Hi Everyone,

I recently started a new job and my health insurance is going to be changed to PacifiCare. From what they are telling me, I am going to have to pay a $50 co-payment for EACH item of ostomy supplies I get, and they have a $2,000 limit on wha tthey will pay per year.

Criminy. Is this true? Do any of the rest of you have PacifiCare (HMO) and can shed some light on this? I'm gonna go broke if all of this is true.

-Rae

Hi Rae...sorry to hear!! I have a co-pay too, but once I hit $1500 on the out of pocket for my supplies, it is paid for. Prescription meds though is straight co-pay , %20 of total cost. I have paid as little as $1 up to $150 as co-payments!

nys

*heh* Once I hit $1,500 out of pocket for supplies, my benefit will be exceeded. They only pay $2,000 per year. Dear LORD! I'm going to go through $2,000 in like... three months. It doesn't help that I have to get my supplies through Stirling or Shield. They cost a lot more than where I buy if I have to go out of pocket and their service is AWFUL (I have not received any supplies since MARCH, and I'm STILL fighting with everyone to get some).

I just don't know what to do about this. I'm going to end up paying $300 or more per month for supplies.

Talk to your employer ask them to negotiate a better medical supply provision (become allies with the diabetics that have the same problem).

They can't charge you $50 an item if the item is less than $50. For instance, my 10 pouches run about $23, the five wafers $35 and my paste is $10. I buy one box of pouches, two boxes of wafers, and one tube of paste every month.

That's $103 if I paid out of pocket. At the moment, it's 80/20 until an OPM of $2500.

But, if it were like your insurance, I'd pay $50 for the bags, $100 the two boxes of wafers and $50 for the paste. I'd be paying $200--twice what I should be paying, and somebody would be profiteering off of that. They can require a high co-pay, but it's illegal to require a copay over the cost of the product. That's fraud.

No, they aren't saying they'd charge a $50 co-pay for items less than $50. I'd just pay the cost of the item then.

I have no idea how much the contracted rates for supplies will be for pouches and such. All I can say is that this plan sucks compared to what I've had so far, and THOSE plans sucked.

I would definitely talk to your benefits administrator in HR. A lot of time the insurance people you talk to first have no idea what ostomy supplies are or what category they fall under. They are considered durable medical. I had to fight with UHC at first, but eventually got it worked out. UHC is also now offering a program that give you up to 50% off certain medical supplies that are not covered. Of course you probably have to use their suppliers and there is no guarentee they will carry what you need. (I don't know this for sure, but this is what I am betting on) I think this is yet another move by UHC to phase out ostomy supplies from their formulary completely. I will hit the roof if that ever happens. I mean come on, it's not like we all decided to have our colons removed because we had nothing better to do that day!!!!!

Have you looked at the cost if you took COBRA from your previous insurance/employer? The premiums would be more expensive, but calculate it all out to see how it comes out by the end of the year. You only have 30 days (or some set time period) before you can apply for COBRA through your other employer.

Lori

Yeah, I considered the COBRA approach. The cost would be even worse.

I'm thinking maybe plastic tubing and a bucket?

*grin*

-Rae

Good idea Rae! Then you could send the "contents" of your bucket to whoever set up your policy.

Is there anyway you could start looking for a different job with better benefits? I don't say that flippantly, I know it's a hassle but I've done it when my insurance became more than I could handle. My mom is doing it now because of the ridiculous costs of their health insurance now and my Dad having a lot of health problems.
You might not be able to find something right away but maybe before that $2000 limit is up.
I wish you the best.

UHC...the textbook example of what's wrong with American health insurance. And it isn't just ostomy supplies that they're trying to phase out. Mental health counseling, other durable medical equipment, and more. Meanwhile, their CEO rakes in hundreds of millions of dollars in stock options that were, apparently, back dated. I would throw a block party if UHC ever went under.

There are other companies that are better. It's a shame that UHC has to lead a "race to the bottom."

*LAUGH* Hi Olive! I just GOT a new job with the crummy health benefits. I'm not going to be going anywhere in a hurry. A good suggestion, under other circumstances.

-Rae

I have been thinking about this since I read it. I wonder what would happen if someone were to go into a PacificCare office with a full bag that was coming off and tell them that he/she was out of supplies because he/she could not afford more and/or the supplier had not sent them--and that he/she intended to sit there, with the ostomy flowing freely, until a solution was found. Would they hand someone a bucket? Call the cops? I'm 50, and I swear I would be tempted to find out by making it someone else's problem. Seems to me it would be a sanitation/public health issue that someone would have to address. It's like making everyone pay $2000/month for the use of their bathrooms.

Excellent point Connie! Go for it Rae.

kathy

I'm also wondering how your health situation is, Rae. Couldn't find it in a quick search of three pages of your most recent posts.