Politicians and Insurance

One of the benefits I have is working for the state is supposed to have better benefits and insurance.  When I started working for the state, I never paid for anything. 

Since Act 10 was sent through, I’ve lost pay and benefits.  Last year when my husband and I both had health issues, I ended up with a couple thousand dollars of bills to pay.  Not enough to itemize on my taxes but very much a burden on our budget.  Now this year I went to the ER for a kidney stone.  It was my first one so I had no idea what was going on. 

I got the bill.  Next time I’m staying home and not paying for all the crap.  Again, I’ve been with the state since 2006.  In that time we’ve had to make trips to the ER.  This time I got a bill over and above my co-pay.  The co-pay I believe was $75.  The bill – was nearly $900.  Then I had to do a follow up with a doctor.  That cost me more money.  The doctor wanted me to come back for a second visit.  I set it up but really after I got the bills for the ER and doctor visits, I knew I could not afford another CT scan and doctor’s visit.  I canceled both.

I pay over $200 a month for my husband and I to have insurance.  Back when we were first together, we had insurance that was 80% /20% which meant for every medical thing the insurance paid 80% and we paid 20%.  We had three little kids.  Having this insurance drove us into bankruptcy because we had so many bills between the kids, my broken leg and three surgeries, and some of Ken’s stuff.  Now I’m looking at the same situation with my supposedly better benefits. 

I’m left thinking it’s better to stay home and cope with whatever the problems are rather than going to the doctor or to ER because the cost of it will drive us quickly into a place I don’t want to go.  My choice is to have this crappy insurance which I’m paying for every month and not go for more than checkups.  There’s now co-pays on everything. Beyond the co-pays, I’m getting bills for things the insurance isn’t covering.  There’s no money in the budget for this.  I’m still paying for last years medical bills. 

It’s no wonder the state can’t fill positions.  They’ve lost the edge of having better benefits and strong unions to protect the workers.  Now the state has become a crappy employer where the benefits are sub standard and the pay is mediocre.  It has become an employer who abuses their employees by calling them names and blaming them for the fiscal problems which are caused by mismanagement at the upper levels.  It’s no wonder they can’t get guards for the prisons or keep faculty in the universities or keep clerical workers.  Businesses are offering better everything with less abuse.

The politicians better wake up.  They better start looking at the good of their employees or they won’t be able to run the state.  I’d like to see the governor go into the prisons to be an officer or walk into a classroom and teach students.  I’d like to see our legislators spend 40 hours a week doing clerical work or maintenance or janitorial.  The politicians (on all levels) are great at looking out for them but they suck at looking out for the best interests of the people – which should be their biggest concern.

It’s time to wake up and remember that this is a collaborative affair.  The politician govern at the will of the people.  If they aren’t serving the people, they need to go.  Whatever elections are out there, please go vote.  Please voice your opinion and make yourself heard. 

Medical Bills

It’s been a rough year for us with urgent care and emergency room visits, doctor’s appointments, tests, and procedures.  Last year our co-pays were lower and a few years ago, we rarely saw a bill with our insurance.  We paid our premiums and co-pays and the insurance paid the rest.

Unfortunately that isn’t the case.  Ken had a kidney stone this year.  The emergency room visit cost us nearly $7K.  The procedure they did to blast it was about $23K.  We paid our co-pays but we’re still going to be left with $715 to pay.

One of the benefits for my job – a flex plan.  I set aside money every year for medical expenses.  This year we were going to do eyes and teeth.  That was the plan.  It won’t be happening.  My flex plan funds have been eaten up with co-pays, prescriptions, and tests.  I don’t have enough left to pay the hospital bill for Ken’s procedure.  I’ll be budgeting that in – somehow.

We aren’t done either.  I’m supposed to have an allergy test and sinus surgery this year.  I’m waiting on approvals from the insurance to be able to do these things in the hopes I won’t spend six months on antibiotic.

I guess paying off bills and loans is going to be slower than I hoped.  I look at my budget and wonder how I’m going to fit in yet another bill and the continuing costs.  I start to wonder if I should put off some of the procedures, cut back on prescriptions, and so on.  All in an effort to save funds.  But aren’t I supposed to put my health first?

Next year the state is going to self-insure.  If I’m paying this much now, how much more will I be paying?  I already have a lot of money taken out of my check for benefits and insurance.  How will we manage if I need to set aside more?  These are some of the questions weighing on my mind.  It makes me wonder if I should cope with my health issues and not have tests done.  The allergy test is $1000 if the insurance doesn’t cover it.  I won’t be having it done if the insurance denies it.  The question becomes how much will the insurance cover?  Same with the surgery.  They’ll be knocking me out which means a full day in the hospital if there are no complications.  How much of it will the insurance pay?  How much will go on our ever growing bill?  Makes me wonder if it would be better to wait.  Antibiotics are less expensive but the stress on my body is unbearable.

We’re lucky in that we have good insurance.  I cannot imagine how bad it is for those who don’t have – or won’t have – good insurance if ACA (Obamacare) goes away.  I’m also very concerned with what happens next year with my own insurance.  With self-insurance, I’m betting we will end up paying more – probably a lot more.  This is one of the reasons I am going ahead with the tests and surgery this year.  It is an added stress for me, especially since working for the state means raises are rare and small if you do get one.  I’ll hope we don’t go too far into debt in order to get these things done.

The one good thing – I believe I’ve finally made the last payment for last year’s medical bills.  Now I have to figure out how I’m paying this years.  Anyone want to buy a book?

It’s a Racket

Unfortunately I’m not talking about tennis or badminton.  And yest before you read further – you should probably know this is going to end up being a rant.

My husband went to the doctor for his checkup and was told – you must get tested for Hep C.  He’s not at risk for it, has none of the symptoms.  But it seems to be the latest “NECESSARY” test we’re all supposed to fall in line to get.

The doctor said – the insurance will pay for it.  I wish he’d talk to my insurance because the blood test cost us $67.  To be fair, when I read through Mayo Clinic’s at risk people, he falls into two of the categories.  Perhaps it is worthwhile to have him tested – perhaps.

To me it sounds like yet another way to squeeze money out of the patient and into the medical insanity we call health care – for profit health care.  We’re supposed to get flu and pneumonia and shingles shots.  But not once – no every year.  This pumps chemicals into our bodies – what are these shots really made of?  Also the people who get these shots still get the flu – so what is the point?  I never get the shots and I rarely have flu issues.

We’re supposed to have all these tests – paps smear, mammogram, colonoscopy.  Yes they are important health checks – but do they really need to be so often?  We have a HUGE population over 50 if everyone over 50 is supposed to get these how much money does that make the doctors, hospitals, insurances, and so on.

What happened to a doctor actually taking the time to listen to their patient, address their questions, and showing concern and care for their patience.

I’ve been working with a rheumatologist for six months.  She asks a lot of questions, she’s run up a ton of bills for us in the way of blood tests and xrays and yet, I still don’t have a diagnosis, treatment plan, or relief from the pain I went to her with in the first place.  I’d ask her questions and get brushed off.  The attitude was – do what I say and don’t ask questions.  When I didn’t agree with her next test – which would have cost me even more money and asked for an alternative treatment – she told me no with no explanation.  When I objected, I was told I should find a different rheumatologist.  Yes, I will but it means being in pain for another six months while I wait for an appointment to get in to the new doctor.  Basically the last six months of visits, tests, and drugs has been a complete waste of time.

We need to put health care on the not for profit line.  We need to reign in the insurance companies, the profiteers of the drug companies, and stop the horrible practices currently going on in our medical community.  We need to start treating the individual.

At this stage I don’t trust any of my doctors enough to take their advice at face value.  I don’t believe in them or believe they have my best interest in mind.  I think they are showing up to fill their pockets and don’t care about my quality of life.  Until one of them proves otherwise, I’m going to be stubborn about saying no to everything until they can explain the options available, the reasons they are choosing this treatment over another, and offer me a say in my own treatment.

Updates

The insurance came back early and not with good news.  They aren’t going to pay for anything with my scooter.  I could fight it but don’t really feel I have the time.  I’m waiting for my doctor to get back from vacation to see if he will write a letter for the folding scooter in order to not have to do anything to my car.  He’s back tomorrow but I don’t know if he will call me as it’s his first day back.

Meanwhile, the rheumatologist prescribed drugs to help with the pain but it’s a steroid.  I’ll see how well this goes.  I don’t normally do well with steroids.  She did come back to say she thinks my arthritis is inflammatory.  Part of me is like – see I told you.  Part of me is relieved it isn’t something worse.

My pain levels been through the roof.  I’m still trying to manage and get to work.  I hate missing because I’m in pain but this last week I’ve spent a lot of time laying in the recliner in the dark.  It’s unproductive and a waste of time but when I can’t close my hands, put weight on my legs, move my shoulders without pain searing through me, there’s little else to do.

I have to keep reminding myself to do what I can, to keep looking forward.  There will be an end to this high level of pain and I’ll get back on track with writing and working.  Plus I’m making progress just not at the rate I would like.  I remind myself to give myself a break.

This weekend has been all about errands and a little fun.  Yesterday Ken and I ran errands – pharmacy, post office – and then we went to see Star Trek Beyond.  It was good.  I enjoyed it and there were some great lines – Dammit Spock from McCoy as well as others.

Five Vials of Blood

Five vials of blood – my rheumatology appointment got moved up to this week.  Of course she ordered blood tests and x-rays.  After seeing her, I went to have all this extra work done.  They took five vials of blood from me.  I asked the woman if she was leaving any which made her laugh.

I also got an Explanation of Benefits for the last set of blood tests (cholesterol, uric acid, sed rate) my regular doctor ordered.  Now my insurance premium went down this year – I knew it was going to be bad.  The insurance paid for $88 of labs.  I have to pay $130.  I can just imagine what the rheumatology screening is going to cost me.

I also had x-rays of my hands.  I’m sure these are going to be costly too.  The “savings” in premiums is not going to be a savings.  I had to pay a co-pay at the regular doctor and was supposed to pay one at the rheumatology doctor but their machine wasn’t working.  I’ll end up being billed for it.  Ken’s annual stuff is coming up and I’m sure we will have more expenses with his stuff.

I have good insurance through my work.  We pay through the nose for it.  Up until it was messed with last year by the Governor, it was worth the premium I was paying.  Now I’m not so sure.  All these added costs are going to be difficult.

I know I have it good with my insurance.  It could be so much worse.  However, I’ve not had a raise in at least three years and I keep losing benefits.  It’s frustrating when I’m doing everything possible to reduce costs.

Instead I’m racking up the costs because the doctors want to check for all sorts of things.  The fact is – I have arthritis which is painful.  They don’t know how or can’t treat it to make it less painful.  More money spent to tell me what I’ve known all my life.  I have arthritis and it is painful.

Insurance Companies

My daughter takes a very expensive medication – like $500 a month.  When she got her own insurance, the company refused to pay for it.  Their logic was that there were less expensive drugs out there that she could try.  They told her that for them to pay for this expensive drug then she would have to try these less expensive options.
This sounds reasonable except that this will make the third time she went through the process.  The first time was when the doctor initially prescribed the meds for her.  The second time was when I switched insurance companies (to the same one she has now).  It is in her records that she has done this before but they were insistent. 
Since she can’t afford the drug without insurance, she had to jump through the hoops they demanded.  The first drug – did nothing.  The subsequent three drugs she had allergic reactions to.  The first allergic reaction she had a hard time breathing and broke out in hives.  The other two she broke out in hives.  At one point the pharmacy didn’t want to give her a prescription because she had an allergic reaction to one of the other drugs. 
I made her call me and talk to me while she took one of the prescriptions because I was worried she would stop breathing and not have anyone there to help her. 
It is ridiculous that the insurance company had any say in which prescription the doctor gave to her.  She has been on this medication for ten plus years and it works.  Why mess with that?  Especially when she had already tried other medications that didn’t work or that she was allergic to – this seems wasteful as she now has four prescriptions she has to discard because they didn’t work.  It isn’t saving money if she can’t use them. 
It is ridiculous to change a person’s medication when what they are taking is working successfully.  Isn’t that the point of taking medication – finding what works and sticking to it?  I know it is a lot of money but that is something to take up with the pharmaceutical company not the patient – especially when there was documentation that other medication hadn’t worked.  

Rip Off

My daughter has no insurance.  She qualifies for none of the programs that help people with no insurance because she lives at home.  Maybe we should just kick her out?  I don’t think so.  Johnson and Johnson produces one of the medications – the very expensive medication – she takes.  They have a program which allows her to get assistance from them to get her medication.  For the last year, she has been getting this nearly $700 prescription for free because of Johnson and Johnson. 
She got a call from the doctor’s office to let her know Johnson and Johnson had sent them a form for the doctor to sign for her to continue to take this very expensive drug.  This is great news as we were just talking about seeing what we had to do to continue with their program.  However, the bad news (and you had to know there was some) came when the nurse told Vicki the doctor wouldn’t sign the form unless she came in for a visit. 
Now Vicki has no job, no insurance, no income.  If she goes to the doctor, I have to pay for it.  She was unhappy about a completely unnecessary visit to the doctors’ office as it cost $108.78 for a miniscule visit.  Literally they wanted us to pay that much money to get the doctor’s signature. 
Obviously we had to because we sure cannot afford the roughly $700 a month and this drug works wonderfully for her.  I feel we were robbed.  We had no choice but to pay the doctor for his signature.  Now I know the medical profession will say – we were paying for his expertise and he was being responsible about making sure she truly needs this drug. 
I say it is a maintenance drug and there was no need to review whether it was needed.  Nothing in her health has changed and all they did was rip us off.  Our health care field is broken and we need to fix it.  Maybe the politicians should be looking at that instead of being ridiculous about fiscal cliffs and other idiocy.

Took the Plunge

We bought a minivan.  We found a really good deal and I like it a lot.  We signed the paperwork and got the insurance set up Monday.  We turned over a large check and got the van. 

Ken cleaned out the garage so I can still park it in the garage.  There is a garage door opener right in the van so we programmed that first thing.  I like that feature. 

The best thing about the van is that it has stow and go seats.  I am able to put the seats up and down on my own.  I don’t have to wait for Ken to take out a seat.  We don’t have to figure out where we are storing a seat.  Also when the seats are set up it gives me more cargo space.  I like that because the next time we drive to Georgia it will give us the room to take the scooter with us and still have room for luggage.

Buying a Car

I hate car shopping.  It is complicated and has more impact on the budget than most people consider.  Not only do you have to think about what you are paying for the car, how much it is worth, and what your payments will be but you also have to think about how much your insurance will cost.  Other things to consider is how old the car is, how many miles it has on it, and how soon will you have to replace it?  
For me, I have to look at how it fits.  I’m a large woman with a handicap so I have to fit comfortably and be able to drive without it hurting my bad ankle, knees and so on.  Also I now have a folding scooter that needs to fit in the vehicle.  The scooter allows me to go places I can’t without it.  Many stores provide scooters but they aren’t always charged properly or are available. 
We’ve been shopping.  We have a budget according to what our lender is willing to loan us and what is within our price range for keeping the monthly payments manageable.  I’ve looked at a lot of vehicles.  I’ve done research online for vehicles and vehicle values.
You know what is truly astounding to me?  That salesmen and dealers are more conscious of the tools available to buyers.  Maybe I’m just really anal about this stuff but I don’t want to pay more for a vehicle than Kelly Blue Book or NADA (this is what a lot of financial institutions use to look up car value) says a vehicle is worth.  Also with the research tools available online dealers have to know they aren’t just competing with the dealer down the road but with those 50 – 100 miles away. 
Yet I’m looking at cars and seeing prices that are 3-5K higher than the value of the vehicle.  To me this is a rip off and I question whether they are reputable.  I spoke with our lender and he said by buying a vehicle that overpriced you are instantly underwater on the vehicle.  This means you have an asset that you owe more than it is worth on.  That is not a good financial decision. 
I am struggling with whether to buy a vehicle we can just pay for which will in reality only last us a year or two which will have little impact on our monthly budget.  The other option is to buy a vehicle which will hopefully last us three to six years but will impact our monthly budget significantly.  My third option is to just wait to buy a car until later in the year.  My car does have 193,000 miles on it though. 

Stay tuned to see what we end up doing

Politics…

There is so much going on in our political world right now.  Perhaps I should say there is so much going on in our political world that I am appalled and disappointed about. 
Women’s issues:  The Supreme Court which is supposed to be impartial and fair, just ruled that women were not allowed to have a class action suit against Walmart.  It is interesting to note that the three women on the court dissented (as well as one man) and those who agreed with the ruling were all men.  How is this judgment by our peers?  I think it shows that women still are considered second class citizens.  We still aren’t allowed to make as much as a man.  Women are still undervalued and demoralized.  We are still considered property essentially. 
All the nonsense about Planned Parenthood is another HUGE concern.  What will happen to the poor women who cannot afford health care?  If birth control becomes too expensive and cancer checks are out of reach for women (poor or not) then what will happen?  I’ll tell you what will happen.  Women will go back to having babies every year.  They will wear out their bodies to the point where they die.  Women who use birth control to regulate their cycle and help control heavy bleeding or sporadic periods will find themselves suffering every day. 
Conceal and Carry:  I’m all for the right to own guns.  Everyone touts that this is a right because of the 2nd amendment.  Well the 2nd amendment says:
Amendment 2 – Right to Bear Arms. Ratified 12/15/1791. Note
A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.
I’m not a constitution scholar but to me this says for the protection of and to keep a free state, regular citizens are allowed to have guns.  The historical background for this amendment is because when the British were governing us they took away the citizens guns.  This meant that in a hostile country with Native Americans and wild animals the settlers didn’t have a way to defend themselves or hunt for food.
I don’t know about you but I don’t think that any of us need a gun to hunt for food in our society today.  Having said that, I do believe we have the right to own guns.  I don’t believe that everyone should be walking around with a pistol strapped to their leg or in their purse. 
The guns of today are vastly different than the guns of the 18th century.  You weren’t going to hide a flintlock pistol easily or a rifle for that matter.  Now we have weapons that can shoot faster and further than ever before.  They are smaller and more accurate than ever.  We want to have a law that acknowledges the advancements of this field and also of our societal standing.
Yes our constitution says we have the right to bear guns but does that mean we should allow our citizenry to walk around with guns in their purses and on their bodies?  I don’t think so especially if the person is not trained or hasn’t gone through some sort of process to determine they aren’t completely nuts. 
Collective Bargaining:  I know that people are tired of hearing about this.  Hell, I am sick of the stress and difficulties we’ve had this year.  I want to preface this with a statement.  I’m a union member for five years.  I believe unions do good things in our society.  I also believe that unions have flaws. 
Pre-unions (yup more history lessons) owners of businesses could arbitrarily change any work condition or pay without repercussions.  Some unscrupulous bosses took advantage of the work force and created unhealthy, unsafe, and even deadly work environments.  The industrial revolution was great for the country – got our economy booming and put people to work.  However, it also introduced what most people would agree were horrible working conditions with people working in conditions unfit for anyone and pay was so bad that even the children in the family had to go to work in order to support the family.
Unions came in and said if we all band together than the bosses will have no choice but to come to the table and negotiate fairly with all of us.  This essentially made the work place a more level playing field. 
Here we are a hundred years later, we have safe working conditions (mostly), good wages and benefits, and a regulated work week.  The unions have been successful.  Does this mean they are done?  No because we don’t learn from our past.  The unions have to be able to bargain collectively about every aspect of work otherwise we will revert to the conditions of the past.
In fact, we are already doing that with Walker’s proposal to change child labor laws.  He wants to allow teenagers (16 & 17) to work as many hours as they want.  In a time when parents are unemployed by the millions and people are struggling to make ends meet, should we allow our children to work 40, 50, 60 hours a week in addition to going to school?  Something will give. I guarantee if it is a choice between food on the table for the family and school, school will go by the wayside so that families can eat.
Walker claims that taking away collective bargaining rights will make it easier to balance the budget and accommodate the cuts he proposes.  If he were to talk to the unions and ask for reasonable accommodations, the unions in all likelihood would give those accommodations.  I as a state worker, union member, and tax paper am just as concerned about balancing the budget.  I’ve taken furlough days to help with the budget issues.  Every payday money comes out of my check in order to assist with the balancing of the budget.  Thousands of union workers have made this concession. 
Collective bargaining isn’t just for union workers though.  It is for all workers.  It is the unions that improve working conditions.  Once a union has negotiated for better working conditions or pay then it becomes a standard practice.  This then ripples out to the non-union workers.  Take away collective bargaining and you take away all the protections that workers have – union or not.
Health care costs:  I’ve heard so many complaints about the health care system.  It is broken.  Insurance companies, pharmaceutical companies, and for profit hospitals / doctor’s offices are running our system.  This is why the costs are through the roof.  When we look at profit rather than well-being of an individual we lose what the medical profession is supposed to be about.
We need to take a close look at this industry and figure out a way to regulate and change it so that the costs are not so high.  I don’t know the answers here but I do know that what we are doing isn’t working.  If we continue this way than we are going to end up with even more people who don’t go to the doctor when they should which in the long run ends up costing the system more.
Health is something that should not be dependent on financial status.  Health care should be available to all and at a cost that any can afford even if they only make minimum wage.
There are more issues like the environment, wars, medicare/Medicaid, social security, education but anymore and my head is going to explode…