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-   -   Why we must all remain vigilant about how our health insurance plans are administered (https://www.neurotalk.org/peripheral-neuropathy/35317-remain-vigilant-health-insurance-plans-administered.html)

glenntaj 01-04-2008 08:32 PM

Why we must all remain vigilant about how our health insurance plans are administered
 
--at least until the day there is universal coverage (in the US) under a system with far less complexity that's far easier to understand.

In the process of getting together my records for the 2007 fiscal year, in order to get tax returns started, I took a look at my wife's last paycheck stub for the year. (Our family receives insurance through my wife's place of employment, and while we shan't mention names, the company's initials are the Child Care Center of NY. :p ). The employer offers a number of health care plans, and also a flexible spending account for non-reimbursed medical expenses, both are deducted from paychecks. But when I looked closely, I noticed that only the flex plan was designated as being funded through pre-tax dollars; the insurance premiums were not.

This, of course, came as a complete surprise to me. Not having had reason to look closely at my wife's pay stubs previously, I had assumed that all of these deductions were made using pre-tax monies--that is to say, taxes are not figured on the pay until all dedicated deductions are subtracted. Ever since this was legislated, almost every company I know has used this method to save employees money on their tax bills. Given the ever increasing contributions that employees are being asked to pay towards their coverage, this can be a pretty substantial tax saving.

I naturally was not happy, and asked my wife to investigate. I eventually wound up contacting her human resources director. He initially said he thought that insurance premiums did not fall into this category. When I assured him they could--I have previous human resources experience myself--he went to do a little investigating and, surprise, yes, these deductions could be made with pre-tax dollars, and he was going to institute that right away.

The point to be made here is don't assume the employer, union, or organization you get your coverage through always has researched all the options to cut the bill; don't assume they are necessarily competent or vigilant in this area. Scrutinize your statements and materials carefully, and speak up if something seems amiss.

I've probably saved the employees there, on average, several hundred dollars on their tax bills for the coming year. I imagine as this info gets disseminated, though, there's going to be some disgruntlement among employees who are going to wonder why a non-employee had to point this out, why the human resource/benefits people did not investigate the possibility, which means employees there have likely lost significant monies over the past several years. (Don't know if this rises to negligence, but I know I was ****** off. And if I were an executive there, I'd be looking for a new head of human resources.)

The bottom line--beyond the ingrained problems of our current health system, there's a lot of waste, lack of savvy, and plain old incompetence out there. Keep a critical eye out.
__________________

Curious 01-04-2008 08:36 PM

glen, can i copy your post to the communtiy forum feedback? i think it is really important and more should know this.

:hug:

LOL..never mind. thank you for spreading the word.

Alkymst 01-04-2008 09:32 PM

Thanks
 
Glenn,
Many thanks for the heads up and I'm sure many people will benefit from your scrutiny and persistence. I'm fortunate in that my current employer, well for a soon to be very short time, uses pre-tax funds for medical & dental insurance and health accounts too - I've been characterized as "a mother hen with one chick" when it comes to watching these kinds of issues but, bloody 'ell, it's my money.

Thanks again for your post.

alkymst

BEGLET 01-04-2008 09:38 PM

Pre-Tax
 
Hi Glenn - good catch! And one more thing - if an employee has a choice on paying for a long term disablity plan with pre or post tax dollars - it usually means that the benefits they receive - if ever - will be taxed if paid pre-tax and not-taxable if paid with post tax dollars.... in this case if you ever do need to collect LTD - its more beneficial to pay for this one benefit post tax while working...!

shiney sue 01-04-2008 10:07 PM

Glen
 
Thanks,I'm sure going to past this on to my children and they to there friends
and so on...Thanks to you as well K...Saving any amout of money
today is so much appreciated..:hug: Sue

dahlek 01-04-2008 10:23 PM

Glenn, Thanks!?
 
I put both the ! and the ? to it as I left the 'benefits' world long before this stuff went into effect, and believe me, things were boggling enuf before ...but later..turned mind-boggling...This confirms my instincts that good deals weren't always so...

I do know that every new year, when I get the ostensible 'plan benefits' for the next year...I call and GRILL every key aspect as it relates to both my and my DH's coverage..in detail...While every plan known to man has a caveat of: We reserve the right to change this plan without notice...they usually notify you in a 'hummm' 30 day period or something? Then you find yourself up a creek or the like...I'm not that old yet...[so's I'd like to think?] but this whole thing is scary and scaring me beyond. Then more?
Yes, you must keep an eagle eye out for things, but at the same time, we are little voices to do much about it...
If you want, I can look and find the advocacy sources one should/could check out. The 'Beatles' song 'When I'm 64' is holding more fear for me now...ya know? I shouldn't have to be, but is...so far. Wish it were different - truly - j

mrsD 01-04-2008 10:38 PM

I just asked my husband...
 
and he said this was changed about 3 years ago or so for Federal employees. This was done for a long time for military, so the Federal system made it uniform for all other Federal employees. It is an OMB decision.

However, he says there is no law requiring taking the monies out before taxes.
He says it is clearer on the W-2 forms. Otherwise you have to know your tax rate to calculate it all out.

More details here:
http://answers.yahoo.com/question/in...9064557AAAgzKf

Notice you cannot take a deduction if you pay insurance on pretaxed income.

I find this stuff very confusing.... duh?

glenntaj 01-05-2008 07:04 AM

You're quite right, Mrs. D--
 
--this has been available as a choice for about three years now.

What I find ridiculous is that a company that could take advantage of this does not. It's a nice tax benefit for the employees--migth even make them feel better about the company--and doesn't cost the company anything.

True, one can't then take the medical expenses deduction on one's taxes, but since the 7.5% of total income threshold is not met by many people who are employed in companies big enough to have comprehensive coverge anyway, that's pretty much of a wash. Although, to be fair, I think that 7.5% level is too high and arbitrary, and this would become an issue if it were set more properly lower.

Kmeb's point about long-term disability is important, as that's a situation that involves possible income at a later date, and in that situation there are pro and con implications about paying with pre-tax dollars. But I can't see the downside for almost anyone for paying employer-sponsored insurance premiums with pre-tax monies under current regulations.

flsun01 01-05-2008 05:04 PM

great advice...
 
.....and because of outsourcing of HR by so many firms , you are on your own !

nide44 01-06-2008 09:19 AM

Its been a while (30+ yrs) since I haven't been self employed, but I thought that pre-tax benefit payments were a 'no-brainer'.
I used to work in the temporary help industry, & we were always looking for the clients' angles in the benefits packages.
I thought it was a 'given' that most deductions were pre-tax unless otherwise regulated.
When I had employees, my accountant set up their benefits as pre-tax deductions.

BEGLET 01-06-2008 12:49 PM

Nide44
 
Hi - I think probably the benefits to the employer your referring to were as an employer, bringing in a "temp" - the employer was not responsibile for any liabilitites associated with the temp employee's benefits (Social Security, ins, etc) - instead it was written off directly as an expense paid to the temp agency and much less expensive overall for the employer... as far as writing off all your employee expenses as employer liability was an epense you could write off, but the employee paying their share of cost for insurance or items like that - back then I dont think it was legal for them to pay pre-tax! :) (I was "Catbert' the "evil HR director" - remember Dilbert?)

dahlek 01-06-2008 04:23 PM

This is becoming more eye-opening with every
 
post! The world we live in, and what we thought we were entitled to change daily, and how we can best take advantage of what fewer 'entitlements' we have are definitely getting more complicated.
I do know that I, and others here have and are encountering increasingly more difficut experiences in actually getting information out of our insurance companies, personnel offices and so on...Just simple answers and not squirrelly ones would do, thank you very much. I am afraid that the system might collapse on itself at some time.
Then I look at Katrina and all that's happened to that. The insurance companies weaseled out, the states, cities, counties and parishes did the best they could...but they lost probably what? 3/4ths of their tax base in the process? The governments are still around, doing les, the insurance companies have refined their 'policies' and well, more is excluded for/at a higher cost. As we all age, less is going to be include in SS benefits and any medical coverages. I guess I'm grateful I've a little bit of 'equity'....mite last me about 3-5 years IF I'm conservative. Scares me beyond the beyond! - j

MelodyL 01-06-2008 04:42 PM

I'd like to know what is going to become of those over the age of 65 who have no family, no one to care for them?? What happens when they fall ill, and can't take care of themselves??

Do people just come in and put them someplace??

I'm serious. I really don't have any answers.

I'm 60 now and I can take care of me and I can take good care of Alan. But we're 60. What the heck is going to happen if god forbid we are 75 and we can't move our legs or arms because of arthritis and god knows what else we have. And we are living in the same apartment (thankfully we'll not be moving anywhere), so let's just use us as an example.

What happens when we are 75 or 80 and fall completely ill that we no longer can do any shopping, etc. Or fend for ourselves.

Where do people go??? And who comes in and puts us wherever they will put us?? It's not a stupid question. No one thinks of these things way ahead.

I guess I'm just curious.

I once asked my Aunt Lucy (when she was about 70 (and survived breast cancer and a stroke) She lived with my other Aunt, (her sister). I was visiting and I said 'Aunt Lucy, what happens to you when you're 80 and if you don't have any relatives left. She had 5 sisters 5 brothers, and they all died except for the sister she was living with.

Her answer:???' 'I don't want to think of those things". I said 'what do you mean, you don't want to think of those things, you HAVE to think of those things". She just passed me a cup of coffee and said 'No, I can't think about that'. End of discussion.

I won't be that naive. It's not my nature.

I just want to know what can happen to us.

Melody

BEGLET 01-06-2008 04:51 PM

Melody
 
I can tell you what happens - and to those of us who arent 65 but are disabled and have no other help too - if you have any assets you must get rid of them - you are expected to pay for your own in home care as needed until they are gone, etc... when those are gone they will stick you in a state nursing home - and those are awful places..... sad, but thats what happens.... (if you have your health and are able to work - many elderly are now doing just that so that you can try to continue to stay at home or go into assisted living - which is much different then a state home)

dahlek 01-06-2008 05:07 PM

Could we all form
 
large loud vociferous physical communities [back to the 60'-70's Communes?], we could control costs as in co-ops and well, disperse our funds[assets] into the non-profit co-op before all assets are lost? Or something?

Silly thought, I know, but IMAGINE....all of us going on a BUS to go vote...walkers, canes, wheelchairs...voting for X or Y? Imagine the press and the FEAR that it could strike in the hearts of syncophants! How delicious! I might giggle all nite at that mere idea...

Right now you have to be bereft to qualify for many SS benefits, yet others who are not bereft can get same and could do just fine without?
I do qualify, but I don't need it now...Should I file? I mean...now I don't need it? I do not want to be a person to simply collects benefits unless entitled...ya know? Sigh...I am getting more confused. I better stop and learn more about it all-thus get even more confused? Hugs to all - j

HeyJoe 01-06-2008 05:38 PM

IN NYC many older people who for example break their hip or need other long term rehabilitation wind up in BirdColer/Goldwater hospital /nursing home on Roosevelt Island(nice view of manhattan). There is another nursing home in Rockaway(nice view of the ocean) run by the NYC Health and Hospitals Corp. Im not sure what other locations there are. It doesnt take long to go through whatever savings or real estate you may own with the cost of a nursing home. If you sign over assets to your children, there is a formula of so much per month that is deducted from your total worth that they can keep and was at a 5 year maximum, im not sure what it is now. In other words after 5 years of signing it over your children could keep it all. It might be up to 7 or more now, i dont know.

cyclelops 01-06-2008 07:39 PM

Great detective work....I just asked hubby about our premium....our is deducted properly.

As far as health care goes....how can it be a 'free market' if your insurer is also your provider, and your insurer/provider has an exhorbitantly paid CEO? Duh.

If your physician is employed by your insurer (or payor)....is it wise for him to bite the hand that feeds him? Many, many plans now are providers...there are actually fewer and fewer third party payors. I am also wondering how these endeavors get classified 'Not for Profit'. It was not for profit back when churches and or nuns ran hospitals as charitable endeavors...it isn't the case anymore. When I see big bucks for player piano's for hosptial lobbies, I shake my head and wonder who is running the show.

We have the option of HMO or PPO, and we go PPO, with a very large choice of providers, that is paid by a third party...however they are under a contract. At least they are not employed by them.

I spent 11 years in a large HMO, not affilliated with a research facility, and it was the worst experience of my life...Three years after leaving it, I was diagnosed with substantial PN...go figure. If you only have an EMG machine and MRI scanner, and a neurologist who looks like he should be on the set of Frankenstein:eek:....you may get monstrous care.

Isn't your insurer going to save money by providing less...and there really is no one to guard the henhouse.

I feel the docs should be independent of the insurer. Period. Universal health care should be available to all. My daughter spent a year in Germany....they all have universal health care available to any one living legally in their country...she got it as an employed legal alien...AND, you can also get private insurance from your employer as a benefit. Now isn't that novel?:p They seem to make it work just fine.

She also lived in DC and could not find a provider under her private plan...that was a useful benefit.:rolleyes:

Despite all the hullabaloo about lawsuits, it is very, very hard to prevail in malpractice or negligence against any HMO or doc affiliated with them.

I know quite a few docs who gave up practicing or switched to different types of practice after the HMOs and yes, PPOs burned them out (not lawsuits)

A famous politician once said"Too many good doctors are getting out of the business. Too many OB/GYNs aren't able to practice their love with women all across the country" Now I understand why I did not go to med school. rolleyes:


I am still trying to get an answer to why I pay the $35 brand co pay on my generic zolpidem...which doesn't seem to work as well as ambien. Generics are supposed to be $4

Yes, I am aware of the Walmart deal....haven't made the switch....pretty soon we will have our docs at Walmart too....

I am having problems with the logic of healthcare....I need Dr. Spock...oh wait...that is MR. Spock....sorry.

MelodyL 01-06-2008 09:08 PM

Hi Hey Joe:

Thanks so much for that information. You never know when it might be needed.

Our country, well it's a crying shame what it's doing to certain people.

Around my neck of the woods, there are many people coming in from other countries and they are immediately given benefit cards. They go into the supermarkets and pay for their food with these cards. Used to be food stamps. Now it's all on a card. They just swipe the card.

Alan and I don't qualify because we make $100 over the limit (or something like that). But I bet if I came from another country and went to the food stamp place, BINGO, I'd get the benefit card in two seconds flat.

What the heck happened to our country? Why don't they care about our welfare any more??

It's very sad.

Melody

nide44 01-07-2008 10:28 AM

Quote:

Originally Posted by MelodyL (Post 184093)
What the heck happened to our country? Why don't they care about our welfare any more??

Its our reps on DC. They are in the pockets of the big bucks insurance lobby and pharmaceutical firms, to make an Rx plan for SSI 65'ers+ that cannot be understood by a clear thinking 35 y.o.,and has a 'donut hole'
of lotsa $$ out of pocket.
Mrs. Clinton tried to get a national health pan thru when her hubby was playing games in the White House- didn't happen !. She tried.
Now she's campaining to do the same. Think it'll happen?
Until Congress and the Senate have to exist with the same heath care and Soc. Sec. the rest of us do, no one in DC who could make it happen, will give a damn about it.

When I visited the UK a while back, I needed some medical attention because my sciatica decided to put me horizontal for a while. I went to hospital there, and never paid a cent for my emergency treatment, or my medication Rx'd at the time. As a legal visitor, I was entitled to the health care system.

With the US dollar worth less than the Canadian dollar (I never thought that would happen) and Canada's health paln covering every occupant of that country, it might be wise to move over the border, and collect our Soc. Sec. retirement benefits there. Have it deposited to a US bank, and use a debit card with the money exchange....... if'n we gotta.

The US doesn't make sense anymore.
Washington is catering to big business and letting the citizens suffer.
Its time for a change. A big change.
But we may be fooling ourselves thinking that any significant change
will happen, no matter who we vote for.

cyclelops 01-07-2008 10:58 AM

Well, Nide I have to agree with you that the country went to hell in a handbasket.

As for who we vote for...I think it IS important that we vote, and for some one who is focusing on health care and the economy.

My daughter told me during the Bush administration that thousands of laws were changed to bring benefit to large corporations and basically dismantle our democracy....these were little bills, little line item things thrown in. Stuff many did not notice We had one party control here for quite a while....right now it takes a 60% majority to override a presidential veto.

Democrats do not have a 60% majority...plus Dems have one hawk in robin feathers, if you know who I mean.

Maybe the Dems should have control of the senate, house and presidency like the repubs did until 2 years ago.

What about this move to redistrict California to manipulate the electoral college...any one up on that move?

I say we get rid of that electoral college...and make sure people in this country are educated enough to read and make wise choices.

We are in really deep doo in this country and it has been a good long time in the making....this is what happens when people get i-pods and cell phones stuck to their heads, and the travails Brittney Spears becomes news, and single issues sway voters.

I listen to the 24 hour news channels and they drone on and on...about nothing. You get almost NO international news.

I knew I should have moved to Canada five years ago, it isn't that far away for me...I remember looking at real estate and thinking 150,000 Canadian dollars bought me a cute log home up north on a lake. Man we could have retired.

And on the self employment thing...I was employed by employers most of my life....then for 2 years I was self employed and took no salary, therefore made no SS contribution...guess what that does....if you do not contribute to social sec. for 10 consecutive quarters...you can not collect SSI.

I still qualified a few years ago, applied, but..had the docs start to back off...NOW they mention to me, by the way, you are pretty disabled. Uh...now what!

I am lucky my spouse tolerates me, I am supported and have health insurance. If he finds a new chick, well, put me to the curb on Tuesday morning.

25 years of work in the health care profession, no less, up the wazoo...until I turn 62...if I live that long...or I can try to go back to work and pay in again, but right now, that isn't happening. Personally I would love to be back at work, I am bored to death at home sitting on my tuffet....only thing is, who is gonna let me come in when I can, take off for incessant doctor visits and time off for invasive procedures, and all that muck....not to mention....the dreaded drug screen...even if they are legal, who wants that showing up on some employment physical! By the time you explain why you need these meds, do you think they want you on their payroll???

Ugh, the world we live in.

HeyJoe 01-07-2008 12:08 PM

Cyclelops if you are ever self employed again, it might be wise to take a salary of at least 4,000 a year which this year would get you 4 work credits. The amount goes up almost every year but not by that much, so next year you might need 4100, you can look that up. YOu need 20 work credits in the last ten years to qualify for ssdi. SSI is based on income and it doesnt matter how many credits you have.

cyclelops 01-07-2008 01:14 PM

Thanks, maybe when my hands decide to work again, I will take to weilding a syringe again....just be glad it isn't you whose backside I am aiming at. Right now, my thumb isn't strong enough to push the plunger. I have visions of some poor person flailing out of the exam room with a needle stuck in their rump.

Most non patient nursing jobs are full time...and start at 8am...which on many days is when I settle down to sleep for an hour....

Let's see if we can all pick a new career for me...I had landed on free lance writing, but as Glenntaj pointed out...unfortunately that is for free...hmmm.....

The closest bigger city is 30 miles away....

If I could raise Waterhorses, I could make a fortune.

cyclelops 01-07-2008 01:20 PM

My hubby makes a decent living....we are not qualified for SSI, and we should not be.....I just wish the docs had come to the conclusion that this was disabling a year ago, when I still had credits...AND as they say, I should have paid myself first in the business....instead of reinvesting it all. With the economy in a bit of a slump...I think I shall just sit put and scratch veggies out of my garden for a while until the perfect opportunity comes along.

Man are we having bizarre weather....we just had another huge thunderstorm...it was cracking like mid July! I am about 400 miles south of the Canadian border....by way the crow flies. Just about bad enough to turn off the computer at times!!!

For a while I thought the ethanol plant blew up!!!

Yorkiemom 01-07-2008 09:47 PM

New career.... Hmmm. I think I remember that you have some acreage... Maybe you could become a gentlewoman farmer and grow some kind of crops that help stop pain... :) :) :) Heh heh heh....

Cathie

fanfaire 01-07-2008 10:20 PM

My husband works for a small company. There is medical insurance, but only one type, so it's either take it or go without. It is supposedly better than Medicare Part B, but let's just say I'll be wayyyy over my 7.5 percent of my household income spent on medical this year; I'm figuring ten percent at the least.

My husband's employer is considering switching to a new plan, so they had him fill out some exhaustive forms asking VERY detailed questions about my medical conditions, treatments, surgeries, etc. The forms were so complicated that I actually ended up talking with a rep over the phone for an HOUR getting things straightened out. I suspect that I am going to end up making insurance more expensive for everyone where my husband works.

The human resources department doesn't know what to do with me and all my questions. I need to know things like whether a new plan would be creditable compared to Medicare Part B, whether it would be paid with pre or post tax dollars, whether it would be a PPO or one of those new types I can't remember the name of. I don't think it's any big deal to them what they switch over to because none of my husband's co-workers have major health issues, but the answers to these questions could cost or save me thousands of dollars.

Luckily, my previous employer was smart enough to have the LTD premiums be post tax. So my benefits are not taxable at all. Of course, I don't suppose that will matter much in the future if I can't get my benefits reinstated. :rolleyes:

Since I got sick, it seems I've had to become a doctor AND a lawyer AND an accountant. :D These things are so unnecessarily complicated.

fanfaire
:cool:

dahlek 01-07-2008 10:54 PM

Humm, Maybe
 
'contract' Kmeb as a consultant? Probably not, tho as her LTD plan seems to demand certain forfeiture of personal rights...such as volunteering in any way shape or form....
Golly this all can be such the PITS? The only 'consultants' out there only wanna sell you something..that probably isn't what you thought....kind of like cars.

I do know that Kmeb has spend not hours but weeks dealing with folks who have no clue what they are talking about...when she does talk to someone who knows...THEY are surprised... I think I'm lucky having problems that have only taken me days to deal with over this diagnosis/treatment phase...But I expect and anticipate new ones each year...Are our insurance plans outsourcing all med info customer service as well? Somehow I'm feeling more and more that the'service' aspect is getting long and well lost...deliberately. Scares me, it does...yep, scares me...overall. -j

BEGLET 01-08-2008 10:58 AM

Hee Hee
 
In the process of some of my "discovery" of programs last couple of months that even the workers didnt know about - I found going up and up the ladder to find a legitimate answer from those truly in the know was the only way to get help... I have tried to contact two of those at the bottom of the chain in the last two weeks who I had worked with - they have both left their jobs - I'm hoping its promotion (with more training) and not the urge to strangle certain clients!!!!

But yes, some of this some takes so much research - but done wrong - we can pay dearly both health and financial wise...:eek:

MelodyL 01-08-2008 11:30 AM

Please allow me to give you a flash course in how to deal with insurance companies over IVIG coverage. I'm not naming any names. I don't want any private information about me going over the net.

But here's the conversation I had the other day.

They changed the co-pay part of certain portions of the Insurance plan. Where, before there was no co-pay, now there is a co-pay. And because there are so many various parts of the plan, there's different co-pays for different services. There's deductibles for some things and co-pays for other things. And I do know it's all about codes and how something is billed.

BUT, they bill various things differently. Sometimes, it's billed under medication, and that would mean Medicare Part D.

Other times, if it's a blood product, or something to do with a blood product, it's billed under BIOLOGICALS.

So we read the new insurance plan that comes to your house to explain what is covered ...beginning in January 1, 2008.

We couldn't understand many things. We couldn't figure out what the heck was covered, and if IVIG was covered.

So I called the people at the insurance company.

Well, this was the conversation.

Is my husband covered for the IVIG??

Well, lets' see, what is IVIG??" I explained. She said 'oh, that has so many different aspects, so many sub-accounts, so many this so many that. blah blah blah....

I then said 'well, I need to know if we need to have a co-pay because last year there was no co-pay".

Her response: "oh, I see where you are going with this, you want to know what your responsibility will be?" I said 'exactlY" She then said "Oh, I don't know, it's so complicated, your husband's case is very complicated".

I then said "well, if it's too complicated for you, perhaps I can speak to your supervisor". She replied: "I am the supervisor".

I then just stood there staring at the phone because if the supervisor doesn't have any answers, I'm doomed and Alan needed an infusion this month. His last one was December 7, of 2007.

So she's reading, and reading the manual and she goes:

"Oh, AHA!!!!! I see" I said 'what do you see?"

She responds: 'well, exactly what is in this IVIG". So I explain.

Then she goes "Aha, it s a biological product, right". I said 'I would imagine so".

Then she goes: "Oh, then it's 90/10. I said "what the heck is 90/10.

She said "Oh, we pay 90% and you pay 10%.

I said 'oh really, and what if the product costs $5000 and she said 'then you have to pay $500.

I then said: "is that on a per month basis or is that once a year?"

Her response: "I have no idea"

I said: "what do you mean, you have no idea, I have to contact the infusion company, I need to know things".

She said "It's just too complicated"


So I thanked her, phoned back the infusion company, (they are very nice). They did not understand anything this woman said. I told them exactly what she said but they said "we have to call". They called the insurance company and even they DID NOT UNDERSTAND WHAT WAS SAID.

So I simply called them back, mentioned the 90/10 thing, and thankfully we got it all straightened out. I can't go into detail but suffice it to say, Alan is getting his infusion because as the lady on the phone said "this is a life saving product, right?"

I said 'Of course it is". (and now that he has better balance and a bit of feeling in the tips of his toes, what do you think I'm going to say "no, it's not a life saving product".??)

The infusion company was very nice and we worked it out. We'll pay whatever we can afford to pay as a co-pay and that's that.

I have never, in all my born days, have spoken to an insurance company rep (a supervisor no less), who had the manual in front of her, and she says to me "oh your husband's case is so complicated I DONT' KNOW WHAT HE IS COVERED FOR".

We are doomed as a society because if it is this bad now, What on earth is it going to be like in 10 years.

Good grief.

mel

Silverlady 01-08-2008 01:05 PM

You forgot one thing Mel..
 
And when the person you are speaking to doesn't even speak English as their first language, it is even more difficult. I spent hours last week trying to get approvals for two of my medications. They insisted on the generic and I cannot take the generic. It took me three hours on three different days with three different people who didn't understand me to get this straightened out. They acted like they were reading from a pre-determined script. No deviances allowed. Pain in the patootie.:rolleyes:

Billye

MelodyL 01-08-2008 03:35 PM

Billye:

I've never had the pleasure of communicating with a foreign speaking person (insurance companies, I mean). But if I did, I would just switch to whatever language they spoke. That god, I can speak a few languages. You have no idea how handy this comes in sometimes.

I did, last week, have to call up Verizon because did his thing on the computer (once again. sigh), and he downloaded stuff he had no business downloading.

I wound up with a guy in the Phillipines who spoke spanish. He spoke English but he was better in Spanish. So we spoke both.

I finally (after 3 hours), told him: "wouldn't it be better if we deleted the software and downloaded a new version, maybe the original software is corrupt??" He said: "wow, that's a good idea".

I had to waste 3 hours with a verizon tech guy to find my own solution.

jeez.

dahlek 01-08-2008 06:06 PM

Humm. What a GOOD idea!
 
Outsourcing the customer service section of the insurance company to another country...where English is NOT the primarly language...THOSE REPS will never be able to figger this policy out and WE [the insurance companies] will be off the hook?

I suspect, that...IF any of these insurance companies try that...and receive gummint bucks, well they mite be in trouble?

Either way, we get the lowest common denomenator 'value' in terms of customer service rep's knowledge...And once they learn stuff? They're promoted or quit...Hey! After all WE all are calling them angry about every so many things. Vicious cycle...Wonder why the insurance companies never 'poll' us about 'satisfaction' issues?

I won't growl now, I'll just grit my teeth and say - Hope all are safe and sound tonite? - j

HeyJoe 01-08-2008 06:40 PM

judging by the first few primaries for president many people want a change in the way things are being done in this country and in the way insurance companies among others are affecting our lives. oops cancel that!(after hearing the results)


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