Saturday, November 18, 2017
Friday, November 17, 2017
Today found me back at the dealership for yet another appointment, this time my 60,000 mile service. Not bad considering that my car is a 2010 lease return. This major service includes tire rotation (told them to skip it as I just had the tires put on), oil change, full inspection, changing of cabin and other air filters. I also had my break fluid changed. As I was checking out with the service writer, I reviewed the computer screen with the itemized charges and noted that there were fees associated with the oil change. I questioned this as I have free oil changes for life as an owner of this car, a nice perk for having purchased the car from the dealer. No worries, the charges were removed, the bill lowered.
Auto maintenance is a a known, and necessary expense. I set aside monies every month so as to have the funds when needed.
I am good to go for a while, until my tires get switched over again. Other than the cost of 2 new tires, I won't have to pay for a rotation or balancing as again, they are/will be purchased at the dealership. I await one of their promos come Spring.
Thursday, November 16, 2017
Goal met: As of this afternoon, my Christmas shopping is compete. I had 2 more things to pick up, and took care of that as I ran errands in the area today.
I can now enjoy the upcoming season, slowly wrap presents, decorate the home, bake and listen to holiday music. Perfect in my book.
When I was at the cable company's store recently, I paid a small fee and walked away clean from them. Fast forward, and I received a bill from them yesterday. Huh? So, today's errands included a return trip back to the store to find out what's up. I was directed to call the 800 number and ask for billing and then to ask for the supervisor, which i did.
Bottom line, one hour later, is that there is an error-no kidding! and in fact, I am due a credit of $80, which they will be mailing out to me within the month, along with an updated "bill" for the account.
A quiet, relaxing day, saw all of the kiddos except for college kid in NY, who will be here on Thanksgiving. Breakfast out with DD, and decided upon Chinese take out for supper. Very nice.
Wednesday, November 15, 2017
Sunday, November 12, 2017
Once I determined, back in August, what my new medical insurance plan would be, I set up a plan to handle the increased cost in medical premiums, and how the impact they would have on the monthly budget. Luckily, premiums are paid out on a pre-tax basis, saving a bit there. I also had to calculate how much to set aside into a newly set up by me, savings account, to handle the deductibles. Effective Sept 1-Dec 31, my new plan "year" as I joined at the tail end, would find me eating the first $2500 in medical costs, outside of preventative care such as my October annual physical, vacinations (flu shot at CVS, pneumonia shot at the internist's), well woman care, mammograms and the like. I already knew of a few specialist's appointments (orthopedist and rhumatologist) that I would be responsible for, allergy shots, as well as RX needs, which found me mapping out on a calendar when I should refill from now to Dec. My plan was to avoid all non preventative medical needs if at all possible, until Jan. I no longer have vision screening or dental coverage. I determined that the $900/year rider didn't make sense for me. I already see an opthalmologist for chronic eye disease, and my dental needs, historically speaking, haven't been all that great.
Life had a different plan:
-internist had me do repeat blood work to check my cholesterol
-orthopedist sent me for a MRI of my back
-orthopedist sent me to PT for 6 weeks (may last longer)
-a retinal issue came up, sending me twice already to the specialist, a third visit is this week
It's been frustrating learning the ropes on how this new insurance works. Note that I was considered the insurance guru at my former employer, with many co-workers still turning to me on how to handle insurance issues. The new company really is a trinity: one part is the overarching medical, another is pharmacy, a third is specialty pharmacy. Several occasions have found me making 6-9 phone calls in succession being bounced from one entity to another in an effort to get some information. Grr. . . .
As time has passed these past few months, I am learning the ropes on how they operate, who to call, how to address things. I had all of my maintenance RX's as well as my specialty pharmacy RX prescriptions transferred to the mail order company and the special pharmacy division. I ordered a maintenance RX in a generic form $11.15/90 days and that went smoothly. I could see the deduction on the deductible page of the medical insurance company's website.
The million dollar question recently was about how do they treat my $$$$ specialty RX? Once I got clearance that they will cover my drug (I planned ahead, forwarded all of my clinical notes from my MD to ensure that access to my RX would go smoothly), no one could tell me how it would impact my $2500 deductible and co-pay system. Sadly, the on line Rx site doesn't allow a patient to monitor tracking of a delivery, nor EOB's, which I was used to with my former insurance company. I now await arrival of the EOB within a few weeks as it comes out of California. I have also had it set up that I get an email with the tracking information for me to follow.
I recently ordered my specialty RX through them for the first time. I was able to use a co-pay assistance program, meaning that I had $0 OOP for the drug. I wanted to know how much, if any, would go against the $2500 deductible's balance, how much, if any, would go towards the second deductible of an additional $4100 OOP but based on a 30% patient responsibility co-pay system. No one could tell me but the EOB will give me concrete numbers. I do know that the insurance company paid $900 or so for the $3200 or so cost of the drug for one month. This company will only fill one month at a time, where my former insurance company would do 3. Fine.
My $2500 deductible is met, with $1231.65 in medical OOP plus $1268.35 in RX OOP (but I actually only had to pay $11.15 for the first RX, the remaining $1257.20 was paid on my behalf by the drug company).
I am now working on the second aforementioned deductible of an additional $4100. To date, an additional $456.09 for medical OOP has been applied as a co-pay (I suspect it's my PT but nothing is yet on the website-Update:DANG! I'm GOOD! The EOB just showed up on the site, I was right, to the penny!), and an additional $943.20 (again paid on my behalf by the specialty drug company so no OOP). Using this max OOP figure of $6600, I have spent (with the help of the drug company) $3899.29, so $2700.71 yet to go.
Will I meet this by Dec 31st? I just might.
-I have to reorder my specialty RX in early Dec. I don't have the actual cost yet (awaiting EOB) but assume $3200 with a 30% responsibility of $960 (to be paid by the drug company).
-I have 3 weeks of PT in November so estimate $450 (await EOB from oct to determine actual costs)
-I have to order several maintenance meds while I am at the 30% co-pay system as come Jan 1 (even though my stockpiled prior to leaving last insurance company's supply will for the most part take me into Jan):
-eye Rx will be $391.84/90 day (less $250 co-pay assistance- so 141.84 OOP)
-a second RX will be $182.78/90 day OOP for generic
-I have an estimated $43.81 for a follow up appointment with the retinal specialist this week
-2 allergy shots (one monthly Nov and Dec) is another $4.47 x 2
-I see the rhumatologist in early Dec, estimate $33.95 based on charges at my former ins company
My calculations include estimates so remain a bit fluid, but a guestimation of a remaining deductible total of $662.84. An additional issue recently discovered when I called my new RX mail order company to get quotes on prices with my 30% OOP deductible, was that my medical overarching insurance company excludes the name brand of one of my maintenance RX's but will cover generic. Normally, I'd say fine-give me the generic but I once trialed the generic after being on the name brand and it didn't work well for me at all-Skittles would have been better. So, my gastroenterologist is appealing with clinical chart notes. Hopefully we can get somewhere. It's a $1500/90 day RX-I can't afford that 4 times a year OOP with no impact on my deductible. Egads.
I also am in the process of reviewing all of my usual medical appointments and scheduling them for now if not into next year, 2018. This includes reviewing my allergy RX's, skin RX's and perhaps getting those transferred and filled NOW while I am at a 30% OOP obligation. SHOULD I hit the magic $6600 OOP this Dec, any additional charges will be born upon the insurance company.
Recently got my renewal for insurance next year:
-my premiums are going up $16 and change/month effective Jan 1
-my second co-pay OOP deductible is going up $1200
So, yes, it's imperative that I am proactive in addressing my medical and RX needs while I only* have to pay 30% OOP. I knew that this would be a difficult 4 month period (Sept-Dec). I anticipate now that I am understanding the ins/outs of the insurance plan, that being in a full year plan starting Jan 1, things will go smoother.
I am also reviewing how much money I set aside monthly into my aforementioned special savings account. Since the end of Aug, when I got my monthly pension, I have been placing $500/month into that account to help me cover OOP costs, hoping to ideally have a nice nest egg of $2500 minus some bills, come Jan 1.
Bills to date, by month:
Sept: $824.91 (all bills paid to date)
Oct: $862.83 (I await receipt of bills from MDs, the hospital for PT and will pay them off by Nov 30th when I get paid, when I have an additional $500 to put towards OOP costs, having amassed $2000 total since the end of August with $312.26 extra carrying into Dec)
Nov: $11.15 for RX, est total OOP will be $509.43 (to be paid with $312.26 l/o plus $500 from the end of Dec)
Dec: est total to be $39.48 before I start ordering RXs
As of Nov 1, I had accumulated $1500, paying the September bills as they came in from the service providers. I literally just got the 9/16 MRI bill the other day, the check is sitting in my mailbox. The way this system works is that by the time the bills arrive after clearing insurance, it's already into the new month (or even further out like in the case of the MRI) and I use the end of the second month's $500 to pay any obligation. It's a bit backwards to what I am used to: accumulate the funds, pay it off. I'm adjusting. In the end, I have the monies, I can pay it off.
It's somewhat of a game, a circus really. In early Jan, although I will have to pay the first $2500 in costs completely before the 30% co-pay system kicks in, by ordering my specialty RX in early Jan, that will be completely covered by the drug company, leaving my $500 placed into savings at the end of Dec untouched. I already have appointments for Jan (including blood work which ins covers at 70%), a preventative care appointment to be covered at 100%, a specialist appointment well after the date that I will have already ordered my specialty RX for the month.