Confessions of a Starbucks addict

I really don't know who to blame here... Either it's my husband's company or it's the association they're affiliated with in order to get insurance at a discounted rate.

Back in June we found out that the association was changing from one insurance provider to another. Not such a big deal, but I didn't like that they were changing insurance on us again. They always seem to do that when you've got some big issue going on. For me it's been during two pregnancies and, as you all know, my breathing issues this year. Another big change that was part of this year's insurance change was that our copays, deductibles and coinsurance jumped significantly. We went from having $20 copays for office visits to $35 copays. Not too bad if you're only going in to see the doctor for ear infections or physicals once or twice a year. But if you're me, and have to be seen at least three times a month (for the breathing problem, as well as all the testing that's been going on), it can get quite expensive and prohibitive to the budget. Our deductible remained the same at $500, which was good, but our coinsurance doubled. It was $2000, now it's $4000. For those who don't know, coinsurance is the out of pocket maximum for the calendar year, not including the deductible and copays. So technically the out of pocket maximum is $4500 plus all of the $35 copays.

Here's the rub. When you switch insurance companies in the middle of a calendar year one of two things happen: 1) the old insurance company lets the new insurance company know what you met regarding the deductible and coinsurance or 2) the new insurance company can choose to not recognize the old insurance deductible and coinsurance paid. Luckily our new insurance company chose to do option 1. However, herein lies the rub... Apparently old insurance company still thinks that we're members! So, they have not been notified that we've changed insurance by the (I'm assuming) association that Troy's company is involved with. Which means that basically option number 2 is what is currently happening. Growl!

Even though I met the deductible and was $4 shy of the coinsurance max on the old insurance, new insurance thinks that I didn't meet anything, causing me to have to pay out an additional $500 for the deductible and possibly even the max of $4000 for the coinsurance. With all that's gone on since the insurance changed, I met the new deductible with my first order of insulin pump supplies under the new insurance...and I've so far met $900 of the coinsurance max with all of the tests and new doctors and whatnot. So technically I've paid out $500 more than I should have and am really only about $1100 away from the new coinsurance maximum. Even with this, I'm steaming because this will probably never get resolved! I've asked the benefits person at Troy's company what to do...he says contact the two insurance companies and have them deal with it. I did that, was sent a letter from the old company and they were supposed to send the same letter to the new company. Apparently that's never happened. Otherwise, all of that would be reflected on the new insurance statements...but it's not there. :( I think now I need to call someone at the association, especially because the old insurance company still thinks we're members...which would tend to make a person think that the association and/or the company is still paying their premiums, no?

All I know is that one of these days the new insurance company is going to say to us that since we're double covered, they're going to stop processing the claims as the primary insurer. We're technically double-covered, even though I'm being good and not using the old insurance at all! Who knows what would happen if I did and then the old insurance got its act together and retroactively canceled anything that it had paid out? Bad stuff, that's what would happen!

I know a lot of people don't even have insurance, so I'm grateful that we do. It's just that this is much more of a fiasco than I'd like to have right now...considering every time I get on the phone to straighten all of this out, I get short of breath! Who knew that talking on the phone could be so taxing!?!?