Right now we have Anthem BCBS through my husband's employer, at no charge to us. This is what I have going at this time to try to get well:
1. I have an appeal in to Anthem, which took me a lot of time and effort, to overturn a denial get me botoxed. I believe very strongly I will win it, they have no leg to stand on. Their review of the literature in making their argument against botox, does not include anything published after 2002. Among other things, I sent them everything that has been published since then. They received my appeal May 11 and have 30 days to review it.
2. I have a phone conference pending with Dr. Feigenbaum in Kansas City, to see if I am a candidate for tarlov cyst surgery. His assistant told me he reviews charts and calls patients every Wednesday, at an average of 3 patients per Wednesday. I am now #7 in line, but he is on vacation until June 20. So I can expect a call in the 1st half of July. They take my insurance which is a Point of Service plan.
Today I got surprise news from my husband. The city he works for has decided to switch insurance providers as of July 1. He doesn't know the name of the company yet, but was told it is an in-state HMO with an option to use it as a Point of Service plan instead if we pay a premium of approximately $300 per month. So how does that effect me?
1. Assuming Anthem uses their full 30 days to answer my appeal, I will be informed after June 11. Even if they approve my appeal, there is no way I will be able to get a hospital procedure scheduled and done by July 1. So the whole process will have to be re-started with a new insurance carrier, and maybe a new provider.
2. My phone conference with Dr. Feigenbaum will not happen until after July 1. His office took all my insurance info so I think they bill for it. I know Dr. Feigenbaum's office won't take the HMO, but if we pay for the POS it is a crapshoot whether they will happen to take that or not. Then, since he has a long wait list for surgery, I have to magically come up with $300 per month for insurance, for quite awhile. At the same time as my husband is taking major pay cuts because the city is broke. That's why they went with some low bidder insurance company too. It will be interesting to see where that extra $300 per month will come from.
So, looks like it is time to start from scratch. I will have to go down to Human Resources next week with a typed list of questions to find out where this is going to leave me. I love the group of providers I worked so hard to find and am dying to find out the name of our new insurance company to find out if any of my local providers and most important, Dr. Feigenbaum, accept this insurance. if Dr. Feigenbaum does not take the new insurance but thinks I am a good candidate for the surgery, I will if necessary pay out of pocket and go deep into debt to do it. Am wondering if I could keep the Anthem BCBS under Cobra instead as that would be less expensive overall, but I don't know if I am entitled to COBRA since new insurance is being offered to me.
This is horrible news to me. I have given it to you wonderful people who have bothered to read it, and now I am going to give it to God and chill out about it. Could not have come at a worse time, huh? If you got this far thanks for reading my rant
Even us non-cuddly-seeming people love hugs!
I also work for municipal, although my insurance isn't free. I pay $200/week for the BC/BS PPO. The Town I work for sends out bids to insurance companies every fall, so there's always the potential I could have a different provider each year. So far, I've been lucky, but ... there's talk about them completely doing away with the PPO plan this fall, only offering an HMO. I fully understand the devastating effect having your insurance change has on trying to get proper medical care. Especially when you've got all kinds of things in the works!
