Monday, January 21, 2013

Change

Change can be hard.

It can also be also be a chance to reflect on what is important.

This sweeping statement sounds somewhat romantic until you learn that I am talking about health insurance.

Up until recently, M was covered on her father's PPO coverage at his place of employment. This worked out pretty well on the day she was diagnosed. We paid about $38 each time we visited a specialist, and about $84 per month on insulin, and $87 per month on test strips. Also, we paid about $50 every six months for lancers, since M only changes them about once per day. Infusion sets cost us about $240 every quarter, so about $800-$1,000 per year.

All of this totals roughly $3100 per year in maintenance.

All very interesting, I'm sure.

But then Daddy got a new job. And insurance doesn't kick in for 90 days.

Okay then, let's get on Mommy's insurance plan: an HMO.

The insurance itself costs less, for sure. And prescriptions are a lot cheaper: $15 for test strips and insulin. Doctor's visits are $10. But M's current endocrinologist is not on the plan. In HMO speak, this means that the insurance will not pay anything toward M's care if we see her current doctor. At least on the PPO, if M's specialist was not on the plan, we would still get some coverage, but not as much as those "participating" in the plan.

So now what?

We have to change doctors.

We have been thinking about this for a while, anyhow.

After all, M's diabetes nurse educator would frequently give us conflicting advice, and although we asked repeatedly to be part of trials, we were never even told if any were going on. I assume that we were put toward the bottom of the list due to the fact that we live over one and a half hours from the hospital.

Fortunately, we have heard many great things about the hospital just 40 minutes away.

Searching the web, I learn which doctors are on our plan, which is somewhat helpful, but I can't find any information about the doctors themselves. So I turn to my new resource: the STAR parents.

I send an e-mail to the group explaining our situation, and within two days I have the names of the two favorite pediatric endocrinologists in the Dartmouth area, as well as the name of a favorite Diabetes Nurse Educator.

I contact our PCP (Primary Care Physician) and request that we be referred to the new doctor. (For all of you Russians out there who are mysteriously reading my blog, we in the States cannot refer ourselves to our own specialists: another doctor must "officially" make the request in order for our insurance to approve and pay for the visits.)

Service was excellent, and within a week I received a phone call from the new hospital confirming an appointment with our new DNE. The copay for the visit was $10.

So an HMO doesn't sound too bad, does it? Lower prescription prices (even if they do give us 100 fewer test strips per month), lower copay prices, a specialist nearby....

Except that if the diabetic stuff hits the fan, and we need to see someone "outside of the plan", the expenses may very well not be covered.

Which is why, after 90 days, we will be switching back to a PPO through Bill's new job. I will continue to remind myself: change can be good. But hopefully after the 90 days, we won't have to make another one for a while.

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