I quit smoking on March 22, 2011 with Electronic Cigarettes

Wednesday, January 14, 2009

why prozac is a number one selling drug

Today I decided to delve off into the world of insurance.
We dont have it. I havent had it in years. Usually its no problem. I mean when you get knocked up after thinking you cant have more kids, it does pose a slight inconvience. But, BR's job offers it, and even though we can scantly afford an extra 500.00 a month taken out of his check, we decided that we should look into it.

And they have dental. All the kids will need braces. And we have cavities galore. I have the worst teeth known to man. THey just break off for no reason, and with each kid they get worse. There is litelry not a tooth in my head that is not filled, fixed, or covered with something. You would think I would stop having places to get cavities, but no, They appear beside fillings, or better yet, the whole filling just breaks off. There is nothing worse than eating and breaking a tooth in half. Not for the physical pain, not for the cosmetic appearance, its when you hold the tooth in your hand, with 3 visable fillings in it, KNOW they cant 'put it back on' and you toss away 400.00 worth of dental work that hurts.

So I called the number listed on the paperwork for BR's dental plan through him employer. .
The lovely automated voice said to pick if I was a broker, provider, employer or employee. I picked employee. So the lovely, voice says "this number is for brokers and employers only, go to our website and get the phone number"
I dont WANT to go to the website. I want a freakin human. They have all this overhead they are always griping about. well Last time I checked, you dont give a weekly stipend to that annoying, upbeat voice. its a one time expendature.

SO, I called it back, got her again. Told her I was an employer. I spent 37 minutes listening to her 'try to help me get to the right department' Instead of giving me to a representative, she would take me back to the que of speaking into the phone for the correct department. Pretty soon I was screaming at the phone and proceeding every yes and no answer with a socially unacceptable word.

I FINALLY got someone. I told them I was inquiring about the dental avaliblity in my area.
"what is your plan number?"
"I dont have a plan, I am trying to decide if I should get one"
"well, with out a plan I cant tell you anything"
"you cant tell me anything about buying a plan, if I dont already have a plan?"
"yes"
"lets go about this differntly, I just want to know, if there are dentists in my area that accept your plan"
"I dont know about dentists, this is the medical part of United Health care"
"okay, can you connect me with the part of UNited health care that screws over dental patience?"
"ohhh, that I can do"
so another round with the automated cheerleader from hell. FINALLY I get another representitive.
"is this dental?"
"are you looking for dental?"
"yes, so are you dental?"
"yes. what is your group number"
"I dont have one yet, I am trying to decide if I should sign up with your company through my employeer"
"are you comparing us to another company?"
"no, I am trying to decide if the cost of your services outweigh the cost of the prozac I will need if I have to call in very often"
"I cant do much with out a group number"
"can we just start with if you have coverage in my area?"
"dental or heathcare?"
"dental"
"well if your company contracts with us, we should cover you"
" I am in a rural area, a satilite office from the headquarters, They are located north of me. I am in the country, and I need to know if its worth the expense"
"well we have two differnt plans"
"okay, I have a peice of paper that says a few things, I just need to clarify them, and find out if there is a dentist around here, do you think with the information provided TO me from my employer we can deduce the plan they subscribe to?"
"I dont know, but if you know a few of the benifits of the plans they have, we might can fiqure out which one they are a member of."
after asking a few questions, repeating everything on the sheet and listening to her 'think' she finally said "well, one plan has no waiting period, and no out of network"
"my paper lists waiting periods for certain procedures and in and out of networks"
"well, it might be plan B"
"is there more than plan A or plan B?
"no, we just offer 2 plans"
"well, by George, we have got that out of the way! Lets go with plan B"
"and what do you want to know?"
"lets start with eligable dentists please"
"what is your zip?"
"my zip is 75951"
"no, there is noone in your area"
"okay, how about within 50 miles?"
"no.. I went 100 miles"
"okay, then lets talk about the out of network"
So, basicly, I would have to pay 65.00 a month, to have them pay 80% of their ALLOWABLE charges, while I had to pay the OTHER 20%, PLUS the office visit of 30.00, PLUS 100% of anything above and beyond what THEY allow.

AND they only pay 1,000.00 per year per member. And 1,000.00 on orthadonics out of network IN A LIFETIME! When I had braces 20 some odd years ago, they were 2400.00. $200.00 a month for the 2 years I was in the miserable and confounded contraptions, 24 months of absolute pain and discomfert, to straiten teeth that are NOLONGER strait. I wore the retainer for the prescribed amount of time. Until it no longer fit because my wisdom teeth started coming in. and I still have crooked teeth.

And they dont cover anything except cleaning and VERY SIMPLE fillings for the first year.
"So basicly", I ask,"I pay you 780.00 for the privledge of using your coverage NEXT year, but only at 80% of your allowable charges, and 100% of anything above and beyond that"
"yes ma'am, that is correct"

*now, my question is, how do I know that I am not getting screwed by THEM and my dentist. Say my dentist KNOWS they only pay 25.00 on a filling, and he needs to make some extra cash for more paper bibs, who is to say that I dont get the special rate of 97.00, while other patients get it for 52.00? Simply because he KNOWS that I have to pay 100% above and beyond what they concider 'eligable"

When I got off the phone with them, I called my dentist. Come to find out, we are out of network for EVERY company. a call to various other dentists in town came up with the same information.

Now, I am begining to remember what a pain it was to have insurance. you end up being tourtured on the phone until you are a) scared to go to a Dr for fear that they will not pay, b) need mental health therapy because of the tramatic expeirince you encounter speaking with someone who has no knowledge of their job and C) have not only lost precious hours of your current life, BUT have taken years off the end of your life with all the agervation and high blood pressure associated with dealing with the less than understandable policies and procedures.

But my torture wasnt over yet.
OH NO.
I needed to call Blue Cross Blue Sheild, to find out some about THAT plan.
For 500.00 a month, I can insure my whole little family. Now, concidering that we dont usually spend 500.00 a year on health care, this is already hard to do.
BUT, you never know-- right?
I mean, I could end up punching a wall when I am on the phone with these people, therefor needing reconstuctive surgary, a cast and possible rehabilitation.

Seriously though, even if my kids get sick and need medicane I go to the Dr that is 75.00 to see us all, then I argue with him about NOT giving them penecillian and get a script for a 30.00 med that everyone can take.
We do this maybe once a year.

Of course, I do need a hysterectomy, and a few other procedures. having 4 kids really messes you up inside. and I want to guarentee that I stop at the magical number 4. I do still get miagraines, and probebly need back on blood pressure meds for them.
And, you cant tell when they will get a broken bone, or a very tragic illness.

SO, I buckled down, told the kids to shut up and called.

I only went about 7 rounds with the mysterious cheerleader from hell this time.
Got someone. Told her what I was doing. She put me on hold. 8 minutes later, someone else came on the line.
I told HER what I was trying to do. She helped me by looking up a few things. BR already has this insurance, so I know that the Dr's we use are in network. But wanted clarification on ER visits and prescriptions (for the prozac I am sure to need if we have to live on 500 less a month AND I have to deal with these people very often).

My first question was simple. On an ER visit, do I have to pay the co-pay, AND if its less than 1,000.00 ( their deductable) do I have to pay it all?
No.
okay. let me get this strait.
"I go to the ER. The bill is 550.00- I pay 50.00 up front. this leaves 500.00. you pay 80.00 on 100.00 so I pay the other 20. which means all I would pay on a 550.00 bill is 150.00"
"approximatly, I would have to have the exact numbers here"
"the exact numbers?"
"yes ma'am, the amount of the visit"
"550.00"
"well but they are never even numbers"
"I understand that, but this is a 'for instance'"
"well, I dont think you would pay that much, 20% of everything is what you would pay plus the 50.00 copay."
"which is 150.00"
"I cant be sure of that ma'am"
Okay, so I am talking to someone who cant function with simple math.
"alright, so lets say this, if my bill is 1050.00, I pay 50 up front, and you only allow 400.00, am I responsible for ANY of the other 600.00?"
"I would have to look at a bill that explained it all and see what came up from our system"
"I wouldnt pay 130.00?, or would I pay part of the price that you dont allow? and would this go towards my deductable?"
"ma'am, until you GO to the hospital, and get the bill, I cant tell you. the system decides it."
"what if the system is wrong?"
"ma'am, its a computer, doing simple math, they are never wrong"
"Okay, lets try something differnt, IF I get something done in a Dr office, say a blood draw, DO I pay the entire amount due to the DR UNTIL my deductable is reached? say their entire bill is 800.00 minus my 30.00 copay. DO I have to write a check for 830.00? or do you take out your 'allowable' and THAT is what I pay, do I pay my part on your allowable, or my part on the amount they request?"
"it would depend on if you are in network or not"
"in network"
"do you want to find a Dr in your network?"
"no, do you not understand what I am asking?"
"Do you have any other questions?"
"yes, precription drug plans-- DO I have to order them through your mail order thing, or can I pick them up locally, and is there an extra charge for locally?
"oh you want to talk about the drug plans? you will need to call the company that handles that, we just do the health insurance."
"okay, I just need to ask one more question, what is CO-insuance stop loss?"
"where did you read that?"
"on the papers they sent home from the job, describing the plan"
"if you have the papers why did you call?, everything is on there"
"no, its really not, I needed clarification on a few things"
"I understand, and did I answer all your questions to your satisfaction today?"
"you didnt answer any questions"
"so, what can I help you with?"

At this point I hung up. There was very little I could do, and with out health insurance I cant afford to have a heart attack or a nervous breakdown.

At least when you are a cash only patient, you KNOW what is coming at you. a screwing. But honestly, I'd rather be screwed ONCE, then I had be screwed MONTHLY, and THEN get a grand finale screwing if I ever need to use said product.

BR had called while I was talking to this delightful woman, and so I called him back. I explained the little that I didnt know, and he said that every joint in his body hurt. He was shivering cold, and felt like death.
Ohhh peachy. He is sick, has what the kids have, and will now miss about 4 days of work. I couldnt afford the insurance this month anyway.


But in my need for total torture and humiliation for the day I called BR's company. To ask a few questions. Come to find out, they no longer have enrollment in January. Its on July 1st.

I did enquire as to the dental. Their headquarters are a few hours north of me. The guy I got didnt even know WHERE the office was down here. Had never heard of it. This company has like maybe 12 yards. they are a small company. But he couldnt fiqure out where I was located. PERIOD.

The kids are being especially bad today. Bow is into everything, Rayley is annoying me and has said mom no less than 400 times, and Matt feels just good enough to agervate them both, but not good enough to entertain them.

OH and speaking of Matt. I got a letter on him from the school.
He has missed 13 days of school as of 1/7. and 4 of them are unexcused.
If I dont start sending him to school, they might decide to take me to court,

It reads, that I am subject to procecution, an its a class C misdomeanor, plus a bunch of other drivel.
NOW, I HAVE sent a note with my child each day he was absent. EACH day. He doesnt always turn to in to the teacher. I am sorry, I am not going to hold his hand. The rules state the CHILD must bring a note. NOt that I can fax it or mail it. HE must bring it.

Second. THEY susupended him for 7 freaking days. NOT in MY control. HAD they not done this, he would STILL be under the amount of days allowed to be absent. AND if I had sent him to school with 104 fevor, they would make me drive 40 miles to come and get him. AND they state he has to be out for 24 hours AFTER he is no longer feverish.

oh and THIS 3 days that he has been out are not included in his little report.
So I called, I got his voice mail.
"This is Michelle Byerly, Matt Byerly's mother. You sent a letter to my home. I have sent in a note EVERY time my son was absent. They have never came back with him, so they are IN your school SOMEWHERE. and he wouldnt have NEAR the absesnes if the DIstrict hadnt seen fit to suspend him for 7 days. Therefor, unless you have something else to discuss, I will concider this matter closed. "

THey really want me to homeschool my children. First they dont have transpertation TO school, and NOW, they are screwing with me because my kid has been sick for 6 days in a entire semester.
Belive me, I dont want my kids home any more than they do. I WANT to send them to school. I need the break. But when I get called FROM the school to come adn get them, and not bring them back for 2 days cause of a fever, I dont get to argue.

Now, its finally past noon. I want a 5th of whiskey and a pack of cigerettes and for everyone to leave me the hell alone.

2 comments:

Tara said...

You described my conversations almost perfectly, only they happen over and over and over and over and over. Apparently failing an IQ test is a requirement to work for the insurance companies. In the last 12,000 calls 11,999 were morons.

Knock on wood- I love my dental insurance, my teeth, what I have left anyone are just plain rotten- I have used my max on dental for the last 5 years and I'm sure for the next 5 until I just break down and get dentures.

The stressed one said...

You described my conversation with the flooring Company, eerily similar.