Thursday, February 26, 2009

Apparently I have a Cadillac

Last week while I was at PT, I was told that even though I have the 'cadillac' (the physical therapist's word, not mine) of health insurance, I should call and make sure that my PT is covered. I had already checked and found I can have up to something like 50 sessions a year... Anyway, after a little more discussion, I was told that our health insurance plan was one of the best available.

This is interesting. First of all our co-payment is relatively average or high - $20 per visit. Also, there are some things that just aren't covered that are covered under other insurance plans - most dental work is not covered, scalp prosthesis (better known as chemotherapy wigs), opticians. We end up itemizing this stuff on our taxes and deducting it.

But on the other hand, we have a $300/person annual deductible and then a $5000 annual out of pocket maximum for the family. We pay our co-pay and then they pay 90% of the allowable amount, leaving us to pay the remaining balance. we get our regular prescriptions through a mail order service, which gives $10 refills for a 90 day supply and we get four free refills a year. In a given year, we can never spend more than about $5600 on medical expenses. So I guess in the scheme of things, this is a pretty good deal.

Now I am sure there are those of you out there with lower co-pays or had your wigs paid for by insurance. But do you also have the out of pocket maximum and the deal on prescriptions? Medical insurance is a crap shoot - will you need it or not? If you are a family with a bunch of small children who go to a doctor regularly your needs are different than a single person in their 20's who never goes to the doctor or those of someone like me with a couple of cancers lurking in the background. All I can say is that don't buy your medical insurance based on low co-pays and low premiums because you will probably end up with low coverage. I know people who have emptied their retirement savings to pay for medical bills even though they have insurance.

I am just very glad that we have the out of pocket maximum and wonder how soon we will hit it this year. When that day hits, we do not pay for a single medical expense - no prescriptions, co-pays, nothing. In 2007, I was diagnosed at the end of May and hit that magic number in August. In 2008, we reached it in March. So far this year, I have had to pay co-pays for every visit and feel like I am spending tons of money. Anyway, if this is a Cadillac, I think I'll keep it.

In the meantime, today I have to do work from home before I go to work. I WILL ALSO REMEMBER TO GO TO PHYSICAL THERAPY. MY APPOINTMENT IS AT 11:15AM. I HAVE TRIPLE CHECKED THIS. (Which is good because I was thinking it was at 11AM - but that would have gotten me there early instead of late!) Before that I need to go for a walk (and walk off the flabbiness - or at least pretend to), possibly have a conference call, do work for two different people, prepare for my interview tomorrow, and do a load of laundry. Perhaps I should get off my butt and start moving!

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