Why My Health Insurance Sucks

Over the past few Fridays I’ve been making appointments with a variety of my doctors. I’ve seen an optometrist, a dentist, and my general care practitioner. Also, I’ve been back and forth to the pharmacist a few times to get some prescriptions that I need. This Friday I’m going to see a nutritionist, too. But I have to tell you, while I’m going to visit these various care providers, I’ve noticed that my insurance pretty much sucks in all respects.

Below is the bulk of a text of an e-mail that I sent to one of the leaders at my job. The purpose was to explain all of the problems that I’m having with the insurance – frankly, some of this stuff is insane…

Prescriptions: The most aggravating issue that I have is the prescription coverage. My doctor prescribed a certain drug for a condition that I have, but he gave me free samples to use first. Once the free samples were completed, I tried to get the prescription filled and the pharmacy told me that the insurance company didn’t cover the medicine (first they said I wasn’t in their system – a recurring theme as you’ll see). Instead, I have to take two generics – the free samples that my doctor gave me were working very well, too. I don’t mind taking the generics, but now I’m inconvenienced with taking two pills instead of one.

Additionally, I tried to fill the generic prescriptions and one was approved with no problem while the insurance company wouldn’t immediately approve the second one. They wanted additional information from my doctor, which the pharmacy requested. The Pharmacist said that the process should take no longer than 2 – 3 business days, so given the upcoming holiday, I might not be able to get my medication until after Labor Day. [Note: I wrote this e-mail on Wednesday, September 2nd]

Gym Reimbursement: The insurance company has a Healthy Lifestyles program that I am enrolled in. This program offers $150 for reimbursement of gym membership expenses if you go the gym 120 times in a given year. When I switched to my new gym in March I asked if it was covered in the program and they said yes. On a following call with the insurance company, they told me that the visits to this gym would only count if they were made in between certain times of the day (basically when we’re at work). That effectively kills my ability to claim this reimbursement and it makes their program useless.

Request for Information: In one of these calls to the insurance company, I asked them for a package of information that detailed all of my benefits because I, unfortunately, lost the package that the secretary gave me when I was hired (I lost it in the move to Tinton Falls). They sent me a package for those members who are 65+ years old living in Somerset County. I called them back and told them that they must have the wrong guy and that I was 28 and living in Monmouth County while being employed in Mercer County. They apologized and sent out a new package…the same package as the first time. So I threw out both packages since I’m not a senior citizen living in Somerset County and gave up trying to ask them for a listing of my benefits.

Delta Dental: When I went to the dentist two weeks ago, I had to wait an hour before I could be seen by the doctor because the assistant was told by Delta Dental that I wasn’t in the system. Apparently, she called a few days prior to my visit and I wasn’t in the system then, either. I gave her our office contact information, but I was in the dentist’s office at 8am for an 8:15am appointment so there wasn’t anyone in our office who could help that early on a Friday morning. After waiting on hold and going back and forth with the insurance company, I was magically found in Delta Dental’s system and able to see the dentist at 9am.

Optometrist: The insurance company subcontracts their vision coverage to a vision company. I went to the eye doctor about four weeks ago and it took them over an hour to figure out how to bill me AFTER I had seen the doctor. They were on the phone with the insurance company who took no ownership over their contract with the vision company and said that I wasn’t even in their system (they eventually found me). So the eye doctor’s office called the vision company, who said to contact the insurance company. This went back and forth until someone finally got on the phone and figured out what to do and how to bill me.

Pearle Vision: When I was getting my glasses at Pearle Vision, the person helping me pulled up our company’s specific plan with the vision company and it cited that we had a really great plan that covered some parts of the equipment (great discount on lenses). Then when he called the insurance company to get some confirmation number, they wouldn’t speak to him and put him through to the vision company, who bounced him back to the insurance company, who ultimately said that we had no equipment coverage. The folks at Pearle Vision were baffled since their information (which had been updated about two weeks earlier) clearly showed all of the equipment coverage that we should be getting on our plan.

This is where my e-mail ends. However, there is an addition to this mess…

Nutritionist: It turns out that my nutritionist visit (which is essentially preventive care – the stuff that everyone in America should be engaged in) is not covered either. You see, my nutritionist is not registered as a medical care provider and thus can only enter a certain billing code to the insurance company. Well, my plan doesn’t accept that billing code – they only accept nutritionists that bill as medical offices. So I have to pay for this visit out of my pocket.

Here’s my question – if I’m paying for health insurance and I have all of these needs that aren’t being met by the insurance company…why am I paying for health insurance again?

  • Andy

    Damn, sure looks like your health insurance company f^&^%$* you good; I feel your pain though. Why do they charge so much money per month yet we are not covered for everything? they throw out stupid terms like co-pays, deductibles and they say things like “your plan does not cover that”, if you go to the hospital for something they send you a bill in addition to what you pay them every month. They say things like “well that drug is not covered” or “that procedure was not covered”; what a joke. Someone needs to simplify health insurance…..I think we should start a class action lawsuit against these insurance companies similar to what was done in the 1990’s with big tobacco since all they do is over charge and under provide. Hopefully, soon we will have good quality health care like France, Canada and every other first world nation on the globe.

  • http://www.jerseysmarts.com/ Joe


    Yeah, my health insurance got me good. Funny, I thought that I was paying into a system that was there to INSURE me should I ever need any of these types of services. Ha! Foolish though, I suppose.


  • No Name

    I paid for health insurance out of pocket for 3 years $40,000 now business is slow i got nothing.

  • http://vomitcomet.blogspot.com Steve

    You do realize that these providers aren’t in this to help you, right? It’s all about money, just like pretty much everything else.

    and while I’d rather have our Canadian health system than what you have, it’s not perfect either. While people aren’t able to easily get treatments that they need if they can get them at all, our government is busy setting up offices that are supposed to be working on simplifying our health records system but are instead squandering billions of our dollars on consultants to do nobody knows what and billing everything from cars to $15 lunches to us the taxpayers…and that’s just in my province! All of this is going on while joe public gets to sit in an under staffed emergency room for 5 hours at a time waiting to get looked at.

    Amazing that this is still better than the American system, which goes back to how much your health coverage sucks.

  • You got it good

    First of all let me tell you…you have it GOOD! OK..I HAD Delta with a group plan and it’s THE BEST WHEN YOU’RE WITH A GROUP. One of the problems might have been with HR ON your employers end. I NEVER HAD AN ISSUE WITH DELTA DENTAL until I got an individual coverage which was cancl. b/c of hardships. I work for the state and they are tooooooooooooo cheap to offer any dental insurance. I have supplemental, but they don’t pay anything and make you pay a deductable. I pay OUT OF POCKET EXSPENSES FOR EVERYTHING! TO SHOW YOU HOW BLESSED YOU ARE….FOR A CLEANING,X-RAYS AND BITEWINGS IS LIKE 180. You have Delta..you paywhat $25? Free maybe??? Count your blessings. Oh don’t get me started on root canal…for an anterior ..say..oh…tooth #14…659…with Delta you prob get it for only $250 or $300. Don’t say “get it pulled” come on that would leave a visible gap. S o someone has it WAY WORSE THAN YOU.
    Your medical insurance ALWAYS SUGGESTS GETTING GENERICS FILLED (IF THERE IS NO GENERIC FORM THE DISCOUNT IS ADJUSTED FOR THE NAME BRAND) IF I remember correctly, you still get a discount if you don’t purchase generics…it’s just more than the generic…You can’t expect to get Wal-Mart equate pain relief for the price of Bayer Asprin.Wal-Mart brand maybe $2 less, but if you want “the real thing” you have to pay. Unfortunately, that is the case. While some generics are better than others you have to find the right company (Shire, Barr, etc) that works best for you. I know I sure would perfer $10 generic than pay $60 for a 30 day supply. It’s all how you look at it…look at the bigger picture. If you’d like you can take my place and I will take yours…Live a year with my Non-Dental insurance….you would kiss Delta Dental’s feet. While DD did me wrong (yes, they make differences between group and individual plans) They are still good if you are with a group plan. We tried to get our employer at our agency to sign up for DD GROUP…THE …..GAVE US THE THE WRONG # TO THE HEAD OF STATE DEPT..#. APPARENTLY THERE ARE A LOT OF HOOPS TO JUMP THROUGH…SHE DIDN’T WANT TO SO she gave us the # (wrong One) cause they gave us the run around. I can not stress this enough………………BE THANKFUL…I AM more than willing to give you my e-mail adress if you are interested in swapping places with me for a year..try paying 2,000 in out of pocket expenses for non dental insurance. That is exactly what I paid! I had 2 root canals/crowns,and resin based composites.. I hope this offers a little motivation..Girl,you could get veneers if you wanted DD got u covered! I have to wait til 3 more months b4 I am eligable for enrollment after cancellation..then I have to wait another 6 months for basic restorative and a year for major…They (DD) still GOT $100 from me..before they drop me I was 2 monnths away from my 6 month mark..Be happy smile…at least you have pretty teeth to show (or you should)
    Always look on the brighter side cause baby girl…i have it worse than you and someone else has it worse than the both of us put together. Though I still have to pay out of pocket exp…. I (even I) can find some sunshine in my situation..at least I have a job….So if i can find light of my situation …you can find a rainbow through the tiny gliche of DD System.

  • http://www.jerseysmarts.com/ Joe

    I doubt anyone will be able to make it through your entire comment, but some quick items to address. One, I’m a dude and so are all of the other comment posters thus far. Two, you clearly have a problem with your insurance and that is your problem – no one else’s problem. And three, my company pays $1,000 per month for my insurance. Paying $1,000 per month (i.e. $1,000 each month that is taken from my potential salary) should give me a platinum-plated insurance plan – no questions asked.

  • You got it good

    Hey Joe,
    Sorry about that. Did I call you a woman? Now, I think you have it wrong. I don’t have dental insurance period.. I only have supplemental. I never said that my problem was someone else’s problem. I just said, Be thankful. Don’t take it personal. It is not a direct blow. I guess I come from a differnt era than most. I am 29 yrs. old and I have learned to be thankful for my possessions. I begged my mother to sign my workers permit when i was 15 years old and got my first job. I then bought my VERY FIRST PAIR OF NAME BRAND SHOES….Converse’s. Prior to getting my own money we bought things second hand.So i hope you can look at my point of view from a different angle. I understand insurance is based on payroll deduction. There is still a portion your employer pays to the insurance company to make the plan cheaper for employees. You have to pay 1,000 monthly for Delta Dental? That doesn’t seem like a deal. Usually with Delta Dental Group plan it’s like $24 monthly.
    True, insurance companies can really mess with your pockets..Trust me I know.. I pay $18 monthly for supplemental dental and they reduced the amount they would pay for services.. Just an example they use to cover 6 month exams…exrays etc. Now they have a 1,500 dedudctable. Now, who is going to get $1,500 worth of x-rays and cleanings? Two per month without insurance is $190 so even if you got two you still wouldn’t met that 1,500 deductable…They don’t want you to. It is meant torip off. Then, they use to pay 80% for extractions..Now, they only pay 20%. So I am sure you can see why I feel the way I do. If I am not mistakien DD has a 65% allowence yearly on cosmetic dental work.. Have your friends get dental work (like at a different office) then you get dental work done…Then it has to start over the next year. Don’t get mad get even.

    Yes, you should have A PLATINUM -PLATED INSURANCE PLAN!

  • bill

    7vral years ago my wife got a physical and they told her she was having back problems due to large breasts.my wife at 135lbs at age 16 wore a 40d bra so its genetics …they recommended possible surgery to fix the problem but the nurse stated that the insurance company would require her to loose weight to see if that was the cause of the problem before they wouldcover the operation…now tell me,,whose the physician here.

  • Pissed Worker

    FUCK the United States government who is the obvious culprit in this situation. They and they alone are to blame for allowing this monopolization on “We the People”. Obamacare is a scam for PR and a means to screw you and I even more. It will not fix anything, rather it will just PENALIZE those who do not or cannot afford insurance. NOTHING IS FIXED! What is wrong with people? WE NEED A REAL SOLUTION, just give everyone the same treatment and affordability. I am sick of paying for the doctor’s Porsche and vacation homes. YOU ALL SUCK!!!!