So, about that Dr. visit on Friday.

The start of each new year brings changes.  Lately those changes have been related to my health insurance.  Two years ago my employer got a great deal on a crappy plan and they jumped at it.  One year ago my employer got a less great deal on that same crappy plan minus a few little bits and pieces and increased co-pays.  This year my employer got the same less great deal on a really pretty good plan, actually.  There was one minor hitch, of course.

There is now a $3,000 deductible.  THREE THOUSAND DOLLARS need to come out of our pocket as a family, before my health insurance, which I’m already paying MANY THOUSANDS OF DOLLARS for this year, will pick up a penny for anything beyond an annual physical and the associated routine lab tests.  THREE THOUSAND DOLLARS before they will pay for any prescriptions, any therapy, any sick visits, any diagnostic tests at those sick visits, etc.

Clearly, I’m a happy camper.

We’ve had this visit scheduled since last October.  It is the follow-up visit to discuss the potential ADHD diagnosis and the ongoing sleep issue, you know the one where he DOESN’T SLEEP, the one which is going drive me insane if we cannot get it under control…*deep breath in**deep breath out*….so we kinda, sorta, desperately need this visit out of pocket or not.  It’s a 45 minute appointment.   And it’s going to cost us…

Anyone want to guess?

$650!

10 thoughts on “So, about that Dr. visit on Friday.

  • January 12, 2010 at 11:42 pm
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    Tell me again why you can’t get on the waiver? Because this is insane. I mean really, really insane. I will try and help you any way I can, even if it’s just e-mailing back and forth about the stupidity of the paperwork. All you need is a diagnosis of MR.

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  • January 13, 2010 at 12:30 am
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    Each state has their own waiver programs, we’ve been told repeatedly that we don’t qualify because of income in MA. We’re taking another go at it though, what else can we do? It is insane.

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  • January 13, 2010 at 3:47 am
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    GEEZ that is 1/6 my income.

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  • January 13, 2010 at 9:05 am
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    I think that MassHealth might go according to the childs income, which is zero. We have to buy diapers for Nathan through a special needs website and I’ve been told by our insurance company to apply for MassHealth, even though our income doesn’t qualify. I haven’t looked into it yet. Maybe the trick is knowing how to apply…

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  • January 13, 2010 at 9:12 am
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    Does the FX Foundation have any suggestions or ideas on how to deal with all this “Insurance” jazz that you are dealing with. Isn’t this ridiculous?? With the premiums you are paying too you might think it worthwhile to seek out your own personal insurance. Duhdee is self employed and maybe he could get something through the NASE National Assoc for the Self Employed and then between the two you could end up with some better benefits. Grampy and I got on this plan when he was subcontracting his work 2 years ago. It is a discount plan for everything. Anything is worth a try.

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  • January 13, 2010 at 10:49 am
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    Aimee, I think you are on to something. All of the options I’ve ever discussed with people take the parent’s income into account but I found one last night, MassHealth CommonHealth, that is for disabled children who otherwise can’t qualify for other waivers.

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  • January 13, 2010 at 2:04 pm
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    Wow, that kind of plan does make sense (to discourage overuse of specialists) but only where your insurance costs goes down by the $3000 or your company funds a Health Savings Account for you equal to that amount. And I have not heard of routine sick visits going against the deductible. We looked into MassHealth a couple years back and it seemed only to be benificial if we were going to need expensive equipment, although we of course did not have that deductible to meet. Good luck with the doctor visit.

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  • January 13, 2010 at 3:26 pm
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    What makes me crazy is that yes, maybe there is abuse of specialists. Maybe this would help but…this plan, once you meet the deductible, requires NO REFERRALS. That seems rather counterproductive to me if that is the goal.

    We do have an HSA but we have to fund it ourselves. Helpful.

    Outpatient preventative care including routine tests (1 adult physical per year and well-child visits according the age based schedule) and outpatient family planning services are outside the deductible…nothing else.

    You may want to take another look at the CommonHealth option, the more I’m reading about it…it may cover PCAs, additional OT, ST, PT, assistive tech devices, etc. Even if you never use it…it would be there.

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  • January 14, 2010 at 9:04 am
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    The waiver uses the child’s income. Make sure you are being specific when you ask.

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  • January 14, 2010 at 6:58 pm
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    They aren’t going to tell you that you are filling it out wrong. I think the trick is to fill it out as if you are Monkey. I was lucky to have a DHS worker help me fill it out, and obviously I am in a different state, but the only income she put down was Punkin’s child support. My aunt and uncle’s son also qualifies — they live in a different state than me — and their income is high. They used my cousin’s income. They hesitated to even sign up because they don’t really need it, but they want things set into place in case something happens to them.

    Reply

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