Shady stuff with my health insurance. The way that health insurance works with large employers is that the employer pays the bills, and the actual insurance company administers the entire thing. It’s cheaper for the employer that way.
I tried to get added to my wife’s insurance. It is outside of her open enrollment period, so I need a letter saying that I am no longer able to see my chosen doctor under my current insurance. No one will put it in writing- not the insurance company, nor my employer’s benefits team.
The insurance company says that the decision to force me to use certain doctors came from my employer’s benefits team. The benefits team says that it came from the insurance company. They both suggested that I go to the insurance benefits webpage and look up my doctor to see that he isn’t on the list. That isn’t good enough- to get coverage, I have to prove that my coverage changed. No one will give me that.
Even worse, even if I wanted to change doctors, it’s snowbird season. Few of the doctors in the area are accepting new patients. Of the ones who are, the next appointment is in June. I pointed out that I only have medications until mid April. I was told “well, you can always go to the emergency room. They can refill your medicine.” I can’t believe that it’s illegal to pay cash for a doctor visit if you have insurance and your insurance won’t pay for it, so your only choice is to start patronizing the emergency room.
No. The emergency room will only give insulin. That’s the point of this. I don’t want to be an insulin dependent diabetic. That is a death sentence, it’s only a matter of time at that point. I have done this for more than 30 years, and I know where that road ends.
I will have to deal with this on my next weekday off. It’s daunting.
20 Comments
Boneman · February 8, 2025 at 7:19 am
Divemedic, being a fellow Florida Resident (Full time, N. Ft. Myers) nothing chaps my arse more than hearing “well, you know, it’s “Season”… from ANY of these clowns. I jump right in their face with something to the effect of “So us full-time residents that keep your doors open in June, July and August can just pound sand then?”
Usually most effective when stated loud enough that those nearby in the waiting area can “overhear”….
Sometimes that get’s a ball rolling.
And if it doesn’t… at least I feel I’ve rubbed a little poo on a deserving proboscis, aye?
Hang in there, Man. Knowing your perseverant nature, the goal will be achieved.
liberty · February 8, 2025 at 7:42 am
If it’s illegal to pay cash for a dr. visit that is not covered by insurance, they are going to put me away for a long time. You are clearly stuck in a bureaucratic loop, but I don’t think it’s true that paying cash for medical services is illegal. In my area there are a few MD’s who work outside of the insurance system. Perhaps you have some too.
Out West · February 8, 2025 at 7:50 am
It is not illegal, per se. The only way the hospital could threaten your doctor is if your doctor is in network with the insurance company being used by the hospital and as such, signed a contract prohibiting cash payments. If the hospital is self-insured, they are by law viewed as an insurance company and must abide by your state laws. You need an attorney. Make an appeal to the board that oversees medical insurance appeals in your state. On obtaining the meds, I found your meds in Mexico and India (brand name) for 15 -25% of your cost. Go the medical tourist route or order direct from India.
Ralph · February 8, 2025 at 2:05 pm
+1 Get outside the system.
Troy Messer · February 8, 2025 at 8:06 am
This is the kind of shit why insurance CEO’s deserve to get [redacted]. Insurance is just a shell game to make sure a few make millions at the expense of your very literal life.
God Bless St.Luigi.
Divemedic · February 8, 2025 at 9:37 am
I don’t think this is the insurance company. The way it works with large companies, is that the company pays the claims directly.
It’s difficult and time consuming to negotiate with doctors and other providers to set rates and payment schedules, so the company outsources that to an insurance company. They take money out of the employee’s check to cover those administrative costs. Since the claims are all paid from the employer, the employer sets the conditions on what is covered and what isn’t.
In this case, I do believe that it is my employer that is making this change.
Out West · February 8, 2025 at 10:49 am
“In this case, I do believe that it is my employer that is making this change.” That is 100% accurate.
old geezer · February 8, 2025 at 10:29 pm
it’s time to find employment elsewhere
the sooner the better
Regularjoeski · February 10, 2025 at 7:05 pm
Use Goodrx coupon. About 1000/month at Publix. Cash price at Publix is about 1200$.The non network MDs can take you as a cash patient. They probably are thinking out of network not cash.
Mr_Garibaldi · February 8, 2025 at 9:22 am
Is it possible to skip a dosage of monjaro? If so perhaps you can stretch your supply until June or July. Ive only used metformin so I’m ignorant as to the effects of other diabetic drugs. I have missed a pill of metformin with no immediate effects on my A1C.
That said you have one of the most aggressive T2D I have heard of. So I can see how missing a dose could be damaging.
Mr_Garibaldi · February 8, 2025 at 1:25 pm
Sorry. I did not know it was a shot instead of a pill. Shows my ignorance of new treatments.
Someone mentioned in the last blog post the possibility of taking GLP-1 pills. Is there a way to simulate monjaro? Or am I speculating the impossible?
Stealth Spaniel · February 8, 2025 at 1:32 pm
Take the wife to Mexico City for the weekend. See the local Pharmacia and get your meds. Have a fun time seeing the cathedrals, buy some trinkets, and then come home. In fact, I’d make it an every other month honeymoon trip. Meanwhile-lawyer up. Nothing says sudden interest like a lawsuit. Blessings.
Steve S6 · February 8, 2025 at 2:16 pm
Time to get a lawyer to write them a letter demanding a letter from them on the change of insurance? cc: DOGE
Bunkie's Archer · February 8, 2025 at 3:55 pm
I sold all my leftover insulin to a Craigslist buyer, you can check on there.
oldvet50 · February 8, 2025 at 4:20 pm
Sorry to hear about your medical issues. I sincerely hope you get it resolved in a way that will keep you off insulin. I have never understood how a non-medical professional (accountant) could dictate medical procedures and drug therapies…..but they have been doing just that for years.
Mantaman · February 8, 2025 at 5:22 pm
Beer
Mantaman · February 8, 2025 at 5:28 pm
Sorry about previous post (“beer”), I misunderstood the registration for postíng, first time commenting here. I checked the web and monjaro is sold here in Chile as tirzepatide. If it is the same med that you need it might be worth looking at organizing a trip and seeing a doctor here. It is not very expensive and a prescription can be easily obtained with a doctor. Please contact me by email if you need it. Best wishes, stay strong.
Dan D. · February 8, 2025 at 6:55 pm
Long time listener here, first time caller.**
Look DM I could be entirely off-base here – and if I am please forgive me – but this “I’m Screwed”-stuff doesn’t sound like you. How is it possible you don’t know a single MD who will write you a scrip to buy this junk online? You said you were willing to pay cash. People get unnecessary drugs all the time, like candy. I know a lot of docs (and people who have docs, etc.) and I’m just a hard sciences guy – you must surely know 5x more.
I have been thinking about this since yesterday but floating an “insurmountable” problem like this would be great sieve to measure your audience. I hope I’m right – but if I’m not I’ll make it up to you and drive down to Mexico to get you some kit and buy you time.
**not
Anon · February 8, 2025 at 7:55 pm
What about telehealth like mygotodoc dot com. You have to fill out initial forms online and provide a pic of your ID, but only the first time.
I agree with the person commenting who said this doesn’t sound like you, the defeatist vibe.
Himself · February 9, 2025 at 10:03 am
My endocrinologist started a concierge practice. For $2500/year he’d handle all your medical needs. Maybe look and see if there’s one around you. Won’t handle the insurance paying that confiscatory nut for the medicine.
That needs to be fixed. The meds should cost the same no matter where you are, and you can’t tell me that 3K a month isn’t over the top for an ounce or two of medicine.
Comments are closed.