Re: tidbit

On 2008-10-08 21:14:04 -0400, Juniper <juniper@asarian-intl.org> said:

> In article <2008100817200516807-Nahanton@comcastnet>,
>  Nahanton <Nahanton@comcast.net> wrote:
>
>> I pay
>> out of pocket for BC/BS and even my rx's are through the roof.  I'm in
>> that "donut hole" and I've been paying about $400 a month for
>> prescriptions since landing there.  The whole thing is mind-boggling to
>> me.  It seems to me that I pay a lot for medical insurance and rx
>> insurance, and I still have to pay hundreds out of pocket!!
>
> I would double check, since you are paying for some BCBS plan.  You
> might want to consider changing plans, too.  I have BCBS PPO, which is
> excellent, but I get it through my employer, so I don't have to pay an
> arm and a leg for it.
>
> PPO means they have a network of clinicians where I just have to pay a
> copay, but I can see anyone else outside the network and just file for
> reimbursement differently (maybe ending up paying a bit more, since they
> usually reimburse 80% of the charge out of network), plus I don't need a
> referral to see anyone or get any service.
>
> My therp happens to be in the network (as are my primary care physician,
> my psychiatrist, my endocrinologist, and my ophthalmologist), so after
> my annual deductible ($250) is paid, I pay him a $20 copay every session
> until I've used up my 40 sessions.  Then I pay him the full $100 for
> each session for the rest of the year.  Once full parity comes in, I
> expect I'd pay him a $20 copay for every session, no limit, no
> deductible.
>
> Juniper

I'm on Medicare and BC/BS is my secondary.  I have Medex and the BC/BS
is a PPO.  I used to be covered under my ex-husband's business, but he
sold the business a few years ago, so now I'm not in a group anymore
and pay for health insurance independently.  All of this stuff is
fairly new to me (Medicare,  independent health insurance).  I used to
be able to put everything in an envelope and send it to his office and
not have to bother with anything.

Sounds like you have an excellent plan.

Nahanton
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