Insurance Question...

[tiredandthirsty]

Hello ladies and gents,

i am here with another question.  We have our open enrollment period going on through our company.  and they offer quite a few health insurance options.  the insurance option had chosen since i started with the company (the most expensive at the time considering i might need it some day) was 90/10 UHC with the option of in network or out of network.  obviously, out of network coverage is less compared to in network as expected but it is still covered.  and as some of you know, i am currently active on the list with all approvals and blah blah from UHC.

however, for the past two years there has been another option Aetna (4 dollars more expensive per paycheck) that covers 100% but only in network.  there is no out of network coverage.  i am considering this because sometimes the 90/10 option still turns out to be a lot of money out of pocket.  for example, my fistula maintenance surgery 1200 out of pocket.  100 per paracentesis etc.  so my question is, does anyone know how much hassle it would be to switch insurance at this stage?  or is it even a good idea to consider such an option? considering there might be a situation where i may not have the ability to choose an in network doctor and get treated by whoever?  any thoughts, suggestions, ideas, comments are truly appreciated and thanks a lot in advance. 

[Joe]

When I modified my insurance all I did was give them the card when I had my next visit. The office takes care of everything. If you have a situation where you can't get to a network doc, you would have a problem. Not sure what set of circumstances would cause that, I'd check it thoroughly before changing.

[Sydnee]

I'm sure there is a way to figure out whether dr/ clinic you are wanting to see is covered by the insurance before you switch. talk to HR if they don't have a website with that info.

as for the transplant center I'm sure they will be as easy to deal with as ours when we were forced to change insurance at the beginning of this year. We just called our coordinator and she told us who to give are new info to. 

Check to make sure of course.
I hate open enrollment. Good luck

[Joe]

Even easier is to ask the doctors office and see what insurance they take. They can tell you immediately what works and hat doesn't.

[noahvale]

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[Rerun]

In a surgery you know who your surgeon is going to be but not the anesthesiologist.  They are just as expensive as the surgeon.  I would want the in-network and out of-network also.

[tiredandthirsty]

thank you all for your responses.  apologies but is very difficult for me to respond on weekdays because of work (i am still slaving away and it is 8:10 PM EST).  but i needed a break so i am here :-).

i have read all your suggestions/advice and finally decided to keep the same insurance i have had so far.  for specifically the reason posted by Rerun.  "In a surgery you know who your surgeon is going to be but not the anesthesiologist.  They are just as expensive as the surgeon.  I would want the in-network and out of-network also."

i have already experienced this once. when they did my fistula maintenance surgery, the surgeon was in network but the bloody anesthesiologist was not!!! so i had to pay 700 out of pocket for that.  i didn't get to pick him/her ( i am not sure who it was, or was it even a full fledged anesthesiologist or just some assistant).  so i just took the safe side.  hopefully with God's grace, it is the right decision. 

[lmunchkin]

When John worked fulltime while he was on Dialysis, he had UHC and the company switched to Aetna.  They were In-network with more payment for out of network.  The in network clinic was FMC, but when he was in Hospital and neph wanted to keep a better eye on him when he was released, she had him in DCI.  Aetna would only pay for a portion on that, but thanks to the office manager at primary doctors office, she appealed on the grounds that it was medically necessary for observation of John.  He needed to be watched for awhile.

They eventually paid the whole bill, but it took almost a year before they did. All in all, Aetna paid for everything when we were in-network. They were our insurance company for about 5 years.  We never had to pay anything when he was working! That was wonderful for us.

God Bless,
lmunchkin

[tiredandthirsty]

thank you lmunchkin for sharing your story. 

i am currently working full time as well.  mostly for the insurance reason.  it's good to have that.  sometimes i do struggle especially in the evenings when my energy level gets low some time.

but this is the exact same reason why i decided not to switch i didn't want to add on to the stress that i already have fighting with the insurance company for a year!!  hats off to you for sticking to it.  i i don't have support in terms of someone else taking up this fight for me, so basically if i get stuck in such a situation, it will be I who will have to pick up the gauntlet and carry it for as long as it takes.  and considering i already have my plate full with liver problems, kidney problems, two hernias, i think i don't want to handle more :-).