Health Insurance | JerseySmarts.com

Posts Tagged ‘Health Insurance’

Why My Health Insurance Sucks

Wednesday, September 16th, 2009

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?

Posted in United States Politics | 4 Comments »

Another Option for Healthcare Reform?

Thursday, August 27th, 2009

Going back and re-reading some of my posts over the last few weeks makes it pretty apparent that I’m finally taking a long-overdue interest in my health. Between the optometrist visit, the dentist visit (including follow-ups), and the doctor visits, I’m trying to get myself in the best shape possible. Part of this is because I haven’t been to these various doctors in so long, but I’m really going to these places because I have health benefits and I feel that I should use them…before the government finds a way to mess up healthcare.

Speaking of healthcare, one of the subscribers to this blog (by the way, have you subscribed to the blog yet? If not, go to the top of this page and subscribe there!) sent in his proposal to reform healthcare. It’s interesting, to say the least. Frankly, I think there is merit in the proposal, which is copied below from a recent op-ed:

A proposal to reform medical care and save the federal and state governments and the American taxpayer billions over the long run.

Federal and state governments would pay all costs of a medical school education for students who otherwise would not be able to afford a medical school education. No student would be excluded, provided that upon completing medical school, the doctor would be obligated to provide a percentage of their time and practice for treating low-income patients deemed eligible by federal and/or state governments.

The doctor would be obligated to treat a small percentage of eligible low-income people for free (office visits only). The percentage and number of years of obligation to do so would be decided by peer review. The less money provided to the students for their medical education, the smaller the percentage of their obligation for treating the eligible poor.

Participating doctors would not bill Medicare, Medicaid, insurance companies for the treatment of the eligible poor, thus saving federal and state governments billions of dollars in the long term.

The cost of the free medical school education provided by federal and state governments would be offset by the savings achieved by not having doctors bill Medicare, Medicaid and the insurance companies. Students in any stage of medical school would immediately be eligible to participate.

Doctors would have the option to treat eligible patients in their office, at hospitals or clinics. Clinic space could be provided for out of office visits.

The same premise can be applied for health providers and caregivers willing to participate under the same above rules and obligations. The federal/state governments would defray all cost to all eligible health providers and caregivers to open up their medical practice/office. Doctors, labs, chiropractors, and therapists would be eligible under my proposed program.

The potential saving to the federal/state governments from non billing by participating caregivers would be enormous.

Regarding unnecessary diagnostic tests that are ordered by doctors out of fear of medical malpractice, a meeting of the minds could be convened among federal and state policy leaders, bar association representatives, medical insurers, and health providers, to come to an agreement of understanding as to limiting diagnostic tests deemed unnecessary.

Joseph P. Martino
Millburn, New Jersey

What do you think?

Posted in Random Entries, United States Politics | 1 Comment »

Should the Four-Year Degree be Abolished?

Tuesday, December 16th, 2008

Wick Sloane at InsideHigherEd.com wrote a piece on whether or not the Bachelor’s degree is relevant any more. In fact, he wrote an entire pamphlet on the topic, which is available as a free download at the previous link. Before you judge anything that I write here or the notion that a college education is obsolete, I encourage you to read the brief editorial posted at InsideHigherEd.com. One of the better parts of the editorial:

In MBA speak, the central cost driver of a college education is not health insurance, salaries, rising oil costs, or even costly academic journals. It is the four-year, 36-course structure that determines the cost of a college degree. This model, leading to annual tuitions and fees of $25,000 at public colleges and $50,000 at many private ones, crushes families with $100,000 to $200,000 in cost and debt.

Impossible to imagine the end of the bachelor’s degree packaged into four years? Most of us — households or other enterprises — from time to time take a look at the fundamentals of our budgets and ask, “Is there another way?” As an example, consider the bloodless iPod and MP3 revolution. What happened? A demographic cohort, people roughly 16 to 25 years old who wanted access to one song at a time in a form that could easily be shared among friends, revolted and created a new market when the music industry refused any modifications or price breaks.

Could something similar be brewing in higher education? Maybe a better question is whether something similar should be brewing in higher education?

I financed my own four-year degree and two-year graduate degree and saddled myself with $118,000 in student loan debt in the process. At this point in my life, I’m not bitching about the debt – it’s just a fact of life that I live with (and battle) everyday. Frankly, I think I’m doing pretty good in the battle considering that I started repaying these loans some two and a half years ago and thanks to extra payments against the principal amounts I’ve managed to lower my total amount owed to $105,000. Yeah, it’s still a disgusting number that has stifled my ability to do what other people my age are doing, but I’m making progress.

Since I received a Bachelor of the Arts Degree in English from my undergraduate institution I’ve often wondered about what a college degree really gets a person. Let’s face the facts – the world is built on networks, not on pieces of paper. It’s often a matter of who you know and how you know them that supersedes the competition of two equally qualified job candidates. Keeping this in mind, I’ve always considered my Bachelor’s Degree as my passport; in other words, I think that piece of paper is nothing more than a ticket to get on the train.

Going to college doesn’t “make” you smart. Getting a Master’s Degree didn’t “make” me smart. Sure, getting these two pieces of paper greatly increased my knowledge on a broad variety of subjects, but they didn’t create intelligence where it didn’t previously exist! I was always an excellent student and an eager learner. But high school kids don’t have the access to certain networks that college graduates have available to them.

As an Adjunct Professor at my local college, I encourage my students to take advantage of the opportunities that surround them. Become a member of a campus club, join a fraternity or sorority, take up your Professors on their offers to proofread your work or to stop in and have coffee with them during their office hours. I believe that the main purpose of going to college is to develop the types of networks that will get you ahead in life, not to keep your head stuck in a book. Granted, I do believe that college students have an obligation to be actively engaged in their education. However, the idea of what an “education” is needs to be broadened. English majors should be encouraged to take minors in Business or Information Technology. Those in the Business Department should look at minors in the Fine Arts or Art History.

This mixture of disciplines is not only good for the mind, but it vastly increases one’s social and (eventually) professional network. Unfortunately, not many average citizens can live the American Dream these days by simply obtaining a college degree and announcing to the job market that they’re ready to be employed. Let this be a suggestion to all of my college-age and high school-age readers – take advantage of your time on campus and build a diversified social network. Make the investment now and you’ll be glad that you did later.

Posted in College & Fraternity Life, Student Loans | No Comments »