Health Insurance Woes and My Fix

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Hello!

Before I begin I need to put a disclaimer on this post…

*I am not a doctor. I do not possess a degree. I am a lupus patient. Any and all information I am sharing in this post is for me only. I am the one who decided to do something about it. I am the one who implemented the plan. You should not do the same unless you have thoroughly discussed this with your doctor(s). I discussed it with my doctors and this is the plan for me. As you know, each lupus patient is different and we all have different plans of care. Do not do what I am doing without medical discussions with your own physicians. What works for one person might not work for another.  I am not responsible for any injury to you for you doing what I have done. For this reason, I refuse to share what specific things I am doing in alternative medications.*

As  the title implies, I am writing about my experience with the new insurance climate that has changed how my insurance operates now. I moved to Kentucky three years ago. I had to change my insurance because I moved from Ohio to Kentucky. To facilitate the changeover, I stayed with the company I had in Ohio, and just moved the policy to one I could use here in Kentucky. Sounds simple doesn’t it?

The fact is that it took me the better part of an entire day to change the policy. Seriously. I also found out that not only would I be paying the premium as in Ohio, based on the medicare payment, but that in Kentucky, I would have to pay another $60 per month as well. What??

Here is how and why I was told I had to pay that extra $60 per month on top of the $120 medicare premium…in Kentucky, you have a lot of different providers serving different healthcare chains. In Ohio, I stayed in the Kettering Healthcare Network with all of my doctors. They were all covered and I was happy. In Kentucky, my pcp is in the Mercy Health Network which is ironically out of Cincinnati. My local hospital, a small thirty bed facility with an ER, is out of the same Mercy Health Network. My eye doctor is out of UK Healthcare Network. My rheumy is out of Baptist Health Network, my cardiologist is from Kentucky One Health Network, and my husband has been in the St. Joseph Network system seeing his specialist. Here, not only do you drive an hour and a half one way to see a doctor at times, but you also are required to cross networks to see the right doctors for you. Hence the higher premiums.

Now, for those who are lucky enough to have several overlapping diseases, it becomes even worse. As of January first, this year, my premiums again went up, thanks to the lag of the higher priced Obamacare. I now pay over $200 a month just for my premiums alone! Oh, I am on disability and was one of the supposed low income people that it was purported this new scheme would help. Oh yeah? It has certainly helped me all right…it helped me have less money to live on is what it helped me to do!

This is not the only way it “helped” me either. I went to get my prescriptions just as I always have. When I got them, it was not at the usual $2-4 each as before January first. One of my prescriptions went from $4 to $75 a month! Only one stayed the same. One! As anyone with lupus knows, we can be on a few drugs or many, depending on the disease and all. I paid that month but made a drastic decision at the same time. More on that later. I also found out that the place I had been getting my prescriptions, a retail chain, was not on my insurance plan anymore. I live in a rural county in Kentucky. The nearest retail chain that is covered, is 35 miles away. In my town there is only the one retail pharmacy. So, so far, I am paying more premiums, and now prescriptions were cost prohibitive plus I have to drive 35 miles to get to the nearest pharmacy that is covered. What else could go wrong? Surely a low income person like me could try to keep this up right?

Wrong! I had eye surgery in January. It went well. All better. However, when the bill came in I was in for another shock. You see, I now have deductibles. I have not had deductibles since going on disability. Imagine my surprise when I discovered that I have to pay 10% of my bill! My surgery was $10k so do the math folks. Yep, now I am paying a deductible. Wonderful. Just wonderful.

So far, this affordable health care act has priced me out of eating, rent, medications and all other costs of daily living! But wait, I did get a cost of living increase finally this year after 7 years of none. That will help, right? Hm, where do I spend that $20 a month? I got a big fat $20 increase in my benefits…so that should cover those pesky extra expenses right?

Sarcasm much? I find that now half of my gross income is going out each month towards my healthcare costs. I think I have found how it will save money though. I think it will save money because the very people it was supposed to help will be dying off because they cannot afford to live anymore. The only people it really helps are the politicians, lobbyists, and CEO’s of insurance companies who are all getting huge kickbacks and salaries. Those are the ones benefiting from it. Not me.

So, before you can say I should go apply for help, I did. I found out that, believe it or not, my husband (who is also on disability for something completely different) and I make $50 too much in gross benefits and thus do not qualify. It does not matter that we are paying out the wazoo for all this stuff. Nope. Income is what it goes by we were told. Now, if we should separate and live apart we would both qualify for help. We are honest people though and while many might play the game the system forces you into, we will not.

So to recap, this low income disability person has to pay half of my gross income for the privilege of paying even more money out for goods and services previously covered for a lot less.

Now on to what I have done about it. Here was the scary part. I researched all of my meds in more detail to find what specifically they were doing for me. I then looked for corresponding natural things that could do the same. At this juncture, let me state that while I did this for me, it may not be good for you and you should discuss all treatments in detail with your doctors. I am not a doctor. I am a lupus patient who was at the end of my rope here. I took decisive action for myself.

I found interesting things in the process. I found that indeed there were several natural alternatives out there and for the most expensive meds no less. I then made an appointment with my doctor and discussed these with her. I explained the situation. My doctor, who used to be a nurse, is very much on board. After we looked over the alternatives, we decided to try it.

What can I say? The alternative treatments are working and I actually have tons more energy than before. My mood is more stabilized, and I feel alive again. I still live with pain but the pain is more bearable now. I will not disclose what I am taking because as stated before, I am not a doctor. I can honestly say that it is working for me though. A month after started the alternatives, I ran out of one and truthfully thought it had not been working well for me so I did not get more. However, a few days later, I was in pain, bad pain. I got more of the alternative stuff and the pain went away! I am a believer now!

I do want to add that the things I now take are available anywhere. I will not endorse any product here. I am not selling miracles. Honestly, the only major differences I have found is that I have more energy and I feel things again. What I mean is that instead of being in a cloud of medications making me groggy and sloth like, I now can enjoy my life again. I still have the same limitations I had before. I still have lupus. I still have bad days. However, the good days seem to be more now.

I am also aware of a “placebo effect” and what it is. I do not feel like this is the case here because I seriously did not think the new things were helping until I did not take them. I tested them. I also did not abruptly come off my other meds. As I started a new thing, I would wean off my meds. Slowly. All of this was under my doctors care.

I just wanted to share my experience because I have a feeling this new insurance scheme might be affecting your lives as well. I know mine has changed but thanks to an understanding and knowledgeable doctor not afraid to jump in and experiment, and my willingness to try some new things, I find life so much more livable. Just my experience.

Do not lose hope. We are in this together. Research, ask questions and most importantly, pray for help. I now spend a lot less on meds and supplements. I feel better. I am alive. I am happier.

I hope you are all having a wonderful summer! I hope to get back to posting again more often. So much is going on here…good things! Until next time, stay as healthy as you can and enjoy each day you have!

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