When I was first employed with MegaLaw almost 13 years ago I chose Premera as my health insurer – probably because my contribution toward the premium was the lowest one offered. One year and a whole lotta out-of-pocket payments later we opted to go with Group Health. What a relief! Need to see a doctor? Fork over a reasonable co-pay and everything else is covered except prescriptions; and the co-pays for those were even reasonably priced. The only downside is you had to use their pharmacy the same way you had to choose from their doctors. Hubs and I had some disappointing experiences with a couple of the doctors but not Group Health overall.
I had surgery on my knee and paid the same co-pay I would for an office visit. If the doctor wanted an x-ray he gave you a slip and you toddled off to the x-ray department where they took good care of you. Hubs’ weekend in the hospital awhile back was covered in full.
Unfortunately when the original firm I began working for merged to become MegaLaw there were only a few employees in our office still enrolled in Group Health. To “use the firm’s resources more efficiently” we were dragged kicking and screaming back into the world of Premera about three years ago.
Now I need more treatment on my knee. Not surgery thank goodness, but the ortho I consulted recommended a wonder drug which should help buy me some time before I need a knee replacement. My deductible is paid up for the year so I wanted to get in and have this injection (ugh) before the end of the year. Seemed easy enough, the doc’s office called to be sure the wonder drug was covered – it was; and they confirmed since my deductible was met I’d be covered at 80%. Woo hoo! They called me to say they had scheduled me an appointment for January 4. What’s wrong with this picture? Go ahead think about it, I’ll wait.
tick-tock, tick-tock, tick-tock
Yep, January 4 – 4 whole days after my deductible resets to zero. So the whole shebang will have to come out of my pocket. Well, I have an FSA for next year, so I could count on getting reimbursed for it eventually. How much could it be?
After picking myself up off the floor and drying my tears I called Premera, who called the doctor – three times while I stayed on hold. It still comes down to me shelling out $1200 for the drug alone. Add to that the doctor’s fee and the cost for another type of injection for the bursitis in my hip and you can see why I was on the floor weeping and gnashing my teeth. If I can get in before the end of the year my responsibility drops considerably but of course at this late date it’s unlikely. Even a cancellation may not be helpful as I work in a downtown area to which I commute by train. Trains only run in the morning and the afternoon so I’m stuck in town unless Hubs comes to pick me up.
All this heartache over scheduling could easily have been avoided if I was still with Group Health. Need a wonder drug injection? Here’s your referral, see the man and Happy Holidays!