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Insurance Lessons Learned


…In the School of Hard Knocks

david vs goliath corpBecause right now I’m doing a lot of insurance related things I thought I’d share some “tips” drawn from my own experiences.

Disclaimer:  EVERYBODY is different. I believe these tips to apply to most people but you need to double check when applying them to your own situation.

None of this stuff is new, there are tons of sites out on the Interwebz that can tell you this stuff…

HOWEVER…  whatcha get here is proof that those “tips” — well these “tips” actually do produce results.  I’ve “been there” and “done that” and have the battle scars to prove it.

So, hopefully my experience can help you minimize the pain of dealing with insurance companies whose primary goal is to make money.

You gotta know the rules

My personal experience has shown me that “Insurance companies are NOT your friends“.  Insurance companies are not there to make you healthy or to get you healthy.

They are there to make money. They are a BUSINESS and the less that you use your insurance, the MORE money they make.

Which seems counter productive from the view point of us folks who NEED the medical services.  The insurance company will say “NO” unless they are required by law or by contract to say “yes”.

Don’t misunderstand me — I am not advocating that you try to stick it to the insurance companies and rack up unneeded medical costs.  That is called “fraud” and will get you in trouble.  But what I am saying is that if you and your doctor think you need it then make the insurance company do EVERYTHING it is obligated to do.

Insurance companies are restricted by laws and by the contract to which you agree when you buy the policy.  But they are counting on your ignorance to not utilize all of your benefits.

And they do NOT make it easy to figure out exactly what you can get.  sigh

To protect yourself, you will need two VERY IMPORTANT DOCUMENTS:

  1. Your Policy Handbook — This is your contract with your insurance company. It has TONS of information about your benefits under the policy and sometimes has forms and/or procedural information.  Often, near the front is a “summary chart” that gives you the basics of your policy including Out of Pocket Maximums, Copay information for doctors and drugs
  2. Your Drug Formulary — This is a list of the drugs which are covered or not covered under your policy and the level at which they are covered.  Prices and coverage vary from plan to plan even within the same company.  (see the above disclaimer)

Often these are available online either as a webpage or as a PDF file.  The Drug Formulary is often available as a searchable interface online.

Save EVERYTHING!!!!

Save a copy of every email sent and received.  EVERYTHING!!!!

Why?

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My not so “quick” “quick post” about good stuff that is happening!


Random bits of “good news

Awesome Thumbs Up Sketch (CC)OK folks, I have NOT had my morning coffee so this may end up being a bit of “free association”

HOWEVER… I wanted to share a random assortment of things that have happened in the past little while that are AWESOME.

So in no particular order…

My blood glucose number was 119 this morning…

…well below the 130 max my doctor has set for my “fasting” level.  “Fasting” means “just before breakfast” YAY!

I woke up this morning at a teeny tiny bit just past 9 am.

Yes, you read that correctly.  OMG!  Of course it probably helped that I went to bed last night around 11-ish.  But this is unusual for me.  My normal range is 2am – 10/11 am.

And recently, over the past month and a half, I’ve not been able to get to sleep until 4 or 5 or 6 am after which I sleep 8-10 hours and wake up waaaaaaaayyyy after the “day” has started for most folks,

So… getting up at 9am where I’d really LIKE my wake up time to be so this is great.  YAY!

And this has been the case now for almost an entire week! So my sleep patters may be shifting back to the “typical norm”  YAY!

I went to my doctor yesterday…

…and I had dropped 8 lbs from my last visit to her office.  YAY!

Ringing-In-My-EarsI had gone to her because I have ringing in my ears.  She is trying a couple of things and said she’ll send me to a specialist if the stuff she is trying doesn’t work and stop the ringing within a couple of weeks.  YAY!

Since I was there anyway, she went ahead and did the “follow up” stuff — monitoring my diabetes and high blood pressure and weight management stuff.

I showed her my chart from the blood glucose testing meter and I’ve been 95% within the target range that she has set for my blood sugar.  She was all happy about that!  Woot!

And the reason this “doctor stuff” is unqualified “good news” is because thanks to President Obama and thousands of people who worked very hard to pass and protect the ACA, I am under medical care.  Before qualifying for the ACA subsidiy I would have just ignored the ringing in my ears, and my diabetes and … well you get the picture.  Health insurance is good.  YAY!

Not having health insurance.  BAD. – not “yay”

AND this is “good news” because when I called up to make the appointment, she said that she would bill me for the $20 copay.  She said I could pay it after the first of the month when I get my pension check.  Which is awesome because if she had not said that I would have not been able to go.

My checking balance, the day before yesterday, on Monday, when I called her to make the appointment, was sitting at 67 cents.  Yes, under a dollar.  So having a doctor who cares more about getting me in to see her when I need care than about making me wait to get that $20 copay is a good thing!  A very good thing.

YAY!!!  in fact DOUBLE YAY!

Slllluuuurrrrppppp……  Ahhhhhhhhhhh  — first sip of coffee.

c2013 TxCowboyDancer DesignsYou know that you are officially a caffeine addict when you whole body gives this little shudder of anticipation as soon as you have that first sip.

There is no way the caffeine can have hit your system yet, but the taste buds let the rest of the body know that the fix is on its way…

Oh-so-YAY!

By the way, the cute cat clutching a mug of coffee over to the right is one of my designs from my store: TxCowboyDancer Designs (yes this is a shameless plug) — but check it out when you get a chance.  🙂

My doctor also ordered a standard 3 month blood work panel…

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Trauma, Drama, and challenges this week… …wish me success!


Morning Trauma

omron pedometerI can’t find my Omron Pedometer.  It is gone.  And I’ve gotten used to wearing it every day.

In fact is now part of my “morning routine” to put it on.  Which is a problem.  What I’m doing in this “Journey to Health & Fitness” is one, by one, setting up good habits, rituals, routines, replacing old patterns of behavior with new, better ones.

And to do that requires repetition.  Lots of repetition.  And until the “new” becomes “habit” and the “habit” becomes ironclad rock solid do-it-without-thinking-about-what-you-are-doing type behavior, any deviation can be deadly and devastating.

And it bugs me.  A lot. — I’m actually AMAZED at how much it is bugging me.  I’ve rouned up all the usual suspects and put them in the line-up:  under the edge of the bed, under the edge of the desk, under the edge of the kitchen cabinets, inside the pocket(s) of the clothes I wore yesterday.

I’ve even canvased the neighborhood (literally) — I went out on my balcony and the bridge that crosses the court yard and looked at the sidewalk and the stairs to see if I could see it lying there.

2014.05.03 4.50 AM -- My Come to Jesus moment

2014.05.03 4.50 AM — My Come to Jesus moment

In a bit I’ll put on shoes and go look in my truck to see if it fell out of my pocket yesterday when I went on an errand.  And I’ll check the laundry room to see if it fell out there while I was doing clothes.

BUT IT bugs the crap out me that I am not wearing it!

Recording that little number into the spreadsheet each morning from the day before was an act of validation.  It is/was actual numerical quantifiable proof that I was indeed MOVING my body!

siiiiiiiggggghhhh 

I hope I find it.  I don’t want to have to buy a new one.  Buying a new one isn’t in the budget.

Doctor Drama

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Where Tony’s been hiding and Thank Heaven for the Affordable Care Act


I’ve been out of the loop…

I heard through the grapevine that people from the dance world have been asking “Where’s Tony?”  Hmmm…  Is that kinda like “Where’s Waldo but in cowboy boots?  Read on if you’re curious about what’s been going on and why I’ve not been around the dance scene lately

But first… let me share some good news!  On Jan 1st, I’m getting health insurance and…

I’m going to be able to see the Doctor!!!!!!

Handsome Doctor (CC)No, not the cutie to the right..  LOL  YummME!

First of all… some ground rules:

In this post I’m going to be voicing my opinion at great length on a “hot button topic,” the Affordable Care Act”, something which I’ve never really done on my blog before.

But this is important folks!  And, to answer the question of “Where has Tony been? well, it is sorta necessary.

Setting that aside though for the moment, it is important to let folks know that the the ACA not some remote political fight.  There are real people benefiting from this law.  People like me.  By sharing my story perhaps anyone who reads this can put a “real face” to the issue.

Having said that, I recognize that others may disagree and want to comment and/or voice a rebuttal to what I have to say, which is fine.

However… “No rude or mean comments!!!”  If anyone chooses to make a comment on this post, then awesome, but if you don’t like the ACA (I refuse to call it “Obamacare”) then also fine, you are welcome to post an intelligent politely worded comment and disagree with me.

I have absolutely no problems with people holding different opinions than I, nor with people voicing those opinions, BUT there is no need to be rude or mean or demeaning while doing it.   Any such posts will be deleted, not approved for posting,  and I’ll remove you from my “follow” list immediately.  So just don’t go there!

Say it nicely or don’t say it at all! There is too much of that kind of BS in Washington.  I don’t have to put up with it on my blog.

Now… where was I?   LOL  I do that a lot don’t I… start out with one idea then BAM “Squirrel” I’m off on another topic!  Woot!  I should make a tee-shirt…  Hmmmm… now there’s an idea!  Woot!

I have an awesome Doctor!

LOL kitty RXHer name is Karen King; she is caring and kind and sweet, and efficient and knows her stuff and well, she’s just AWESOME!  And for almost 2 years I haven’t been able to see her about stuff that I really do need to see her about.

Uh… you guys did catch that right?  LET ME REPEAT:

For ALMOST TWO YEARS  I have needed to go to the doctor and to the dentist for things and have not been able to do so because I can’t afford it.  We live in the richest nation on the planet and a citizen of that country like myself has to go without healthcare because of money?

It is just wrong, that a person, an individual, has to ignore health issues and scrabble and scramble to make ends meet while corporations are sitting on BILLIONS of dollars protected by loopholes in the tax law written by the guys they helped elect allow them to keep piling up the wealth while people in this country go homeless and hungry and without health care?

Almost EVERY other major industrialized Western nation on the planet has UNIVERSAL HEALTHCARE for its citizens.  And we don’t?  There is something wrong with this picture.

ACA is getting a bad rap and it should not!

A case study of 1 — “Moi” who thinks it is AMAZING!

ACA imageRather than jump immediately into this big huge philosophical discussion of the ACA and it’s relative merits, let’s talk about this in a “real world” kind of thing.

Bringing it down to a “real person” level

Putting a face on it…  My face to be precise.

And after I’m done…  Read the rest of this entry

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