Insurance issues

[Guest guest]

I just found out last week that my husband's employer changed

insurance companies, which is GREATLY going to impact the amount we

spend out of our pocket for . They did not inform us they

were doing this, and in fact, sent home new insurance cards 3 weeks

after the policy became effective. During that time period, we had 2

doctor's office visits with a non-participating provider on the new

plan and ordered monthly medical supplies from a non-participating

DME provider. Of course, we wouldn't have done this had we known his

employer switched insurance coverage!

We are going from an HMO (have always had one) to a PPO. I know most

people bash HMOs, but it has been a godsend for us. We already spend

a LOT of money on co-pays for doctors, pharmacy, hospitalizations,

diagnostic testing, etc. even with an HMO. This PPO is going to kill

us. The biggest cost we are facing is to cover durable medical

equipment (DME) expenses and I have no idea what is going to happen

with the GH & Lupron now. We finally got the HMO to approve a Zevex

Enteralite Infinity pump a little over a month ago, and now the DME

company we were using is not a provider under the PPO. It took us

months to get this pump covered. Now we have to start all over, and

here's the kicker - after meeting a $1000 deductible (in which co-

pays for covered services do not count towards), we then have to pay

20% of the DME expenses. We paid nothing for DME on the HMO. Also

unfortunate for us, is that the effective date was 9/1/05. That

means we need to meet our deductible & maximum out of pocket expenses

for this year between now and 12/31, and then we have to start from

zero again in January.

I have to admit I don't fully understand how a PPO works as I have

never had one, but I have read the benefits book from cover to cover

several times, and it doesn't look good for us. For anyone who has

had both an HMO and a PPO, which plan was most beneficial for your

child with extensive medical issues? Does it make sense for me to

add to my insurance policy to provide him coverage under 2

policies? I am covered under my employer - not my husband's, and I

have an HMO for myself, but with a different company. My open

enrollment period is now, so I need to make a decision quickly. Does

anyone know how it works when you have additional insurance coverage?

We are already paying about $260/month for coverage of the kids on my

husband's plan. I'll have to pay another $410/month to add him to my

policy. Is it worth it? We don't qualify for Medicaid or any other

services, but I have read about others on this listserve who also

have health insurance & who get assistance from their state with

medical coverage that is not based on income. If you are one of

these people, how did you get this?

I don't know about the rest of you, but I spend HOURS on the phone

with insurance companies, doctors, hospitals, etc. trying to get

things authorized, correct billing errors, and just get what my son

needs. It is extremely frustrating for me (lucky for the insurance

company I haven't had a nervous breakdown yet, as that would be more

expenses they would have to pay for my psychiatry fees - lol). But

all joking aside, sometimes I feel like I am not far off.... I am

sure some of you can empathize with me. To top it off, is

having surgery on Tuesday, and I have no idea what we will have to

pay for this with the new insurance. Sorry to vent for so long, but

I don't know how else to relieve some of this frustration!

Kim C.