"Can You Trust Your Health Plan?"

If you haven't thought about it, maybe you should!

Dear Friend,

I am a retired computer professional.  I was 65 years old when I retired, but my wife was younger so I elected to purchase group health insurance through my employer to keep the premium costs down.  We were with a regular HMO plan at the time. Because of her weight, my wife was starting to have medical problems.  Two years ago as health care costs started to spike upwards, my employer decided to outsource retiree health coverage to a large health insurance company.  I trusted my employer to give me a good choice!

Disillusionment!

Boy, was I wrong!  The problems started immediately!  The insurance company offered two types of medicare plans to me, one with drug coverage and one without.  Because the information provided to me about drug coverage indicated much higher cost, I elected to get health coverage for me and my wife without drug coverage. 

I called my new insurance company that December to see if they had set up the correct coverage.  They had set up the wrong coverage!  Repeated weekly calls for the next several weeks did no good.  They had defaulted all company retirees to coverage with drugs.

We were still with our old HMO that December when my wife suddenly developed respiratory failure and had to be rushed to the hospital.  As we went into the new health plan, my wife was still on a respirator in the old HMO hospital.  In early January after three weeks in the hospital, my wife was transported to a skilled nursing facility for recovery. 

I called the new insurance company to see if I could move her to a facility closer to home.  The insurance company representatives misinformed me.  They had not been properly educated about my plan because it was new for that year.  I commuted 80 miles everyday until I had my wife transported home.

More Problems

Although the old HMO hospital did get my wife past her respiratory failure and help her to loose 40 pounds in the process, they failed to turn her properly and she had a huge bed sore in the small of her back when she was taken off the respirator.  It took six months of daily wound care to heal the sore!

I waited six weeks before having my wife transported home.  Skilled nursing facilities have less staffing than hospitals and poorer care as a result.  When you are confined to a bed for more than a day, the muscles of your limbs weaken.  My wife needed physical therapy just to stand up again and physical therapists were available at the skilled nursing facility for daily help.

With the new health plan, I picked a doctor for my wife and I that was close to home.  We had physical therapists coming to our home two or three times a week.  My wife progressed to be able to transfer from her bed to the wheelchair, but not enough to transfer in and out of a car.  We needed to get her to the doctor, so I had to hire a wheelchair transport to  take her to the doctor.

The wheelchair transport had straps to anchor the wheelchair, but like a bus or train, nothing to secure the rider.  I managed to hold on to my wife to keep her from falling during the trip.  The doctor gave my wife a prescription for some new thyroid medication, and we went to the lobby to look for the transport driver.  He was not there!  His dispatcher had moved him to a location 40 miles away.  My wife was very uncomfortable, and we had to wait two hours for transportation home!

Her Doctor Put Her on Hospice!

Our doctor didn't tell us why, but she wanted my wife to come in for lab tests.  Because of the difficulty and costs of using wheelchair transport, we did not want to repeat that experience.  Three months later, her doctor placed her on hospice and resigned.  It wasn't until September, when I had to rush her to the ER and tests were done, that I realized that the doctor had given her thyroid medication that was 1/10th of the dosage she should have had.

At the end of September, my wife went back to the hospital with respiratory problems.  She also had some internal bleeding problems which required a one unit transfusion.  After a week, she went home.  At the end of October, my wife's internal bleeding became much worse, so she returned to the hospital.  This time her doctor had to temporarily plug the bleeding source and replace 6 units of blood.  Her doctors suspected the possibility of cancer and scheduled her for Surgery in the next county where a skilled surgeon was available.  After two weeks, I had to hire an ambulance for the 100 mile post-surgery visit and return.

The Insurance Nurse Said, "Oh MY"!

Late in November, a nurse from our health insurance company called to inquire about my wife.  When I updated her, she exclamed, "Oh my!".  She said she would check again in a few weeks.  Late in December, we received an explanation of benefits for my wife that denied that she was eligible for coverage during the year.  When I called the insurance company, I was told that my wife had been dropped for the calendar year.  The insurance representatives told me that they would have to investigate and call me back after a week.

It was close to Christmas, and I now had no confidence in the health insurance company, so I decided it was time to look for a new health plan!  I was getting telephone calls from some of my wife's providers that the insurance company had requested payment returns from them.

What I Learned!

Before you choose a health plan, it is wise to take the time to investigate the reputation of that insurance provider.  We are very happy with the plan for this year!  We have saved thousands of out-of-our-pocket dollars.  It is November now, and we are still waiting for the final settlement of last year's plan.  Choosing the wrong plan is a costly mistake!  When you don't need to use a health plan, you don't think about it.  Once you need it, it's too late if you have a poor choice!

Regards,

Phillip Work

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