again I'm not sure if it would be good for my health! (I'd probably blow a gasket! :rolleyes: )

#5 barefut

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Posted 02 August 2007 - 05:15 PM

I actually think it would be easier to just move to England and become a citizen.! :lol:

#6 jefa

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Posted 02 August 2007 - 07:53 PM

I smiled when I read your last post, barefut. Your dollars would only go half as far and just about everything has 17.5% value added tax added on to it - nothing is free! :)

Don't worry about being too personal with your posts. The way I look at it, for every post someone is bold enough to make, there are at least ten people reading who might have a similar problem but would rather not speak up about it.
Warm wishes,
Jefa

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#7 VEGAN

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Posted 03 August 2007 - 12:00 AM

I live in Washington too, and since my symptoms seem to be progressing, I've been trying to plan life after work. I was considering Basic Health too, but now you've given me more to consider. Seems like there are no good options.

Regarding England, when people in countries with universal health care have situations where they have a lot of medical expenses, they don't have to worry & apply for charity, etc. on top of coping with their condition.

It's akin to if we had to pay for the fire department when our house caught on fire. In addition to loosing your home, you also have to deal with paying the fire department. Instead, communities spread the cost through taxes.

I'll take England & their taxes anyday. Even if I never got sick, I wouldn't want my neighbor to have additional worries & expenses when they get sick.

Let's do keep one another posted with insurance ideas since many of us eventually have to deal with this issue.

Peace.

#8 LisaBulman

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Posted 03 August 2007 - 12:47 AM

But over in England things are not so great with health insurance and care. A friend of mine who lives there, his mom needs to have her gallbladder removed. They discoverd this around last December. She is finally having the surgery today!! She had to wait this long to get the surgery done. She has been in pain since December and they made her wait. Like Jefa said it it so much more expensive there!!! The grass isn't always greener.

Hugs,
Lisa
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#9 Sweet

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Posted 03 August 2007 - 05:19 AM

Hey Barefut,

As I've told you before, this lack of a safety net for the working poor or under-insured is near and dear to my heart. I actually wrote a 80 page paper on it, which is now being used in one University for teaching purposes, describing the current plight of those without insurance, how it affects their health and what the solution is. There are so many ways our government could remedy this problem, and my idea was but one. Will it ever happen? Most likely not.

I'm glad that your current clinic has you on their charity program, but I can certainly understand your concern for not being insured. I'm sure the charity program will not play for your cellcept or any other meds you need.

It really is so sad, this whole thing. I understand your feelings on working the system, so many people do, and it just isn't right, however, sometime you are left to fight for yourself and that may be the only answer. One question - have you talked with DSHS (department of human resources). If you qualified to get on "straight" DSHS (welfare) - I use the word "straight" as that means you are not connect to any HMO, they would pay 100% of all of your medical care and meds. I know you don't care to do charity, but it might be worth looking into.

As far as the UK (England, Scotland, Wales) or Australia, NZ, there are many from those places here on the board. I'm sure most of them will tell you the coverage is HORRIBLE there. :) (sorry guys). The health care may be free, but what you get for the "fee" isn't much. It's kind of like "Basic Health" here. They will make sure you get the basics, but anything over and above that you may have to literally die for. Lisa gave a good example and I've heard and seen that happen in many many situations. We by far in the the U.S. have the best health coverage. My in laws live in New Zealand, they have both the universal coverage and have always taken out a private policy as well. They said without it, they would be sitting in the ER for years, hoping to get help.

Anyway, Barefut, I'm really sorry you have to deal with this. I'm here for you whenever you need me. By the way thanks for the compliment on the picture. Last night I tried to put up a new pic of myself as the other one is a couple years old and it just won't let me. I tried over and over. I allowed me to remove the old one, then each time I tried to upload my new picture, it put up a distorted old one. Too strange. So I took the flower. lol
Warm and gentle hugs,

Pamela
ISN Support Specialist
International Scleroderma Network (ISN)

#10 Sweet

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Posted 03 August 2007 - 08:28 AM

Hey Barefut,

I just sent you a PM with the name of a website you might want to look at as an health insurance alternative. :)
Warm and gentle hugs,

Pamela
ISN Support Specialist
International Scleroderma Network (ISN)

#11 Clementine

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Posted 03 August 2007 - 10:45 AM

Barefut,
I am really sorry! I've been there done that with health insurance too. The system is messed up. I hope Sweet has some information that is helpful to you.
Good luck!

Sweet,
I would LOVE to read your article. Is there a chance you could send it to me via email or tell me where I can find it? I am really interested in this too. It's a major problem.

Thanks,
Jennifer

#12 Jordan's Mommy

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Posted 03 August 2007 - 02:03 PM

Hi Barefut,

Have you looked into the drug company that makes Cellcept? A lot of drug companies will give their medications to you for free or for a reduced cost if you qualify. I don't know much about Canadian restrictions on prescription medications or your ability to walk into a store and get it off the shelf (you can do it in Mexico!) but is it possible for you to make the trek north? Also, there are internet drug companies that sell medication out of Canada, and they will ship to the US if you have a prescription. A very close family member of mine did this for years, and the prescriptions were far less than the cost of getting them in the US. Anyone in Canada who has some insight?????

Take care,

Jennifer